RADIOLOGIC FEATURES OF CARCINOMAS ARISING IN HIATAL-HERNIAS

OBJECTIVE. The aim of this study was to present the spectrum of clinic al and radiologic manifestations of carcinomas that originate within h iatal hernias, to emphasize their increasing prevalence among the elde rly patient population, and to assess the reasons for radiologic misdi agnosis. MATERIALS AND METHODS. Medical records and radiologic studies of 27 adult patients (15 men and 12 women; 54-83 years old [mean, 71 years old]) with surgically proven adenocarcinomas in the herniated pr oximal part of the stomach were reviewed. RESULTS. A hiatal hernia wit h intrinsic abnormalities suggestive of carcinoma was shown by upper g astrointestinal tract examination obtained before surgery in all 27 pa tients, A diagnosis of malignancy was reported at the time of examinat ion for 24 patients (89%); for the remaining three patients, diagnosis was made by endoscopy. The predominant feature, seen in 15 patients ( 56%), was an infiltrative process that caused deformity and rigidity o f the hiatal hernia in conjunction with thickened, nodular mucosa, The intrahernial tumor appeared as a well-demarcated sessile polyp or lob ulated mass in nine patients (33%) and as ulcerations and eccentric wa ll thickening in three patients (11%), All errors were perceptive in n ature, On review, we saw minimal evidence of infiltration or small pol ypoid masses. CONCLUSION. Although some of the radiologic abnormalitie s were minimal, our review of 27 cases in a biphasic upper gastrointes tinal tract series resulted in detectable radiographic findings of car cinomas associated with hiatal hernias for all cases, Meticulous asses sment of the herniated fundus and gastroesophageal regions is crucial for the detection of such tumors.