Imaging Pearls ❯ Small Bowel ❯ Metastases to the Small Bowel
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- “Melanoma is the most common source of small bowel metastases. In a series of 2500 patients with melanoma, 110 patients (4.4%) had gastrointestinal metastases; among these, the small bowel (35%) and the colon (14.5%) were the most frequently involved organs. The prevalence of small bowel metastases increases with the stage of the disease (0% in stage I/II, 1.7% in stage III and 28.6% in stage IV) . The jejunum is more frequently involved than the ileum (22/32 vs. 11/32, respectively) . When present, clinical symptoms include obscure bleeding causing iron- deficiency anemia, abdominal pain, small bowel obstruction and rarely small bowel perforation.”
CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor‐specific therapies
Maxime Barat et al.
Abdominal Radiology (2021) 46:2219–2235 - "At imaging, a common manifestation of small bowel metastases from melanoma is mural thickening that may result in an aneurysmal pattern or single or multiple, endoluminal, solid masses. Approximately 50% of small bowel metastases are polypoid masses that may act as leading points for intussusception. Intussusception is a remarkable manifestation of small bowel metastases from melanoma. Most of them are jejunal intussusception but ileal ones have been reported.”
CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor‐specific therapies
Maxime Barat et al.
Abdominal Radiology (2021) 46:2219–2235 - "Most patients with small bowel metastases from melanoma remain undiagnosed during their life time. The diagnosis of small bowel metastases of melanoma can be made using videocapsule endoscopy (VCE). One study found that VCE is superior to 18FDG PET-CT in the detection of small bowel metastases from melanoma. Although CT can also reveal small bowel melanoma metastases when they are large, the sensitivity and specificity of CT is less than that of VCE. One study reported one ileal metastasis depicted with CT-enteroclysis but no seen on VCE. CT-enteroclysis allows depiction of small bowel tumors as small as 5 mm. However, to date no studies have specifically addressed the issue of detection of small bowel metastases from melanoma.”
CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor‐specific therapies
Maxime Barat et al.
Abdominal Radiology (2021) 46:2219–2235 - “The stomach represents 16–22.7% of gastrointestinal tract locations of metastases from melanoma. Symptoms are often nonspecific including nausea, vomiting, abdominal pain, weight loss, and anemia. On imaging, gastric metastases generally present as intraluminal polypoid masses, although an infiltrative pattern has been described. They are hypoattenuating, with heterogeneous enhancement during the arterial phase and persisting enhancement during the portal phase.
CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor‐specific therapies
Maxime Barat et al.
Abdominal Radiology (2021) 46:2219–2235
- “The small bowel is frequently the site of metastasis. Metastasis may reach the small bowel by the hematogenous route or by direct invasion or contiguous spread.The most common sources of hematogenous metastasis to the small bowel include lung cancer, breast cancer, and melanoma. These lesions tend to arise in the submucosa and may have a target or ulcerative appearance. The most common tumors to directly invade the small bowel include ovarian cancer and colon cancer. Tumor implants from carcinomatosis may be seen along the small bowel serosal surface and can cause obstruction.”
Small Bowel Neoplasms: A Pictorial Review
Jasti R, Carucci LR
RadioGraphics 2020;40:1020-1038 - "Small bowel neoplasms overall are rare. Small bowel lesions may be identified or evaluated with cross-sectional imaging such as CT or MRI.The differential diagnosis of focal small bowel masses found at cross-sectional imaging includes a variety of benign and malignant neoplasms and other masslike processes. Cross-sectional imaging is useful for evaluating the location, characteristics, and extent of disease. CT enterography and MR enterography are the best noninvasive imaging techniques for diagnosing, evaluating, and staging small bowel neoplasms. Imaging features of the small bowel lesion and associated findings at CT or MRI help limit the diagnostic possibilities. A high index of suspicion coupled with optimal imaging technique is often necessary for detection and accurate diagnosis.”
Small Bowel Neoplasms: A Pictorial Review
Jasti R, Carucci LR
RadioGraphics 2020;40:1020-1038 - “Metastases to the small bowel often occur many years after the initial diagnosis of the primary malignancy or entering remission and may be symptomatic. Attention to the small bowel is particularly important in melanoma patients, who may have multiple small bowel metastases, even after many years of being disease free. As oncology patients undergo numerous surveillance scans and improved therapies allow for longer survival, detection of these masses at a small size can facilitate elective resection to avert urgent surgical intervention.”
Clinical time course and CT detection of metastatic disease to the small bowel.
Lee MH, Zaheer A, Voltaggio L, Johnson PT, Fishman EK.
Abdom Radiol (NY). 2019;44(6):2104-2110
- Location of Small Bowel Tumors
- Purpose The purpose of this study was to identify the CT characteristics of metastatic disease of the small bowel and define the clinical time course between primary tumor diagnosis and small bowel metastasis detection.
Results Melanoma was the most common malignancy to metastasize to small bowel (7 of 16 patients). Only one of the 16 cases was detected at the time of initial diagnosis of their primary malignancy. The average time from diagnosis of the primary malignancy or remission to the time of detection of the small bowel metastasis was 7.2 and 8.3 years, respectively. The most common symptoms were gastrointestinal bleeding (N = 5) and small bowel obstruction (N = 5). In 3 cases, the masses were not identified on pre-operative CT.
Clinical time course and CT detection of metastatic disease to the small bowel
Megan H. Lee, Atif Zaheer, Lysandra Voltaggio, Pamela T. Johnson, Elliot K. Fishman
Abdominal Radiology (2019) 44:2104–2110 - “Metastases to the small bowel often occur many years after the initial diagnosis of the primary malignancy or entering remission and may be symptomatic. Attention to the small bowel is particularly important in melanoma patients, who may have multiple small bowel metastases, even after many years of being disease free. As oncology patients undergo numerous surveillance scans and improved therapies allow for longer survival, detection of these masses at a small size can facilitate elective resection to avert urgent surgical intervention.”
Clinical time course and CT detection of metastatic disease to the small bowel
Megan H. Lee, Atif Zaheer, Lysandra Voltaggio, Pamela T. Johnson, Elliot K. Fishman
Abdominal Radiology (2019) 44:2104–2110 - ”In this retrospective case series of pathologically proven metastases to the small bowel, there was a relatively long latent period from the time of initial diagnosis of primary malignancy or remission to the time of detection of the small bowel metastasis. The most common primary malignancy was melanoma, which is especially known to recur at any time, even after a long remission. In only one patient was the metastasis detected at the time of initial diagnosis. In the majority of the cases, there was already distant metastatic disease at the time of diagnosis of the small bowel metastasis. The most common symptoms were gastrointestinal bleeding and small bowel obstruction.”
Clinical time course and CT detection of metastatic disease to the small bowel
Megan H. Lee, Atif Zaheer, Lysandra Voltaggio, Pamela T. Johnson, Elliot K. Fishman
Abdominal Radiology (2019) 44:2104–2110 - These findings suggest that attention should be paid to the small bowel on routine surveillance scans, as metastases to the small bowel tend to occur years after the initial diagnosis of malignancy or even after years of remission. Furthermore, gastrointestinal symptoms in oncology patients should also be cause for careful attention to the small bowel. Although the total number of cases in this series was small, a significant number of lesions were not seen on CT. Further work is needed to optimize the detection of metastases to the small bowel mucosa on CT, as these can have a significant clinical impact.”
Clinical time course and CT detection of metastatic disease to the small bowel
Megan H. Lee, Atif Zaheer, Lysandra Voltaggio, Pamela T. Johnson, Elliot K. Fishman
Abdominal Radiology (2019) 44:2104–2110