Lesion Pedunculated

There are common types of colorectal morphologies evaluated in CT colonography. These include the focal polypoid lesion, pedunculated lesion, flat or sessile lesion and advanced mural lesions. This section will describe these morphologies and their corresponding false positive counterparts. The differential application of 2D and 3D image displays to assess these morphologies will also be reinforced. 

During a 17-year period, 83 workers in a benzidine department were examined cysto-scopically 34 workers had congestive lesions, 3 had pedunculated papillomas, 4 had sessile tumors, and carcinoma was found in 13 of the workers. ... 

Excision is the removal of tissue utilizing a number of different techniques. A snip excision using a pair of Wescott surgical scissors can be used to remove or excise any pedunculated lesions such as skin tags or stalked verrucae. A shave excision, using a no. 15 scalpel, is used to remove a lesion or a section of a lesion. It is often used to take a tissue sample fc>r a biopsy. 

Fig. 5.9. MRI of leiomyoma - locations. T2-weighted coronal image of a polyfibroid uterus. A subserosal pedunculated uterine fibroid white arrow) is easily identified by its low signal intensity and continuity with the right lateral aspect of the uterine fundus while sonographi-cally the lesion could not be separated from the right ovary (black arrow). (Reproduced with permission from [223])...

Fig. 17.3. Pyosalpinx in CT. A pedunculated cystic lesion (arrow) is identified adjacent to the retroflected uterus. It extends from the left adnexal region posteriorly and displaces the opacified rectum (R). The distinct wall enhancement is indicative of a pyosalpinx...

Types of papillomata were separated by Hodgson and Whitely into four morphologic groups (1) flat shiny lesions (2) sessile lesions resembling plantar warts (3) pedunculated skin tags (fibro-epithelial polyps) and (4) plaques (seborrheic keratoses). 

Future Advances in Image Display Techniques Different Categories of Colorectal Morphologies 76 Focal Polypoid Lesions (r/o stool) 76 Pedunculated Lesions 79 Sessile/Flat Lesions (r/o thick or confluent Folds) 79 Advanced Mural Lesions (r/o collapse) 81 Standardization of Reporting of Clinically Significant Colorectal Findings 82 References 85... 

Fig.7.6a,b. Pedunculated lesion in area of luminal narrowing and marked diverticulosis a axial 2D MPR view best visualizes the characteristic stalk (arrows) from the polyp head (arrowhead), compared to b b 3D volume rendered view, with polyp head shown (arrowheads), but stalk obscured by luminal narrowing and muscular hypertrophy... 

C-RADS describes the use of three morphologies of lesions sessile (broad based lesion whose width is greater than its vertical height), pedunculated (polyp with a separate stalk), and flat (polyp with vertical... 

First of all, there is the problem of insufficient awareness and familiarity with those lesions surveillance programs, based on the known adenoma-carcinoma sessile or pedunculated lesion, have mainly focused on identifying sessile of pedunculated polyps. This explains why flat lesions are frequently characterised as normal folds. As a rule, a thickened fold in an otherwise well distended colon should raise the question whether or not this lesion could represent a flat lesion. 

Pedunculated lesions may remain undetected because of mischaracterisation as fecal residues or even residual fluid. 

Lesion size (mm) For lesions 6 mm or greater, single largest dimension of polyp head (excluding stalk if present) in either, MPR, or 3D views. The type of view employed for measurement should be stated Sessile-broad based lesion the width of which is greater than the vertical height Pedunculated-polyp with stalk... 

The diffuse form presents with multiple polypoid lesions and is called diffuse mucosal nodularity or malignant lymphomatous polyposis (O Connell and Thompson 1978 Callaway et al. 1997). The polyps appear smooth and sessile but can also be irregular or pedunculated. Often, the entire colon or a long segment is involved. 

Fig. 14.24a-e. Pedunculated polyp a supine 2D axial image and b prone 2D axial image show a polyp in the descending colon associated with a stalk (arrowhead) c soft tissue window setting shows the head of the polyp to be of soft tissue attenuation. Note that the lesion changes position to the dependent position due to its long stalk d,e endoluminal appearances of the pedunculated polyp... 

Fig. 31.1a-f. CTC showing pedunculated adenomatous polypoid lesion, a, b Axial and coronal multiplanar CT reformatted image obtain on supine position, showing a polypoid lesion (arrow) of the sigmoid, c-d see next page... 

Fig. 31.1a-f. (continued) CTC showing pedunculated adenomatous polypoid lesion. c,d Three-dimensional threshold-rendered endoluminal CT colonograph and corresponding conventional endoscopic image showing the precise correlation between radiological and endoscopical aspect of the lesion... 

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