Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
Abdom Radiol (NY). 2020 Oct;45(10):3007-3027. doi: 10.1007/s00261-019-02278-8.
Hematologic malignancies include several lymphoproliferative and myeloproliferative disorders, many of which are frequently encountered in current health care settings. These malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. In fact, the GI tract may represent the most common extranodal site of involvement in many of them, such as lymphoma. Furthermore, in the current era of improved cancer treatment and advanced transplant procedures with increased survival, it has been quite common to encounter GI involvement by these malignancies through the disease course. Post-transplant lymphoproliferative disorder following kidney transplantation, for example, very commonly involves the GI tract. Other conditions that can involve the GI tract include multiple myeloma, plasmacytoma, myeloid sarcoma, mastocytosis, and Castleman disease. Imaging diagnosis of these malignancies can be challenging, since they are much less common than primary GI cancers and both share many common imaging features as well. However, certain imaging features, particularly in combination with a matching clinical scenario, play a pivotal role in diagnosing these conditions and directing further evaluation. In this article, we review common and rare hematologic malignancies of the GI tract and discuss their pathophysiologic, clinical, and imaging features.
血液系统恶性肿瘤包括多种淋巴增殖性和髓系增殖性疾病,其中许多在当前的医疗保健环境中经常遇到。这些恶性肿瘤经常通过继发性结外或骨髓外扩展到胃肠道(GI),或者作为原发于胃肠道的疾病过程来影响胃肠道。事实上,在许多恶性肿瘤中,胃肠道可能是最常见的结外受累部位,如淋巴瘤。此外,在当前癌症治疗改善和先进移植手术提高生存率的时代,这些恶性肿瘤在疾病过程中通过胃肠道受累已经很常见。例如,肾移植后发生的移植后淋巴增殖性疾病非常常见于胃肠道。其他可能累及胃肠道的疾病包括多发性骨髓瘤、浆细胞瘤、髓样肉瘤、肥大细胞增多症和 Castleman 病。这些恶性肿瘤的影像学诊断具有挑战性,因为它们比原发性胃肠道癌症少见得多,并且具有许多共同的影像学特征。然而,某些影像学特征,特别是与匹配的临床情况相结合,在诊断这些疾病并指导进一步评估方面发挥着关键作用。本文回顾了胃肠道常见和罕见的血液系统恶性肿瘤,并讨论了它们的病理生理、临床和影像学特征。