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Res specific appearances will vary according to location (see above), but in general these tumours appear as rounded soft tissue masses, arising from the wall of a hollow viscus (most commonly the stomach) and projecting into the lumen, or less commonly outwards from the serosa. Mucosal ulceration is present in 50% of cases 1â with large necrotic cavities communicating with the lumen also seen. Plain film when large, soft tissue density displacing bowel loops may be seen. This is of course non-specific. cheap viagra for sale usa online (see case 10) fluoroscopy : barium meal filling defect projecting from the wall of the stomach, with overlying ulceration or cavitation. generic viagra online pharmacy reviews Ct appearances vary with size and location. Typically the mass is of soft tissue density with central areas of lower density when necrosis is present (usually in larger tumours). Enhancement is typically peripheral 1. Calcification is uncommon (3%) 1. â  metastases (distant, peritoneal, omental) or direct invasion into adjacent organs may be seen in more aggressive lesions. Lymph node enlargement is not a feature 1. Mri presence of necrosis, haemorrhagic and cystic change make appearances variable. T1 : low signal intensity solid component enhancement is usually present, and predominantly peripheral in larger lesions t2 : high signal intensity solid component treatment and prognosis surgical en-bloc resection is the primary mode of therapy for gists 4. Up to 50% of all gists will have evidence of metastatic disease at the time of presentation 3, which significantly impacts prognosis. generic viagra online pharmacy reviews Historically, prior to st-571 (imatinib; glivec) up to 85% of tumours would locally recur or develop subsequent distal metastases despite treatment â 3,4â and had proven to be resistant to standard chemotherapy 4. Adjuvant chemotherapy with st-571 (imatinib; glivec) is effective in the majority of cases and has had a dramatic impact of prognosis even with only 1 year of therapy, reducing recurrence at one year from 17% to 3% 4. Longer treatment regimes (2 and 3 years of imatinib) are currently under investigation 4. Other second line agents (e. G. Sunitinib) are also being studies and used for patients with imatinib resistant tumours. Differential diagnosis gastrointestinal leiomyomaâ  most common in the oesophagus, accounting for 75% of mesenchymal tumours 1 rare in the remainder of the gastrointestinal tract gastrointestinal leiomyosarcoma rare gastrointestinal lymphoma more extensive mural thickening aneurysmal dilatation common gastrointestinal schwannoma gastrointestinal carcinoid references 1. Levy ad, remotti he, thompson wm et-al. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiographics. buy generic viagra low cost online 23 (2): 283-304, 456. Doi:10. 1148/rg. for sale viagra 232025146 - pubmed citation 2. Kumar v, abbas ak, fausto n et-al. viagra safe during pregnancy Robbins and cotran pathologic basis of disease. W b saunders co. buy generic viagra (2005) isbn:0721601871. Read it at google books - find it at amazon 3. King dm. The radiology of gastrointest. viagra 10 mg orosolubile prezzo

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