Intraluminal Tumor Research Articles

Can CT Features Differentiate Between Inferior Vena Cava Leiomyosarcomas and Primary Retroperitoneal Masses?

The objective of our study was to evaluate and describe CT features that may differentiate inferior vena cava (IVC) leiomyosarcomas from primary retroperitoneal masses. A records search revealed 18 CT examinations with a soft-tissue mass contacting the IVC. Three readers evaluated the scans for four signs: an imperceptible IVC at the interface with the mass; a "positive embedded organ" sign (IVC embedded in the periphery of the mass); a "negative embedded organ" sign (IVC compressed at the perimeter of the mass); and tumor in the IVC lumen. CT findings were compared with pathology and operative reports. Performance and significance of CT features and interobserver agreement were calculated. Four of 18 (22%) retroperitoneal masses were IVC leiomyosarcomas. The IVC was imperceptible at the interface with the mass in three of the four (75%) IVC leiomyosarcomas (κ = 0.88) and in no alternate diagnosis (p < 0.02). No IVC leiomyosarcoma showed a positive embedded organ sign versus one of 14 masses of alternate origin (p = 1.0, κ = 0.56). The negative embedded organ sign was seen in most primary retroperitoneal masses (11/14 or 79%, κ = 0.85) but in no case of IVC leiomyosarcoma (p = 0.01). Intraluminal tumor was seen in one of four (25%) IVC leiomyosarcomas and in two of 14 other retroperitoneal masses (p = 1.0, κ = 1.0). An imperceptible IVC at the point of maximal contact with a retroperitoneal mass was the most useful CT feature for predicting the origin of IVC leiomyosarcoma. A negative embedded organ sign was useful for excluding IVC origin. Knowledge of these CT features may assist with preoperative planning.

Transoral Endoscopic Resection of Esophageal Liposarcoma

A 63-year-old man presented with a 1-month history of dysphagia. Endoscopy showed the patient had a mass in the cervical esophagus. Multiple biopsy specimens were taken, which were inconclusive for a diagnosis. A positron-emission tomography scan showed a hypermetabolic lesion. A transoral endoscopic approach was used to resect the tumor. Final histologic examination revealed a completely resected low-grade liposarcoma.

Cystic and Papillary Neoplasm Involving Peribiliary Glands: A Biliary Counterpart of Branch-Type Intraductal Papillary Mucinous Cystic Neoplasm?

Peribiliary glands (PGs) are located around the extrahepatic and perihilar bile ducts and are reportedly involved in the development, as well as diseases, of the hepatobiliary and pancreatic systems.1, 2 Intraductal papillary neoplasm of the bile duct (IPNB) is a newly described entity characterized by intraluminal papillary tumor(s) with mucin secretion.2 IPNB is an early neoplastic lesion of invasive cholangiocarcinoma and is proposed to be a counterpart of intraductal papillary mucinous cystic neoplasm (IPMN) of the pancreas. Though there are main duct and branch types of IPMN of the pancreas, the IPNB cases reported on, so far, seem to correspond to the main duct type, IPMN.2 Recently, there have been several reports of IPNB that might have arisen from PGs.3-6 Nakanishi et al. reported on a case in which the cystic and papillary neoplastic lesions only involved PGs.3 In another case,4 IPNB showed diverticular dilatation, and neoplastic changes involving PGs were found at the tip of the diverticular dilatation. Papillary neoplastic changes were also continuously found on the luminal surface of the neighboring bile ducts. It seems possible that the first case3 may correspond to branch-type IPMN, whereas the second case4 corresponds to the combined branch- and main-duct-type IPMN. These cases3-6 not only suggest that cystic and papillary neoplastic changes primarily involve PGs, but also that such neoplastic cells spread to the adjacent bile duct, with the formation of IPNB showing diverticulum-like dilatation. The relationship of PGs and the adjacent bile duct in cases of IPNB involving PGs are schematically shown in Fig. 1. In type A, neoplastic involvement is confined to PGs, and in type B, PGs are mainly involved and the adjacent bile duct(s) are also secondarily and partly involved. Type C represents extensive involvement of PGs with the simultaneously significant involvement of bile ducts. These three types can be called “branch-type IPNB,” whereas the majority of IPNB cases reported on, so far, with main duct IPMN can be called “main-duct-type IPNB.” Schema of cystic and papillary neoplasms involving the PGs. Blue epithelium is non-neoplastic, and red epithelium is neoplastic. L, bile duct lumen; *unaffected PGs. Type A shows neoplastic involvement confined to the PG, and type B shows the main involvement of the PGs with partial secondary involvement of the adjacent bile duct. Type C reflects extensive involvement of the PGs with simultaneous involvement of the bile ducts, and this type may appear grossly as peribiliary cysts in the perihilar regions. Yasuni Nakanuma M.D.*, Yasunori Sato M.D., Ph.D.*, * Department of Human Pathology,Kanazawa University Graduate School of Medicine, Kanazawa, Japan.

Giant Fibrolipoma of the Esophagus

Benign tumors of the esophagus are uncommon, representing <0.5% of esophageal tumors. Fibrolipomas are a subset of benign fibrovascular tumors, which present with dysphagia, odynophagia, and substernal fullness. These intraluminal tumors can become elongated and molded into a long pedunculated polyp by constant peristaltic movements. They can cause esophageal obstruction if large and long enough and can cause asphyxiation if they become lodged into the glottis. A barium swallow is the main diagnostic tool; treatment is surgical via a transoral, transcervical, or transthoracic approach. We report the excision of a large esophageal fibrolipoma through a transoral laser microsurgical approach.

A Case of Gastric Adenocarcinoma Presenting as Portal Hypertension

Portal vein thrombus has been detected in patients with liver cirrhosis, pancreatitis, ulcerative colitis, septicemia, myeloproliferative disorder, and neoplasm. The formation of portal tumor thrombus by hepatocellular carcinoma is well recognized, because of its high incidence, and subsequent development of portal hypertension such as rupture of varices, ascites and liver failure indicates the poor prognosis. In gastric cancer, portal hypertension as an initial presentation is extremely rare. Herein we report a case presenting as portal hypertension caused by tumor thrombus without invasion of liver parenchyma. It is presumed to be intraluminal tumor thrombus originating from primary foci of gastric adenocarcinoma. Tumor thrombus in the portal vein is demonstrated on the PET-CT.

Primary Signet-Ring Carcinoma in the Bladder Presenting as a Hypervascular Luminal Polypoid Mass

Primary signet-ring carcinoma is a very aggressive and rare variant of a primary urinary bladder cancer, accounting for less than 1% of cases. We reported on a 76-yearold patient with primary signet-ring carcinoma who occurred metastatic lymphadenopathy with extranodal invasion causing intraluminal tumor thrombi in the adjacent vein, and pulmonary metastasis over the course of three months. We demonstrated the computed tomography findings of primary signet-ring carcinoma of the bladder and correlated the imaging findings with the pathologic features. We reviewed the distinguishing imaging findings of the primary signet-ring carcinoma compared with urothelial cell carcinoma, the most common subtype of the bladder cancer. Index terms

Cyst-Forming Intraductal Papillary Neoplasm of the Bile Ducts: Description of Imaging and Pathologic Aspects

Intraductal papillary neoplasm (IPN) of the bile duct is a newly described pathologic entity characterized by the presence of intraluminal tumors, which sometimes produce a large amount of mucin and form a cystic tumor. Cystic IPN of the bile duct is different from biliary cystadenoma or cystadenocarcinoma in that the former produces intraductal microscopic and macroscopic papillary tumors without ovarian-like stroma, whereas the latter produce a mucin-containing septate cystic tumor without communication with bile duct and with ovarian-like stroma in the cyst wall. The purpose of this study was to evaluate the potential relationships between cyst-forming IPNs of the bile duct and peribiliary glands and also intraductal papillary mucinous neoplasms of the pancreas. From a cohort of 87 patients with surgically resected and pathologically proved IPN of the bile duct, 12 patients with cystic IPN of the bile duct who underwent CT (n = 12), MRCP (n = 3), ultrasound (n = 3), and ERCP (n = 4) were included. Imaging findings were evaluated for the relationship of cystic tumors to the bile ducts; in particular, a diverticulum-like appearance was considered as suggestive of the peribiliary gland origin. Pathologic examination was conducted, and both gross and microscopic findings were recorded. Radiologic examination revealed aneurysm-like dilatation of the involved bile ducts in five patients and intrahepatic biliary cystic tumor in two patients. Interestingly, the remaining five patients had diverticulum-like cystic tumor with or without communication; one patient had a cystic tumor laterally attached to the extrahepatic bile duct. Histopathologically, cystic tumors are lined by atypical biliary epithelium showing intracystic papillary proliferation, with an appearance similar to that of pancreatic intraductal papillary mucinous neoplasm. This study suggests that cyst-forming IPN of the bile duct may be a biliary counterpart to pancreatic intraductal papillary mucinous neoplasm. In particular, at least some of the tumors seem to arise from peribiliary glands, and these cases might be a counterpart to branch-duct intraductal papillary mucinous neoplasm of the pancreas, given the histologic similarity between peribiliary glands and pancreatic branch ducts.

α-Mangostin extracted from the pericarp of the mangosteen (Garcinia mangostanaLinn) reduces tumor growth and lymph node metastasis in an immunocompetent xenograft model of metastatic mammary cancer carrying a p53 mutation

BackgroundThe mangosteen fruit has a long history of medicinal use in Chinese and Ayurvedic medicine. Recently, the compound α-mangostin, which is isolated from the pericarp of the fruit, was shown to induce cell death in various types of cancer cells in in vitro studies. This led us to investigate the antitumor growth and antimetastatic activities of α-mangostin in an immunocompetent xenograft model of mouse metastatic mammary cancer having a p53 mutation that induces a metastatic spectrum similar to that seen in human breast cancers.MethodsMammary tumors, induced by inoculation of BALB/c mice syngeneic with metastatic BJMC3879luc2 cells, were subsequently treated with α-mangostin at 0, 10 and 20 mg/kg/day using mini-osmotic pumps and histopathologically examined. To investigate the mechanisms of antitumor ability by α-mangostin, in vitro studies were also conducted.ResultsNot only were in vivo survival rates significantly higher in the 20 mg/kg/day α-mangostin group versus controls, but both tumor volume and the multiplicity of lymph node metastases were significantly suppressed. Apoptotic levels were significantly increased in the mammary tumors of mice receiving 20 mg/kg/day and were associated with increased expression of active caspase-3 and -9. Other significant effects noted at this dose level were decreased microvessel density and lower numbers of dilated lymphatic vessels containing intraluminal tumor cells in mammary carcinoma tissues.In vitro, α-mangostin induced mitochondria-mediated apoptosis and G1-phase arrest and S-phase suppression in the cell cycle. Since activation by Akt phosphorylation plays a central role in a variety of oncogenic processes, including cell proliferation, anti-apoptotic cell death, angiogenesis and metastasis, we also investigated alterations in Akt phosphorylation induced by α-mangostin treatment both in vitro and in vivo. Quantitative analysis and immunohistochemistry showed that α-mangostin significantly decreased the levels of phospho-Akt-threonine 308 (Thr308), but not serine 473 (Ser473), in both mammary carcinoma cell cultures and mammary carcinoma tissues in vivo.ConclusionsSince lymph node involvement is the most important prognostic factor in breast cancer patients, the antimetastatic activity of α-mangostin as detected in mammary cancers carrying a p53 mutation in the present study may have specific clinical applications. In addition, α-mangostin may have chemopreventive benefits and/or prove useful as an adjuvant therapy, or as a complementary alternative medicine in the treatment of breast cancer.

Value of Ultrasound (US)-Guided Percutaneous Needle Biopsy of Detected Pathological Gastrointestinal (GI) Tract Lesions but Negative or Incomplete Endoscopy

The study aim was to investigate the diagnostic value of US-guided percutaneous needle biopsy in the case of suspicious tumor lesion of the GI tract revealed by abdominal US but without detection with endoscopy or with incomplete or no possible endoscopy. Over a defined time period, all consecutive patients with no appropriate endoscopic diagnostic specimen or finding were registered. The patient, diagnostic, and periinterventional characteristics were documented. In total, 16 patients (7 males; mean age, 63.2 [range, 43 - 90] years) were enrolled in this study representing a rare but possible constellation from endoscopic practice characterized by no detectable intraluminal tumor growth and a suspicious tumor lesion revealed with abdominal US as found in each case (n = 16) from 01 / 01 / 2003 - 12 / 31 / 2006. The main indications for needle biopsy were pathological colonic cockades (n = 7) and tumor lesions of the stomach and small intestine (n = 9). The first needle biopsy attempt was successful in all subjects (technical success rate: 100 %) using the color-coded US mode in each case (100 %). There were no postinterventional complications (rate: 0 %). Percutaneous US-guided needle biopsy can be considered a safe diagnostic tool for clarifying the differential diagnosis of suspicious tumor lesions of the GI tract (revealed originally only by abdominal US) as the next favorable diagnostic step in the rare situation that endoscopy cannot provide appropriate information, in order to shorten the diagnostic course, to achieve a therapeutic decision and to decrease effort and costs.

Metallic stent placement for malignant airway stenosis

The purpose of this study was to evaluate the utility of metallic stents for treating central airway stenosis caused by malignant tumors. The subjects were 72 patients (16 women, 56 men; mean age, 61 years; age range, 28–87 years) treated with metallic stents for dyspnea due to tracheobronchial stenotic lesions caused by malignant tumors between May 1990 and August 2010. The underlying disorder was primary lung cancer in 42 patients, metastatic lung cancer in 29, and mediastinal tumor in one patient. In 69 of 72 patients (95.8%), dyspnea began to improve following completion of the procedure. The average Hugh-Jones classification score improved from 4.2 before stenting to 2.8 after stenting. The patients' average survival following stent placement was 3.6 months (two days–33 months). Thirteen lesions developed re-obstruction during follow-up. Of these 13 lesions, eight patients with dyspnea underwent re-interventions with metallic stent replacement and improved. Airway stent placement is an immediate and effective method of treatment for dyspnea caused by stenotic lesions of the central airway due to malignant tumor. It is effective for treating stenosis due to either tracheobronchial intraluminal tumor or extrinsic compression. Restenting is also useful to treat dyspnea caused by restenosis following stent placement.

Meningiomas of the transverse – sigmoid sinus junction area

Meningiomas with exclusive or prevalent dural attachment over the transverse-sigmoid sinus junction area represent a well-defined subgroup of posterior fossa meningiomas. This study reports 13 cases of this localisation (10.8% of all infratentorial meningiomas). In this series, six patients (46%) were discovered as an incidental MR finding. One patient with a small (1.5 cm) meningioma presented with an intracranial hypertension syndrome due to severe obstruction of the unique transverse-sigmoid sinus junction. A MR angiography was performed in 11 patients; it showed intraluminal tumour in two cases with dominant and unique transverse sinus, respectively. Tumour removal with excision of the outer dural layer and coagulation of the dural attachment (Simpson II) was performed in 11 cases; in two others with focal sinus invasion, removal of the small intravenous tumour fragment was not performed (Simpson III). No post-operative complications occurred. Remission of pre-operative symptoms was obtained in all symptomatic cases. The management of the transverse-sigmoid sinus junction is the main problem of meningiomas of this region. Excision of the outer dural layer and coagulation of the dural attachment are in our opinion sufficient in most cases, even when there is tumour invasion of the patent venous lumen. The resection of the sinus wall should be reserved to cases with a totally obstructed segment and symmetrical or asymmetrical but present transverse and sigmoid sinuses.

Zero-order release of 5-fluorouracil from PCL-based films featuring trilayered structures for stent application

A trilayered Poly( ε-caprolactone) (PCL)-based film with a coating layer (CL), a drug-storing layer (DSL) loaded with antitumor drug 5-Fluorouracil (5-FU) and a backing layer (BL) are presented for film-based stent application in malignant stricture or stenosis. V-C diffusion cells were used to investigate the drug permeability of the CL, while scanning electron microscopy (SEM) was employed for observing the microscopic architectures and morphologies. Drug release from the trilayered films exhibited a zero-order pattern, and the release process followed an ‘outer-to-inner’ pattern. The formation mechanism and influencing factors of the zero-order drug release pattern were in-depth elucidated, and factors affecting the drug release were also investigated. The reduction of initial drug loading in DSL slowed the drug release and diminished the zero-order release pattern. Drug permeability of the CL depended significantly on CL thickness, but not significantly on PCL molecular weight. Besides, the addition of PEG porogen in the CL accelerated the drug release by elevation of the drug permeability of CL, and the action mechanism of PEG was revealed by the PEG release test and SEM. The loading of 5-FU in the CL could lead to a two-phased release profile. This study revealed the potential of the trilayered film in controlled drug delivery to intraluminal tumor due to its highly tunable zero-order drug release.

A New Method for Intraluminal Gastrointestinal Stromal Tumor Resection Using Laparoscopic Seromuscular Dissection Technique

Introduction: It is difficult to confirm the location of an intraluminal gastrointestinal stromal tumor (GIST) and to laparoscopically determine the appropriate resection line. We report a new technique for the resection of GISTs using the laparoscopic seromuscular dissection (LSD) technique, which can be preformed regardless of the tumor location. Methods: Since 2009, 5 patients have undergone LSD technique for the resection of an intraluminal GIST. The tumor location was confirmed endoscopically, and the exact resection line was marked laparoscopically. After 10% glycerin was injected into the submucosal layer, LSD was performed circumferentially. The tumor was exteriorized into the abdominal cavity and dissected using a linear stapling device. Results: The average operation time for this procedure was 134.4 ± 18.6 min, and the mean estimated blood loss was 10 ± 8.9 ml. None of the 5 cases required open surgery. There was no tumor rupture or disruption or any other perioperative complications using this technique. Conclusion: We conclude that the LSD technique may be a safe and minimally invasive method for the resection of intraluminal GISTs, regardless of the tumor location.

Surgical resection of an intravascular superior vena cava primary lipoma

CLINICAL SUMMARY A 55-year-old woman was referred to our surgical department for enlargement of the superior mediastinum found on a routine chest radiograph. Her medical history and physical examination were unremarkable. Thoracic computed tomography (CT) with intravenous contrast showed an intraluminal nonenhancing tumor occluding the distal right subclavian vein, the right brachiocephalic vein, and the SVC up to the right atrium (Figure 1, A and B). A superior

Aortic dissection associated with an obstructive aortic chondrosarcoma in a dog

A 6-year-old, 35-kg, female spayed German wirehaired pointer was referred for evaluation of collapse/seizure-like activity and a suspected mediastinal mass. Echocardiographic examination revealed an obstructive, intraluminal aortic mass with aortic dissection. Gross and histopathological findings confirmed the aortic dissection with right pulmonary artery compression and an aortopulmonary fistula. The mass was histologically consistent with an intraluminal chondrosarcoma. To the authors knowledge this case represents only the second case of aortic chondrosarcoma in a dog, and interestingly the first case in either a dog or human to have aortic dissection associated with aortic obstruction by an intraluminal aortic tumor.

Raloxifene inhibits tumor growth and lymph node metastasis in a xenograft model of metastatic mammary cancer.

BackgroundThe effects of raloxifene, a novel selective estrogen receptor modulator, were studied in a mouse metastatic mammary cancer model expressing cytoplasmic ERα.MethodsMammary tumors, induced by inoculation of syngeneic BALB/c mice with BJMC3879luc2 cells, were subsequently treated with raloxifene at 0, 18 and 27 mg/kg/day using mini-osmotic pumps.ResultsIn vitro study demonstrated that the ERα in BJMC3879luc2 cells was smaller (between 50 and 64 kDa) than the normal-sized ERα (66 kDa) and showed cytoplasmic localization. A statistically significant but weak estradiol response was observed in this cell line. When BJMC3879luc2 tumors were implanted into mice, the ERα mRNA levels were significantly higher in females than in males. In vitro studies showed that raloxifene induced mitochondria-mediated apoptosis and cell-cycle arrest in the G1-phase and a decrease in the cell population in the S-phase. In animal experiments, tumor volumes were significantly suppressed in the raloxifene-treated groups. The multiplicity of lymph node metastasis was significantly decreased in the 27 mg/kg group. Levels of apoptosis were significantly increased in the raloxifene-treated groups, whereas the levels of DNA synthesis were significantly decreased in these groups. No differences in microvessel density in tumors were observed between the control and raloxifene-treated groups. The numbers of dilated lymphatic vessels containing intraluminal tumor cells were significantly reduced in mammary tumors in the raloxifene-treated groups. The levels of ERα mRNA in mammary tumors tended to be decreased in the raloxifene-treated groups.ConclusionThese results suggest that the antimetastatic activity of raloxifene in mammary cancer expressing cytoplasmic ERα may be a crucial finding with clinical applications and that raloxifene may be useful as an adjuvant therapy and for the chemoprevention of breast cancer development.

69-jähriger Patient mit chronischen Bauchschmerzen und Anämie bei Neurofibromatose

The case of a patient with neurofibromatosis type 1 with chronic abdominal pain and iron deficiency anemia is described. Diagnostic procedures including esophagogastroduodenoscopy and ileocolonoscopy did not disclose a definitive cause. CT scan and MRI revealed multiple intraluminal tumors in the small bowel, especially in the ileum. These findings were verified by double balloon enteroscopy. Endoscopic resection was not performed due to size and number of the polyps, and the patient was sent for diagnostic laparotomy. A conglomerate tumor of the ileum was resected. Histopathological analysis revealed 13 inflammatory polyps and 2 gastrointestinal stroma tumors.

Histopathologic Study of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma

The carotid sheath has not been adequately assessed in the literature as a potential site of neck recurrence. The purpose of this prospective study was to investigate the histopathologic characteristics of the carotid sheath in patients with oral cancer, in an effort to clarify whether it is essential or redundant to include the carotid sheath in the neck dissection specimen. A total of 29 patients underwent 32 selective neck dissections in the Department of Oral and Maxillofacial Surgery at "Evangelismos" General Hospital of Athens, Greece. Twenty-six unilateral and 3 bilateral neck dissections were performed. The carotid sheath specimens were examined to identify possible traces of metastatic disease. The existence of lymphatic vessels and the possible presence of cancer cells within their lumen was also investigated. Light microscopy of the 32 carotid sheath specimens showed that there was no evidence of tumor invasion. Immunohistochemical evaluation showed an abundance of lymphatic vessels in the carotid sheath with no evidence of microscopic intraluminal metastatic emboli. There was no evidence of carotid sheath invasion or presence of intraluminal lymphatic tumor emboli. Evidence of extracapsular spread warrants carotid sheath excision. Our findings suggest that if no extracapsular spread is present, there is no need to perform a tedious dissection of the carotid sheath. Preserving the carotid sheath adds protection to the neurovascular bundle, cuts operating time, and avoids possible injury to the major vessels and vagus nerve, as well as stimulation of the carotid body.

Cystic colon duplication causing intussusception in a 25-year-old man: report of a case and review of the literature

BackgroundColonic intussusception is a rare congenital abnormality, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction with or without bleeding. In adults it may occur idiopathically or due to an intraluminal tumor mass.Case presentationA 25-year-old man presented with an acute abdomen and severe crampy abdominal pain. The clinical picture mimicked acute appendicitis. Transabdominal ultrasound examination revealed a 5 cm circular mass in the right upper abdomen. The ensuing computed tomography suggested an intussusception in the ascending colon. Intraoperatively, no full thickness invagination was detected. Due to a hard, intraluminal tumor a standard right hemicolectomy with ileotransversostomy was performed. The histopathological analysis revealed a cystic colon duplication leading to mucosal invagination and obstruction.ConclusionsIn adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions. Unlike its preferentially nonsurgical management in children, a bowel intussusception in adults should be operated because an organic, often malignant lesion is present in most cases.

A propósito de un caso: tumor miofibroblástico inflamatorio de localización inusual

Inflammatory myofibroblastic tumor is a rare lesion that is usually located in the lung. The most commonly reported extrapulmonary locations are the mesentery and the retroperitoneum. We report the case of an 8-year-old girl with an inflammatory myofibroblastic tumor in an unusual location. The patient was referred to our center for suspected complicated appendicitis. Abdominal ultrasonography detected ileoileal intussusception with a mass in the distal portion. Emergency laparotomy confirmed ileoileal intussusception secondary to an intraluminal tumor. Histologic study revealed the mass was an inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumors are rare mesenchymal masses usually found in children. When located in the abdomen, they can mimic malignant lesions like lymphomas, sarcomas, or metastases. The cause and prognosis of inflammatory myofibroblastic tumors are unknown.