Clinical analysis of 180 cases of primary small intestinal tumor

Abstract

Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor. Methods From August 2012 to August 2017, hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled. The data of clinical manifestations, laboratory examinations, imaging, endoscopy examination, pathological findings and treatment were collected and analyzed. Results A total of 180 patients with primary small intestinal tumor were enrolled. The common clinical manifestations included abdominal pain (76 cases, 42.2%), gastrointestinal bleeding (64 cases, 35.6%), and abdominal distension (30 cases, 16.7%), and 22 (12.2%) patients had no overt clinical symptoms. The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1% (12/21). The diagnostic rates of computed tomography enterodysis (CTE), positron-emission computed tomography (PET)/computed tomography (CT), and abdominopelvic enhanced CT were 96.5% (83/86), 100.0% (29/29), and 91.5% (43/47), respectively. The diagnostic small intestinal tumor patients of barium radiography (14 cases), abdominopelvic magnetic resonance imaging (MRI) (eight cases), small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven, six, fifteen and six cases, respectively. Among 180 patients, 14 (7.8%) patients were considered gynecological tumors by imaging examination before surgery, seven (3.9%) patients underwent emergency operation because of intestinal obstruction, four (2.2%) patients underwent emergency surgery due to gastrointestinal bleeding, and four (2.2%) patients underwent emergency surgery because of intestinal perforation. Histopathological type included gastrointestinal stromal tumor (117 cases, 65.0%), lymphoma (25 cases, 13.9%) and adenocarcinomas (21 cases, 11.7%). Except seven patients with intestinal lymphoma who received chemotherapy, the rest 173 patients underwent surgical resection. Conclusions Primary small bowel tumor has no specific clinical manifestations. It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain, gastrointestinal bleeding and intestinal obstruction. CTE should be the first choice for patients with symptoms but unclear diagnosis. Key words: Gastrointestinal stromal tumors; Adenocarcinoma; Lymphoma; Small bowel tumor; Computed tomography enteroclysis; Tumor markers