Villous Gastrointestinal Tumors: Multimodality Imaging with Histopathologic Correlation

Abstract

Villous lesions are advanced adenomas that manifest most commonly in the colon; however, they can develop throughout the gastrointestinal tract. The duodenum is the most common small-bowel site of these lesions. Although in most cases these are isolated lesions that occur sporadically, patients with certain specific colorectal cancer syndromes, including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, may develop multiple advanced adenomas. Villous lesions are important because although they are histologically benign, they may harbor dysplasia and have potential for malignancy. These characteristics make them a primary target for colorectal cancer screening with optical and virtual colonoscopy. However, these lesions can also be symptomatic and detected at diagnostic imaging when patients present for examination. They have characteristic features at a variety of imaging examinations, including barium fluoroscopy, CT, MRI, and endoscopic US. It is important for radiologists to be aware of these lesions, their potential morphologies, and their typical appearances at multimodality imaging. Although villous tumors can be detected at imaging and confirmed with biopsy, owing to limitations in identifying dysplasia and foci of malignancy with the above modalities alone and the potential for malignancy, referral for surgical resection of these lesions ultimately is required. RSNA, 2018.

Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

“…Duodenal adenocarcinomas are rare, represent 0.3% of gastrointestinal and 33-45% of the small bowel tumors, and with nonspecific symptoms, the diagnosis is incidental. [1][2][3][4][5][6][7][8][9][10] They are prevalent in the second duodenal portion of people between 40 and 60 years. 10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.…”

“…10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis. 2,7,8 Duodenal adenocarcinoma is strongly associated with the rare tubulovillous and villous adenomas, a phenomenon favoring misdiagnosis or late cancer diagnosis. 1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes.…”

“…2,7,8 Duodenal adenocarcinoma is strongly associated with the rare tubulovillous and villous adenomas, a phenomenon favoring misdiagnosis or late cancer diagnosis. 1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options.…”

“…1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options. 10,11 Adjuvant or neoadjuvant chemotherapy are tools for patients considered inoperable.…”

“…10,11 Adjuvant or neoadjuvant chemotherapy are tools for patients considered inoperable. 7,10 Saint's triad (ST) includes hiatus hernia, cholecystopathy, and colon diverticulosis, but aortic aneurysm and dilated cardiomyopathy are additional changes of the pentad. The term herniosis refers to the tendency of any type of hernia in individuals with ST. [12][13][14] Interesting are some published comments about a hypothetical inverse relationship between molecular mechanisms of ST and the development of malignancies.…”