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Not epithelial tumors of a large intestine are a seldom found tumors of a large intestine which develop from the cellular elements which are a part of an intestinal wall excepting its epithelial vystilka. Given V. B. Fedorova (1984), they make 3-5% of all quantity of tumors of a large intestine. As well as epithelial, not epithelial tumors can be high-quality and malignant.
Treat benign not epithelial tumors (to WHO, 1981):
- Lipoma and lipomatoz.
- Vascular tumors (hemangioma, lymphangioma).
- Neurilemoma (shvannoma).
At the initial stages of development the majority of not epithelial tumors proceeds asymptomatically. Further increase in the amount of education up to 3-5 cm leads to disturbance of a passage of intestinal contents and development of a clinical picture of partial or full obturatsionny colic obstruction.
Izjyazvivshiyesya tumors are shown by symptoms of intestinal bleeding that in most cases confirms or the considerable amount of education (4-5 cm and more), or its malignancy (Vorobyov G. And., 2001).
The macroscopic characteristic of not epithelial tumors depends on depth of their bedding, nature of growth and the amount of education. Unfortunately, now any of the available classifications does not meet the requirements of endoscopists (Pantsyrev Yu.M. et al., 1984; Kadushev B. K., 1985). Apparently, it is connected with rather small number of clinical supervision and complexity of their systematization in several parameters. In our opinion, for kolonoskopichesky practice of the most optimum the classification offered To is. Nagasaki (1982) in which the depth and nature of growth of education is considered. According to this classification allocate the following types of not epithelial tumors (scheme):
The 1st type — intramural (the scheme, b) which is usually observed at the educations developing from cellular elements of deep layers of a wall of body. The tumor, as a rule, grows in thickness of an intestinal wall, causing only insignificant deformation of its gleam. The mucous membrane over this area is visually not changed, mobile. The tool palpation of a zone of protrusion reveals limited increase in density of a wall of a gut.
According to most of specialists, endoscopic diagnosis of formations of intramural type in some cases causes certain difficulties that is explained both by scarcity of macroscopic signs, and their wrong interpretation. The intramural type of not epithelial tumors should be differentiated with a prelum of a wall of body education from the outside. As a rule, at a prelum of a large intestine from the outside character of a gleam changes at a postural change of a body of the patient. In diagnostically hard cases performance of an endoscopic ultrasonografiya which results allow to distinguish authentically intramural type of not epithelial tumor from a prelum of a wall of body from the outside of (Stubbe J.W is recommended., Fockens P., 2003).
The 2nd type — endoluminal (the scheme, in, e). Tumors of this type, as a rule, develop from the cellular elements which are a part of a submucosa or a mucous membrane. In most cases growth of education happens within a layer, generally in a gleam of body. Small (to 1,5-2 cm) subepitelialno or podslizisto the located tumors are visualized in the form of a node or tumorous education with the wide basis without clear boundary. At the big sizes (more than 2-2,5 cm) the tumor has oval, hemispherical, spherical or spherical shape. In 40-45% of cases at not epithelial tumors of this kind the so-called "false leg" formed a duplikatury mucous membrane forms. In the absence of inflammatory changes in a new growth zone it practically always movably rather subject fabrics. The mucous membrane is easily displaced both at the basis, and at tumor top that is described as a positive "symptom of a tent". For confirmation like tumor at doubtful endoscopic signs the trial nabrasyvaniye of a loop is used. At its tightening tumors of the 2nd type, as a rule, are completely dislocated in a gut gleam.
The 3rd type — mixed. Tumors of the mixed type can develop from the cellular elements which are a part as more superficial (submucosa), and deeper layers (muscular layer) of an intestinal wall. Usually it is the big educations (more than 2,5-3 cm in the diameter) growing out of layer limits which move apart or otdavlivat the fabrics which are subject and covering them therefore they are located partially in the thickness of an intestinal wall, partially — in a gut gleam.
Depending on a ratio of the sizes of intramural and endoluminal parts of formation of the mixed type can have various macroscopic form (oval, roundish, wrong, etc.) and the size of an eminating fragment. Constants and characteristic endoscopic symptoms of uncomplicated not epithelial tumors of this type are the illegibility of borders, an immovability of formation of rather subject fabrics, a positive "symptom of a tent" at its basis and top.
Scheme. Anatomic types of not epithelial tumors of a large intestine
and. Normal structure of a wall of a gut. 1. Blankets of an intestinal wall (mucous membrane and submucosa). 2. Deep layers of an intestinal wall (muscular coat and serous cover).
. Intramural type of not epithelial tumor (an explanation in the text).
century. Endoluminal type of not epithelial tumor (subepithelial arrangement).
. Endoluminal type of not epithelial tumor (submucosal arrangement).
. Endoluminal type of not epithelial tumor (submucosal arrangement
with forming of a "false" leg).
e. The mixed type of not epithelial tumor (an explanation in the text).
Results of a trial nabrasyvaniye and tightening of a loop allow to judge the size of endoluminal part of a tumor allegedly: at its small sizes the outlined loop in attempt of a tightening slides off education.