Ferrozzi. Garlaschi. Bova CT of Metastases

Transcription

1 Ferrozzi. Garlaschi. Bova CT of Metastases

2 Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo

3 F. Ferrozzi. G. Garlaschi. D. Bova CT of Metastases With a Foreword by P. Bassi With 93 Illustrations in 140 Parts, Springer

4 Dr. Francesco Ferrozzi Istituto di Scienze Radiologiche Universita degli Studi di Parma Via Gramsci Parma, Italy Professor Giacomo Garlaschi Istituto di Radiologia Universita degli Studi di Genova Largo R. Benzi Genova, Italy Dr. Davide Bova Department of Radiology Loyola University Medical Center 2160 South First Avenue Maywood, IL 60153, USA ISBN-13: DOl: / e-isbn-13: Translation from the Italian language edition: La TC nella studio delle rnetastasi by Francesco Ferrozzi and Giacomo Garlaschi Springer-Verlag Italia Sri 1999 All Rights Reserved Library of Congress Cataloging-in-Publication Data Ferrozzi, F. (Francesco), [TC nello studio delle metastasi. English] CT of metastases / F. Ferrozzi, G. Garlaschi, D. Bova. p. cm. "Translation from the Italian language edition: La TC nello studio delle metastasi by Francesco Ferrozzi and Giacomo Garlaschi" - T. p. verso. Includes bibliographical references and index. ISBN-13: (softcover: alk. paper) 1. Metastasis - Tomography. I. Garlaschi, G. (Giacomo), II. Bova, D. (Davide), III. Title RC269.5.F ' dc2l This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfllm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin - Heidelberg 2000 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about the application of opertive techniques and medications contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Erich Kirchner, Heidelberg Typesetting: Fotosatz-Service Kohler GmbH, Wiirzburg SPIN /3l Printed on acid-free paper

5 Foreword It was with much pleasure that I agreed to present this monograph, authored by Francesco Ferrozzi, Giacomo Garlaschi and Davide Bova, on CT diagnosis of metastatic neoplasms. The oncologic question, with its innumerable facets, is a daily reality for every radiologist, with a perpetual challenge of providing the clinician with ever more detailed information that is so essential in treatment planning. In particular, as stated by the authors, the changing philosophy in oncologic therapy - more aggressive and now routinely extended to metastatic tumors - has made it necessary for radiologist also to modify their perspectives and their practice. The authors have approached the topic with an agile text, made particularly interesting by the additional documentation of variants and unusual aspects. The book combines a concise chapter on the biologic and pathogenetic aspects of metastatic diffusion with a discussion of the main modalities of metastasis (lymphatic, hematogenous, etc.), altogether providing extremely useful parameters to comprehend preferential sites of secondary spread in relation to the causative primaries. The analysis of the structural aspects of metastases, where the morphology of lesions is accompanied by etiopathogenetic considerations, is of particular interest in relation to their differential diagnosis and to the possible identification of their origin. The analytical discussion of each site of metastases, both rare and common, is organically and didactically organized and supported throughout by excellent images. More pragmatic aspects are addressed as well, as with the tables of differential diagnosis; the latter, by analyzing the crucial problem of the metastasis of unknown origin, suggest a simplistic but solid diagnostic path based upon analysis of anatomic, pathologic and etiologic criteria. In conclusion, this is a lucid and accessible text, beautifully illustrated - the result of the authors' long experience in oncologic imaging - and of interest to anyone involved in the field. Parma, May 1999 P. Bassi

6 Contents Introduction CHAPTER 1 Pathogenesis of the Metastatic Process CHAPTER 2 Modalities of Metastatic Diffusion Lymphatic Diffusion Lymphangitic Infiltration Hematogenous Diffusion Neoplastic Seeding Perineurial Diffusion. Neoplastic Thrombosis Lepidic Diffusion CHAPTER 3 Structural Features of Metastases Calcified Metastases... Pseudo cystic Metastases Cavitation of Metastases Cystic Metastases... Hemorrhagic Metastases Lipoid Metastases. Infected Metastases CHAPTER 4 Anatomical Sites of Metastatic Colonization Classical Targets Cerebrum Lung Pleura... Liver Adrenal Glands Peritoneum Bone... Lymph Nodes

7 VIII Contents Rare Sites of Metastases Diencephalon Head and Neck Heart... Breast.... Gallbladder Pancreas.. Spleen Gastrointestinal System Kidney.... Ureter and Bladder Female Genital System Male Reproductive Organs Soft Tissue ApPENDIX 1 Bizarre Metastases ApPENDIX 2 Differential Diagnosis Tables References.. Subject Index