Differential Diagnosis of Gastric Diseases

ISBN-13: 9783642657672 / Angielski / Miękka / 2011 / 262 str.

K. Kawai; H. Tanaka

Opis

This book is intended to systematically explain our clinical experience with gastric diseases. We have concentrated on how to avoid overlooking changes on the gastric walls and how to improve diagnostic differentiation of these changes on the basis of the findings. It is difficult to differentiate malignancy from benignancy when the change is a minor or a very small one. Because of this, we have thoroughly classified protruding lesions and eXc: lvated lesions for diagnosis. The criterion adopted for classification is the commonly observed uneven ness of each gastric area. If the change protrudes higher than normal from the mucous mem brane, it is classified as a protruding lesion, and if it is deeper seated, as an excavated lesion. Differentiation follows diagnosis of the presence of disease. The whole process has been described concretely. There often are small size changes which have not been detected by cautious x-ray exami nations and are discovered by endoscopic observations. This book describes the techniques of endoscopic and radiologic examinations and the principles of macroscopic diagnosis based on our experiences. If the detected change is a protruding lesion, the following findings are necessary for differ entiation: 1) size and shape, 2) height, 3) nodular appearance over the protuberant surface, 4) color tone, and 5) morphology of the protuberance. In an excavated lesion: 1) size and shape, 2) depth, 3) nodular appearance at the bottom of the excavation, 4) color tone, 5) border region of the excavation, and 6) nature of the mucous folds."

Spis treści

1. General Section.- A. On the concepts of protruding and excavated lesions.- 1. The protruding type of gastric lesion.- 2. The excavated type of gastric lesion.- B. The fundamentals of an x-ray diagnosis.- 1. General remarks on the technique of x-ray diagnosis.- a. Filling study.- b. Mucosal-pattern study.- c. Double-contrast study.- d. Adequate-compression study.- e. Polysography.- 2. X-ray findings on examination.- a. Protruding lesions.- b. Excavated lesions.- 3. Technical details of x-ray examinations.- a. Application of the prone position double-contrast method.- b. The problem of optimal compression.- c. Direction of the compression.- d. Compression phase and stage.- e. Application of respiration.- f. Conversion of position.- g. Suggestions for x-ray examination of protuberances.- 4. How to diagnose protuberant lesions.- a. Is there a protuberance in the stomach?.- b. Is the gastric phyma nonepithelial or epithelial?.- c. If it is a tumor, is it benign or malignant?.- d. If it is an epithelial malignant phyma, is it an early cancer (type I or II) or an advanced case?.- e. Malignancy judged by surface characteristics.- C. The fundamentals of endoscopic diagnosis.- 1. Basic problems of endoscopic examination.- a. Subjects for endoscopy.- b. Instruments for gastric endoscopy.- 2. Clinical application of endoscopy.- a. Routine examination.- b. Accurate examination.- 3. Technical details of endoscopy.- a. Endoscopic fundamentals for excavated lesions.- b. Practical suggestions in endoscopic observation.- c. The endoscopic features of an excavation in vivo and the resected stomach.- d. Protruding-excavated type lesions in endoscopy.- 4. Special remarks on endoscopic examination.- a. Lesions on the anterior wall and multiple lesions.- b. Difficulties in observing lesions from the frontal view.- c. Limitations in observing existence and quality of lesions.- d. Cytology and biopsy in diagnosing gastric lesions.- II. Case Presentations.- Protruding type.- A. Typical cases of gastric polypous lesions.- 1. Protruding types of advanced cancer of the stomach.- a. Borrmann I type (Fungating type).- b. Borrmann II type (Ulcerating type).- 2. Protruding types of early gastric cancer.- a. Type I (Protruding type) early gastric cancer.- b. Type II a (Superficial elevated) early gastric cancer.- 3. Gastric epithelial, benign tumor (Gastric polyp).- a. Hyperplastic polyps.- b. Adenomatous polyps.- 4. Nonepithelial tumor (Submucosal tumor).- a. Leiomyoma.- b. Neurogenic tumor.- 5. Polypoid early gastric cancer (Type I).- B. Indistinguishable cases.- 1. Prolapsing gastric polyps.- 2. Leiomyoma prolapsing into the duodenal cap X-ray pictures of gastric tumors prolapsing into the duodenum.- 3. Exogastric compression.- 4. A typical neurogenic tumor.- 5. Adenoma and Cyst.- C. Rare cases.- 1. A case of type I early gastric cancer invaginated into the duodenum.- 2. Polyposis.- 3. Polyp accompanied by leiomyoma.- 4. Sarcoma of the stomach.- a. Leiomyosarcoma.- b. Malignant lymphoma of the stomach.- 5. Eosinophilic granuloma (Inflammatory fibroid polyp).- 6. Bezoar.- Excavated type.- A. Typical cases of gastric excavated lesions.- 1. Excavated types of advanced cancer of the stomach.- a. Borrmann type II (Noninfiltrative carcinomatous ulcer).- b. Borrmann type III (Infiltrating carcinomatous ulcer).- 2. Excavated types of early gastric cancer.- a. Type IIc (Superficial depressed type) early gastric cancer.- b. Type III (Excavated type) early gastric cancer.- 3. Gastric ulcer.- a. Acute ulcer.- b. Chronic gastric ulcer.- c. Ulcer scar (Scarring ulcer).- 4. Erosion of the stomach.- a. Flat erosion.- b. Erosive gastritis.- B. Indistinguishable cases.- 1. Small size type IIc early gastric cancer.- 2. Indistinctly bordered, very shallow type He early carcinoma (IIb-like lesion).- 3. Benign or malignant ulcer.- 4. Widespread type Ha early gastric cancer (in which it is difficult to show the presence of an excavation).- C. Rare cases.- 1. Sarcoma of the stomach (Depressed type).- 2. Reactive lymphoreticular hyperplasia.- a. Localized hypertrophic form.- b. Diffuse flat form.- 3. Acute phlegmonous gastritis.- 4. Granulomatous diseases of the stomach.- References.