Renal Carcinoma

Hematogenous metastasis to bowel from a renal carcinoma is rare. In some cases, Batson's vertebral venous plexus is a possible route.261 It typically presents as a solitary bulky intramural lesion92 (Fig. 4-233).

Bulky Cutaneous Melanoma

Fig. 4-215. Different cases of breast metastases to stomach. (Opposite page)

These are characterized by rigidity and narrowing with markedly decreased peristalsis and fixation, spiculation, and angulation of folds. Although any portion of the stomach may be involved, the changes are more common and prominent in the distal two-thirds. The findings are indistinguishable from those of a primary linitis plastica. Note, however, the osteoblastic metastases in (a).

(a and b reproduced from Meyers and McSweeney.1)

Fig. 4-216. Metastatic breast carcinoma to stomach.

(a) CT shows marked gastric antral wall thickening (arrows).

(b) Upper GI series demonstrates an irregular linitis plastica appearance involving the distal two-thirds of the stomach (arrows).

(Reproduced from Kidney, et al.249)

Fig. 4-216. Metastatic breast carcinoma to stomach.

(a) CT shows marked gastric antral wall thickening (arrows).

(b) Upper GI series demonstrates an irregular linitis plastica appearance involving the distal two-thirds of the stomach (arrows).

(Reproduced from Kidney, et al.249)

Fig. 4-217. Breast metastasis to stomach.

A large submucosal mass in the distal stomach and antrum has undergone prominent ulceration.

Fig. 4-218. Metastatic breast carcinoma to small bowel.

Small bowel series shows a short, fixed nonobstructing stenotic lesion in the ileum (arrows).

(Reproduced from Kidney, et al.249)

Fig. 4-218. Metastatic breast carcinoma to small bowel.

Small bowel series shows a short, fixed nonobstructing stenotic lesion in the ileum (arrows).

(Reproduced from Kidney, et al.249)

Fig. 4-219. Metastatic breast carcinoma to small bowel.

There are multiple skip areas of strictures with intervening dilatation. Diffuse submucosal metastases are also present within the stomach. (Reproduced from Meyers et al.44)

Bonnie Clyde Corpses

Fig. 4-220. Metastatic breast carcinoma to ileocecal junction.

CT demonstrates a prominent soft tissue mass at the ileocecal junction (arrows), presumably representing embolic metastasis via the ileocolic artery. (Reproduced from Kidney, et al.249)

Picture Soft Tissure Colon

Fig. 4-221. Metastatic breast carcinoma to right colon.

The entire ascending colon is encased by densely cellular submucosal secondary deposits. It is diffusely and irregularly narrowed, the mucosal and haustral patterns are effaced, and occasional nodular filling defects and serrations resembling minute ulcers are present. The ileocecal valve is widely patulous. The lesion strikingly resembles granulomatous colitis.

(Reproduced from Meyers al.44)

Fig. 4-222. Metastatic breast carcinoma to right colon.

The ascending and proximal transverse colon show asymmetric narrowing, scattered pseudosaccular formation, loss of the normal haustral and mucosal pattern, and the appearance of marginal ulcerations. The terminal ileum is also involved.

(Reproduced from Meyers et al.44)

Patulous Ileocecal ValvePatulous Colon

Fig. 4-223. Metastatic breast carcinoma to colon.

Skip areas of narrowing with localized loss of haustral and mucosal pattern involving the ascending, transverse, sigmoid, and rectosigmoid colon. Pseudosacculations reflect the asymmetric nature of the process. Deep transverse ulcers appear to project from the narrowed segment in the transverse colon.

(Reproduced from Meyers et al.44)

Fig. 4-224. Metastatic breast carcinoma to colon.

The entire large intestine is involved by multiple sites of narrowing and rigidity, with pseudosacculations.

Sigmaresektion

Fig. 4-225. Metastatic breast carcinoma to colon.

(a) Barium enema shows narrowing, angulation, fixation, and buckling of the mucosa in the transverse colon.

(b) CT documents mural thickening with luminal narrowing and mucosal speculations. (Courtesy of Michiel Feldberg, M.D., Ph.D., University of Utrecht, The Netherlands.)

Fig. 4-226. Extramural extension of colonic breast metastasis.

The proximal transverse colon is markedly thickened and its lumen is narrowed and distorted by hematogenous metastases from breast carcinoma. Direct invasion of the anterior abdominal wall has occurred.

Fig. 4-227. Metastatic breast carcinoma to rectum.

There is narrowing of the rectum with nodularity and distortion of the mucosal folds and the appearance of multiple cobblestone ulcerations. There is a gradual transition to normal, distended sigmoid segment. (Reproduced from Meyers et al.44)

Metastases Chest Films

Fig. 4-228. Metastatic bronchogenic carcinoma to small bowel.

(a) A focally stenotic lesion with fixation and angulation of a jejunal loop (arrow) causes proximal dilatation.

(b) The operative specimen confirms the submucosal nature of the metastasis. (Reproduced from Gourtsoyiannis and Nolan.80)

Fig. 4-228. Metastatic bronchogenic carcinoma to small bowel.

(a) A focally stenotic lesion with fixation and angulation of a jejunal loop (arrow) causes proximal dilatation.

(b) The operative specimen confirms the submucosal nature of the metastasis. (Reproduced from Gourtsoyiannis and Nolan.80)

Gallstone Ileus

Fig. 4—229. Metastatic bronchogenic carcinoma to colon.

(a) Chest film shows peripheral left upper lobe squamous cell carcinoma with pleural extension and partial excavation.

(b) Barium enema study shows metastatic annular narrowing in the sigmoid colon (arrows). (Reproduced from Smith and Vlasak.260)

Fig. 4—229. Metastatic bronchogenic carcinoma to colon.

(a) Chest film shows peripheral left upper lobe squamous cell carcinoma with pleural extension and partial excavation.

(b) Barium enema study shows metastatic annular narrowing in the sigmoid colon (arrows). (Reproduced from Smith and Vlasak.260)

Submucosal Fat Deposition Small Bowel

Fig. 4-230. Metastatic bronchogenic carcinoma to colon.

Submucosal deposition results in an eccentrically narrowed segment of the sigmoid colon. (Reproduced from Smith and Vlasak.260)

Fig. 4-230. Metastatic bronchogenic carcinoma to colon.

Submucosal deposition results in an eccentrically narrowed segment of the sigmoid colon. (Reproduced from Smith and Vlasak.260)

Distal Sigmoid Colon Mass

Fig. 4-231. Metastatic lung carcinoma.

Large mesenteric and serosal mass displaces distal small bowel and right colon.

Fig. 4-231. Metastatic lung carcinoma.

Large mesenteric and serosal mass displaces distal small bowel and right colon.

Distal Portion Small Intestine

Fig. 4-232. Hematogenous metastases of carcinoma of lung to stomach and third portion of the duodenum (arrows).

The duodenal metastasis shows irregular central ulceration. (Reproduced from Meyers and McSweeney.1)

Distal Sigmoid Colon Mass

Fig. 4—233. Metastatic renal cell carcinoma to sigmoid colon.

Two and one-half years after nephrectomy for renal cell carcinoma, barium enema study (a) shows a large transmural tumor of the sigmoid colon with both extrinsic and intraluminal components. CT (b) confirms a large secondary mass (M) with displacement and compression upon the colon.

Fig. 4—233. Metastatic renal cell carcinoma to sigmoid colon.

Two and one-half years after nephrectomy for renal cell carcinoma, barium enema study (a) shows a large transmural tumor of the sigmoid colon with both extrinsic and intraluminal components. CT (b) confirms a large secondary mass (M) with displacement and compression upon the colon.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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