Intraluminal tumor

Randomized prospective studies have shown that laser therapy produces comparable or better results than plastic stents (Barr et al. 1990 Carter et al. 1992 Loizou et al. 1991). However, the two techniques are probably complementary and are best suited to different tumors. Laser is more effective for fleshy intraluminal tumors, whilst plastic tubes are better in sclerotic mahgnant stenoses. Overall, laser treatment is the more expensive because it has to be repeated. 

Treatment of stent occlusion includes local thrombolysis, thrombectomy, balloon dilatation and placement of additional stents. The possible causes of occlusion are intraluminal tumor growth, or tumor growth at the free ends of the stent as a consequence of insufficient coverage of the strictures by the stent, vessel contraction, and inadequate stent diameter leading to distal stent migration (Figs. 5.11, 5.12). 

George and colleagues (1992) treated nine patients with malignant central airway obstruction due to tracheal (n=3) or main bronchial ( =6) stenosis with Gianturco stents. All patients suffered from severe dyspnea or asphyxia (four were emergency treatments). All patients had dramatic and rapid reUef of their symptoms after stent insertion. Two patients with intraluminal tumor growth required additional endobronchial measures to control local tumor progression. Patients survived between 3 weeks and 8 months after the intervention. Causes of death were cachexia or pneumonia. 

Miyayama S, Matsui O, Kamimura R, Kakuta K, Takashima T (1997) Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor. Cardiovasc Intervent Radiol 20 60-62 Miyazawa T, Yamakido M, Ikeda S, Furukawa K, Takiguchi Y, Tada H, Shirakusa T (2000) Implantation of Ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 118 959-965... 

Most are carcinoids. Although the general characteristics of these are not too different from carcinoids elsewhere, there are some peculiarities worth mentioning. The majority of the functioning somatostatinomas occur in the ampulla. Moreover, whether functional or not, somatostatin-positive tumors of this region, in addition to the classical features of low-grade neuroendocrine neoplasms, also display tubule formation, focal intraluminal mucin, and psammomatous calcifications and... 

Rodas RA, Fenstermaker RA, McKeevet PE, et al. Cottelation of intraluminal thrombosis in brain tumor vessels with postopet-ative thrombotic complications. / Neurosurg. 1998 89 200-205. 

AFB-LIFE assists accurate delineation of the tumor border [37]. Only 25% of these lesions have been found to be occult, thereby justifying intraluminal bronchoscopic treatment (IBT) with curative intent [81]. 

For palliation of dysphagia in patients with advanced EAC, laser and argon beam are the first choice for friable intraluminal disease (with stent use in the majority of cases). Covered stents should be used to minimize ingrowth of tumor. Covered stents are also the treatment of choice for perforated cancers and malignant tracheo-esophageal cancer. Chemotherapy should only be used in the context of appropriate controlled clinical trials. 

Complex or thickened folds are typically encountered at the splenic and hepatic flexures. Axial CT images might raise the possibility of intraluminal soft tissue masses or tumoral thickened folds. Endo-luminal views are frequently helpful in identifying... 

The radiologic patterns of primary colonic lymphoma, such as intraluminal masses, polyps, stenosis, and polyposis, are often quite similar to those of carcinomatous stenosis, adenomatous polyps, and familial polyposis, and can also be evaluated by CT colonography (Table 13.4). The possibility of lymphoma should be considered when cecal tumors involve the terminal ileum, when tumors do not invade the pericolonic fat or adjacent structures and when there are secondary findings such as splenomegaly or bulky abdominal lymph node enlarge-... 

Duodenal tumours are rare. They account for about one-third of all small bowel neoplasms, which in turn represent approximately 5%-6% of all GIT neoplasms (Kazerooni et al. 1992). Benign tumours include adenoma, adenomatous polyp, lipoma, and leiomyoma. The latter is a benign gastrointestinal stromal tumor (GIST) of smooth-muscle type. A lipoma is the only tumour that can be diagnosed by certainty on CT as a well-circumscribed, homogeneous intraluminal mass with characteristic fat density, based on negative attenuation numbers (Fig. 9.16). 

Fig. 9.17. a Intraluminal villous adenoma. CECT shows a soft-tissue polypoid mass with a small pedicle, arising from the medial aspect of the descending duodenum, with no mural thickening or extraduodenal disease, b Malignant villous tumor of the duodenum. Note the extensive carpetlike lesion involving most of the inferior duodenal flexure as well as the liver metastasis (c)... 

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