T1 Stage

In the esophagus, the distinction of cancer involving only the mucosa (T1m) (Fig. 5-8) from cancer invading the submucosa (T1sm) (Figs. 5-9 and 5-10) may guide the application of endoscopic resection.33

Early gastric cancer may be defined on contrast-enhanced dynamic CT as an enhancing lesion with an intact low-density stripe at its base (Fig. 5-11).

Figure 5-12 illustrates a thickening limited to the mucosal layer of the rectum with a normal muscularis mucosae representing a sessile adenoma, shown by endorectal MRI. In contrast, Figure 5-13 shows mucosal thickening secondary to carcinoma with preservation of the submucosal layer but with a small regional metastatic lymph node.

T1sm Staging

Fig. 5—8. Esophageal cancer limited to the lamina propria shown with a small 20-MHz EUS probe.

(a) The white arrowhead indicates cancer invading the lamina propria. The outlined black arrow demonstrates an intact muscularis mucosae.

(b) The endoscopic mucosal resection specimen. (Reproduced from Murata et al.33)

Fig. 5—8. Esophageal cancer limited to the lamina propria shown with a small 20-MHz EUS probe.

(a) The white arrowhead indicates cancer invading the lamina propria. The outlined black arrow demonstrates an intact muscularis mucosae.

(b) The endoscopic mucosal resection specimen. (Reproduced from Murata et al.33)

Endoscopic Mucosal Resection Esophagus

Fig. 5—9. Esophageal cancer invading the muscularis mucosae shown with a small 20-MHz EUS probe.

(a) The outlined black arrow indicates the muscularis mucosae and the white arrowhead designates the point at which the m4 layer is destroyed by tumor infiltration.

(b) The resected specimen. The black arrowhead shows the point of cancerous destruction of the muscularis mucosae.

(Reproduced from Murata et al.33)

Esophageal Cancer Eus StagingEus Early Gastric Cancer

Early phase of bolus-enhanced dynamic CT of water-distended stomach shows a small, well-defined, elevated lesion (arrowheads) with moderate enhancement in the posterior wall of gastric antrum. Low-attenuation stripe of the submucosa (arrows) is clearly seen at base of tumor. (Reproduced from Cho et al.36)

Fig. 5—10. T1sm esophageal cancer.

EUS reveals a hypoechoic tumor (T) limited to the mucosa (M) and submucosa (SM). A portion of the submucosa beyond the tumor is still intact (arrowheads). MP = muscularis propria. (Reproduced from Tio TL.39)

Early phase of bolus-enhanced dynamic CT of water-distended stomach shows a small, well-defined, elevated lesion (arrowheads) with moderate enhancement in the posterior wall of gastric antrum. Low-attenuation stripe of the submucosa (arrows) is clearly seen at base of tumor. (Reproduced from Cho et al.36)

Eus And Early Gastric Cancer

Fig. 5—12. Sessile tubulovil-lous adenoma of the rectum.

Endorectal Tl-weighted contrast-enhanced MR image demonstrates the tumor. The different layers of the rectal wall can be identified. From lateral to medial: the high signal intensity of the perirectal fat tissue (white arrowheads), the low signal intensity of the muscularis propria (black arrowheads), a layer of high signal intensity representing the submucosal core (small white arrowheads), and the low signal intensity of the muscularis mucosae (thin white arrows). Note the high signal intensity of the thickened mucosal layer (large white arrows).

(Reproduced from Pegios et al.38)

Fig. 5-13. T1N1 rectal carcinoma.

Endorectal T2-weighted MRI demonstrates a sessile lesion of the rectum showing focal muco-sal thickening with a high-signal-intensity submucosal core (black arrowheads). The muscularis propria (small white arrowheads) layer has not been involved. One small, 3-mm-diameter peri-rectal lymph node is completely replaced by soft tissue (large white arrowhead).

(Reproduced from Pegios W, et al: MRI diagnosis and staging of rectal carcinoma. Abdom Imaging 21:211-218, 1996.)

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