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Wang JY, Luo Y, Wang WY, Zheng SC, He L, Xie CY, Peng L. Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review. World J Clin Cases 2021; 9:2679-2687. [PMID: 33889636 PMCID: PMC8040161 DOI: 10.12998/wjcc.v9.i11.2679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Due to a thicker abdominal wall in some patients, ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination, precluding its ability to display or clearly show the structure of a hernial sac (HS) and thereby diminishing diagnostic performance for esophageal hiatal hernia (EHH). Contrast-enhanced ultrasound (CEUS) imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.
CASE SUMMARY In this case series, we report three patients with clinically-suspected EHH, including two females and one male with an average age of 67.3 ± 16.4 years. CEUS was administered with an oral agent mixture (microbubble-based SonoVue and gastrointestinal contrast agent) and identified a direct sign of supradiaphragmatic HS (containing the hyperechoic agent) and indirect signs [e.g., widening of esophageal hiatus, hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS, and esophagus-gastric echo ring (i.e., the “EG” ring) seen above the diaphragm]. All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy. Two lesions resolved upon drug treatment and one required surgery. The recurrence rate in follow-up was 0%. The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.
CONCLUSION CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.
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Affiliation(s)
- Jing-Yu Wang
- Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Ying Wang
- Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Shi-Cheng Zheng
- Department of Gastroenterology, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Lian He
- Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Chun-Yan Xie
- Department of Gastroenterology, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
| | - Li Peng
- Department of Ultrasound, First People's Hospital of Longquanyi District, Longquan Hospital of West China Hospital of Sichuan University, Chengdu 610100, Sichuan Province, China
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Tsai MK, Chen HY, Chuang ML, Chen CW, Jong GP. Gastric Calcifying Fibrous Tumor: An Easy Misdiagnosis as Gastrointestinal Stromal Tumor-A Systemic Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E541. [PMID: 33066662 PMCID: PMC7602413 DOI: 10.3390/medicina56100541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Calcifying fibrous tumor (CFT) in the stomach is extremely rare and is easily misdiagnosed as a gastrointestinal stromal tumor (GIST). This study aims to determine the best method to differentiate between gastric CFT and GIST after a systemic review and meta-analysis. Materials and Methods: A systematic search of articles using electronic databases (MEDLINE, EMBASE, and LILACS) was conducted and resulted in 162 articles with 272 CFT cases published from January 1988 to September 2019. Results: Of these cases, 272 patients, 60 patients with gastric CFT (32 men and 28 women, mean age 49.2 years) were analyzed. The mean tumor size was 2.4 cm in patients with gastric CFT. Both endoscopic ultrasound (EUS) and computed tomography (CT) findings revealed well-defined (100% vs. 77.8%), heterogeneous (100% vs. 77.8%), iso-hypoechoic (71.4% vs. 33.3%), and calcified (85.7% vs. 77.8%) lesions, respectively. The majority of patients (53.3%) were symptomatic, with the most common symptom being abdominal discomfort (55.6%). None of the patients with gastric CFT showed recurrence after treatment, and most patients received nonendoscopic treatment (56%, n = 28/50). Both age and tumor size were statistically significant in patients with gastric CFT than GIST (49.2 vs. 65.0 years and 2.4 vs. 6.0 cm; both p < 0.001). The ratio of children among patients with CFT (5%) and GIST (0.05%) was also significantly different (p = 0.037). The calcification rates of gastric CFT had significantly higher calcification rates than GIST on images of EUS and CT (85.7% vs. 3.6% and 77.8% vs. 3.6%; both p < 0.001). Conclusions: Compared with patients with GIST, patients with gastric CFT were younger, had smaller tumor size, and were symptomatic. Furthermore, gastric CFT was well-defined, heterogeneous in the third layer, and had high calcification rates on the images.
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Affiliation(s)
- Meng-Ko Tsai
- Division of Rheumatology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung 41152, Taiwan;
- Division of Rheumatology, Department of Internal Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung 40402, Taiwan;
- Department of Pharmacy, China Medical University Beigang Hospital, Yunlin County 65152, Taiwan
| | - Ming-Lung Chuang
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Wen Chen
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan;
| | - Gwo-Ping Jong
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Internal Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
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Liu Z, Guo J, Ren W, Tang S, Huang Y, Huang L, Sun S, Lin L. Evaluation of ultrasound-guided Freka-Trelumina enteral nutrition tube placement in the treatment of acute pancreatitis. BMC Gastroenterol 2020; 20:21. [PMID: 31996143 PMCID: PMC6988363 DOI: 10.1186/s12876-020-1172-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background Enteral nutrition should be implemented as early as possible in patients with moderate or severe acute pancreatitis. This study was designed to evaluate the feasibility and Deffectiveness of ultrasound-guided Freka-Trelumina tube placement for enteral nutrition in acute pancreatitis. Methods Patients with severe acute pancreatitis admitted to Shengjing Hospital of China Medical University who needed Freka-Trelumina tube placement for enteral nutrition and gastrointestinal decompression were included in the current study. The relevant evaluation indicators of tube placement included the success rate of tube placement, tube placement time, tube shift rate, and blocking rate. In addition, the evaluation indicators of ultrasound-guided tube placement (from 1 January 2018 to 31 July 2019) were compared with those of previous endoscope-guided placement (from 1 January 2015 to 31 December 2017) by analysing the data from the electronic medical record system. Results The success rate of ultrasound-guided tube placement was 90.7% (49/54). All 49 patients tolerated the Freka-Trelumina feeding tube. The average ultrasound-guided tube placement time for the 49 patients was 18.4 ± 12.8 min (range, 5–36 min). The Freka-Trelumina feeding tube had a shift rate of 10.2% (5/49). The blocking rate of the Freka-Trelumina feeding tube was 12.2% (6/49). The success rate of tube placement, tube shift rate and blocking rate for endoscope-guided tube placement were 100% (62/62), 11.3% (7/62), and 12.9% (8/62), respectively. The average endoscope-guided tube placement time for the 62 patients was 16.5 ± 5.7 min (range, 12–31 min). The comparison between the ultrasound-guided group and the endoscope-guided group showed that the success rate of tube placement, tube placement time, tube shift rate and blocking rate were similar. Conclusion The ultrasound-guided method can be done non-invasively at the bedside, which is safe and convenient, and the Freka-Trelumina feeding tube can be placed in time to achieve the goal of early enteral nutrition and gastrointestinal decompression.
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Affiliation(s)
- Zhijun Liu
- Ultrasound Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Jintao Guo
- Endoscopy Center Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Weidong Ren
- Ultrasound Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Shaoshan Tang
- Ultrasound Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Ying Huang
- Ultrasound Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Liping Huang
- Ultrasound Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Siyu Sun
- Endoscopy Center Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China
| | - Lianjie Lin
- Gastroenterology Department, Shengjing Hospital of China Medical University, Liaoning Province, People's Republic of China.
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Tian S, Zeng Z, Peng X, Dong W. Gastric calcifying fibrous tumor: A clinicopathological study of nine cases. Exp Ther Med 2018; 16:5137-5143. [PMID: 30546412 PMCID: PMC6256920 DOI: 10.3892/etm.2018.6892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study was to analyze the clinicopathological characteristics presented in 9 cases of gastric calcifying fibrous tumor (CFT), and investigate the expressions and clinical implications of G protein-coupled estrogen receptor (GPER), estrogen receptor (ER) and vimentin in gastric CFTs. The clinical and pathological information of 9 patients with CFTs was investigated retrospectively. Subsequently, the expression of GPER, ER and vimentin were examined using immunohistochemistry, and a literature search for gastric CFT was conducted. The 9 patients were 40–71 years old with a mean age of 52.22 years, including 6 female and 3 male patients. Pathological features included dense hyalinized collagen fibers with a psammomatous body or dystrophic calcification, and the infiltration of scattered lymphocytes and plasma cells. Immunohistochemically, all cases expressed vimentin and GPER, whereas ER expression was negative. Using a database research, 25 studies regarding gastric CFT were identified, including 48 cases with a sex ratio (female:male) of 1.4:1. In addition, the number of female patients was twice the number of male patients in patients <50 years old, whereas the number was almost equal between women and men ≥50 years of age. Gastric CFT is a benign lesion with a good prognosis and a predilection for female patients, particularly premenopausal women. Estrogen may serve a role in this female predominance, and this may be mediated by GPER rather than ER.
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Affiliation(s)
- Shan Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Zhi Zeng
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiulan Peng
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430050, P.R. China
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Liu Z, Ren W, Guo J, Zhao Y, Sun S, Li Y, Liu Z. Preliminary opinion on assessment categories of stomach ultrasound report and data system (Su-RADS). Gastric Cancer 2018; 21:879-888. [PMID: 29372460 PMCID: PMC6097085 DOI: 10.1007/s10120-018-0798-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested as a valuable mass-screening tool for gastric cancer. The aim of this study was to propose a producible stomach ultrasound reporting and data system (Su-RADS) using TUS-OCCA for gastric cancer screening. PATIENTS The study includes information of 2738 patients who underwent both gastroscopy and TUS-OCCA examinations recorded in software system. Gastroscopy examination with pathological diagnosis was considered as gold standard. Various gastric lesions were classified into category 1-5 based on gastric wall thicknesses of them (especially the mucosa layer). RESULTS The total malignant ratios of patients enrolled in this study were 17.1% (469/2738). The malignant ratios for category 1-5 were, respectively, 1.1, 1.7, 12.2, 34.2 and 78.1%. Category 2 indicated mild thickening of gastric wall at low risk for malignancy (1.7%); category 3 indicated moderate thickening at moderate risk for malignancy (12.2%); category 4 indicated severe thickening at high risk for malignancy (34.2%); category 5 indicated extremely severe thickening at extremely high risk for malignancy (78.1%). If category 2 was identified as cut-off point distinguishing between benign and malignant, the sensitivity and specificity by Su-RADS are 95.1 and 78.6%, respectively. CONCLUSION The Su-RADS system could inform the physicians about key findings, indicating the risk for malignancy and necessity of additional gastroscopy examination. Prospectively randomly controlled study design with larger clinical trial is needed for further investigations.
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Affiliation(s)
- Zhining Liu
- Ultrasound Department, First Affiliated Hospital of JinZhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Weidong Ren
- Ultrasound Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Ying Zhao
- General Surgical Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yuhong Li
- Ultrasound Department, First Affiliated Hospital of JinZhou Medical University, Jinzhou, Liaoning, People's Republic of China.
| | - Zhijun Liu
- Ultrasound Department, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Chorti A, Papavramidis TS, Michalopoulos A. Calcifying Fibrous Tumor: Review of 157 Patients Reported in International Literature. Medicine (Baltimore) 2016; 95:e3690. [PMID: 27196478 PMCID: PMC4902420 DOI: 10.1097/md.0000000000003690] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations of the human body. The aim of the present systematic review is to give a detailed account of all reported cases of CFT in the literature and to analyze the available data, to completely characterize the entity from epidemiological, medical, and surgical aspects.A bibliographic research was performed from 1988 until 2015. A database with the patients' characteristics was made, including sex, age, location of the tumor, symptoms, symptoms duration, size of the tumor, diagnostic methods, treatment, metastasis, and follow-up.A total of 104 articles were identified, reporting 157 cases of CFT. Mean age of patients was 33.58 years and the ratio between men and women was 1:1.27. The most common locations of CFT were stomach (18%), small intestine (8.7%), pleura (9.9%), mesentery (5%), and peritoneum (6.8%). Mean diameter of the tumor was estimated 4.6 cm. The correlations proceeded showed that as age increases, size decreases (P = 0.001) and that the tumor is larger in females (P = 0.027). Kruskal-Wallis test showed that the larger tumors appear in the neck and adrenal gland (P = 0.001). The percentage of asymptomatic patients was 30.57%. Computed tomography and biopsy were the most common tests for the diagnosis of CFT. Open surgical procedure was performed in the majority of cases. The median hospitalization was 6.06 days and the mean follow-up period was 29.97 months. Recurrences were mentioned in 10 of 96 patients with available data. No deaths owing to CFT were mentioned in the literature.CFT should be included in the differential diagnosis of enlarging mass revealed by clinical or imaging examination either incidentally or after specific acute or chronic symptomatology.
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Affiliation(s)
- Angeliki Chorti
- From the 1st Propedeutic Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Liu Z, Guo J, Wang S, Zhao Y, Li J, Ren W, Tang S, Xie L, Huang Y, Sun S, Huang L. Evaluation of transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent for gastric cancer. BMC Cancer 2015; 15:932. [PMID: 26606926 PMCID: PMC4660843 DOI: 10.1186/s12885-015-1943-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background With the remarkable improvements in ultrasound equipment, transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested to be effective in initial screening of gastric cancer. The aim of this study was to evaluate the diagnostic value of TUS-OCCA for gastric cancer. Methods Consecutive patients with gastric cancers who underwent resection in our hospital were enrolled. Before the lesion was resected, TUS-OCCA examination was performed by a skilled examiner who was blinded to the site, size, and endoscopy diagnosis of the lesion. TUS-OCCA findings were compared with those of endoscopy and pathological diagnoses as the gold standard. Results There were a total of 288 consecutive patients enrolled in the study, including 228 with advanced gastric cancers (T2–T4 stage), 50 with early gastric cancer (26 with stage T1b and 24 with stage T1a), and 10 with high-grade intraepithelial neoplasia. TUS-OCCA had a detection rate of 100 % (228/228) for advanced gastric cancers, 77 % (20/26) for stage T1b, 67 % (16/24) for stage T1a, and 60 % (6/10) for high-grade intraepithelial neoplasia. The majority of patients with undetectable neoplasms using TUS-OCCA were obese (body mass index, 28.7–31.8 kg/m2). The overall accuracy of TUS-OCCA in determining the T stage of gastric cancer was 77.3 % (62.5 % for T1a, 70 % for T1b, 71.1 % for T2, 85.2 % for T3, and 73.3 % for T4). Conclusions These findings indicate that TUS-OCCA achieved a high detection rate for gastric cancers and was useful in assessing the degree of gastric cancer invasion.
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Affiliation(s)
- Zhijun Liu
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Jintao Guo
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
| | - Shupeng Wang
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
| | - Ying Zhao
- Surgical Department, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
| | - Jing Li
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Weidong Ren
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Shaoshan Tang
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Limei Xie
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Ying Huang
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
| | - Siyu Sun
- Endoscopy Center, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China.
| | - Liping Huang
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning Province, 110004, People's Republic of China.
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