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Acta Endoscopica

, Volume 33, Issue 3, pp 291–312 | Cite as

Evaluation par imagerie médicale des Tumeurs Non Epithéliales du tube digestif

  • V. Gillard
Article
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Résumé

Lestumeurs non épithéliales du tractus digestif prennent naissance au niveau de l'une des cinq couches histologiques de la paroi digestive. Ces tumeurs peuvent être bénignes ou malignes et résultent d'une prolifération auto-limitée ou plus ou moins bien limitée de cellules qui sont habituellement présentes ou non présentes dans l'un des constituants de la paroi digestive: lymphocytes, plasmocytes, cellules entérochromaffines, fibroblastes, myoblastes, cellules nerveuses, vasculaires ou de l'endothélium lymphatique, adipocytes…

La plupart des tumeurs bénignes sous-muqueuses sont découvertes de façon fortuite. Elles sont le plus souvent de petites tailles, asymptomatiques et sans risque de dégénérescence. Toutefois, les lésions plus volumineuses ou ulcérées peuvent causer des symptômes et dégénérer. Pour leurs évaluations, plusieurs techniques d'imagerie sont disponibles.

L'étude barytée est particulièrement utile pour diagnostiquer ces lésions car la muqueuse qui les recouvre est le plus souvent normale. La prise en charge rationnelle des tumeurs sous-muqueuses bénignes ou malignes dépend essentiellement de l'endoscopie et des prélèvements biopsiques profonds. Un traitement définitif peut être parfois réalisé par endoscopie pour les lésions bénignes. Une grande variété d'autres méthodes d'imagerie peut être utile pour élucider la nature d'une lésion et pour évaluer son bilan d'extension. L'écho-endoscopie associée ou non à l'aspiration à l'aiguille fine est l'extension logique de l'endoscopie pour l'évaluation de ces tumeurs profondes sous-muqueuses et pour déterminer de façon précise la localisation de la lésion qui prend naissance au niveau de l'une des cinq couches de la paroi digestive. LaTDM et laRMN sont particulièrement performantes pour démontrer l'extension et les phénomènes invasifs de la masse et pour révéler les métastases à distance.

Conclusion: L'évaluation de ces lésions est possible grâce à de multiples modalités d'imagerie médicale et est indispensable afin de caractériser leur nature anatomo-pathologique: caractère bénin, potentiellement malin ou franchement malin. Un bilan préthérapeutique correct est également important afin d'orienter au mieux le patient vers l'option thérapeutique la plus appropriée telle que simple surveillance, exérèse endoscopique ou chirurgicale, radiothérapie ou chimiothérapie.

Mots-clés

lymphomes digestifs tumeurs mésenchymateuses tumeurs non épithéliales tumeurs stromales gastrointestinales 

Imaging modalities for evaluation of Non Epithelial Tumors of the upper GI tract

Summary

Non-epithelial tumors of the GI tract arise from one of the five layers of the digestive wall. These tumors can be benign or malignant and result from a self or more or less limited proliferation of cells which are usually present or not inside one of the constituents of the digestive tract: lymphocytes, plasmocytes, enterochromaffin cells, fibroblasts, myoblasts, nerves cells, vascular or lymphatic endothelium, adipocytes…

Most benign submucosal tumors are discovered as incidental findings. They are most often small, asymptomatic lesions without degenerative potential. However, lesions that are large or ulcerated may cause symptoms.

For their evaluation, many investigation imaging tools are available.

Barium studies are particularly helpful for diagnosing these lesions because the overlying mucosa often appears normal. The rational management of benign and malignant submucosal tumors is critically dependent onendoscopy and on performing deep biopsy specimen. Sometimes definitive treatment can be given through endoscopy for many lesions particularly those that are benign.

A variety of other imaging methods may be helpful in elucidating the nature of a lesion and extent of involvement, including transmural involvement.Endoscopic Ultrasonography associated or not with Fine Needle Aspiration is the logical extension of endoscopy for studying lesions deep beyond mucosa and for determining the precise depth of the lesion that arises in one of the five layers of the digestive wall.CT scan andMRI are particularly helpful for demonstrating extent of the mass and invasion of adjacent structures and reveal metastases.

Conclusion: Assessing these lesions is possible by various imaging modalities and is mandatory in order to characterize their anatomopathologic nature, their benign, potentially malignant or truly malignant character. Proper staging is also important, so that a rational decision can be made about treatment options, such as surveillance, endoscopic or surgical removal, radiation, and chemotherapy.

Key-words

digestive lymphomas gastrointestinal stromal tumors mesenchymal tumors non epithelial tumors 

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© Springer-Verlag 2003

Authors and Affiliations

  • V. Gillard
    • 1
  1. 1.Département de GastroentérologieUniversity de Liège(Belgique)

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