Radiologic features of carcinomas arising in hiatal hernias

The aim of this study was to present the spectrum of clinical and radiologic manifestations of carcinomas that originate within hiatal hernias, to emphasize their increasing prevalence among the elderly patient population, and to assess the reasons for radiologic misdiagnosis.

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 proximal part of the stomach were reviewed.

A hiatal hernia with intrinsic abnormalities suggestive of carcinoma was shown by upper gastrointestinal tract examination obtained before surgery in all 27 patients. A diagnosis of malignancy was reported at the time of examination 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 of the hiatal hernia in conjunction with thickened, nodular mucosa. The intrahernial tumor appeared as a well-demarcated sessile polyp or lobulated mass in nine patients (33%) and as ulcerations and eccentric wall thickening in three patients (11%). All errors were perceptive in nature. On review, we saw minimal evidence of infiltration or small polypoid masses.

Although some of the radiologic abnormalities were minimal, our review of 27 cases in a biphasic upper gastrointestinal tract series resulted in detectable radiographic findings of carcinomas associated with hiatal hernias for all cases. Meticulous assessment of the herniated fundus and gastroesophageal regions is crucial for the detection of such tumors.