Malignant Small Bowel Tumors Research Articles

Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile

BackgroundSmall bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AimTo describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. MethodsRetrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. ResultsA total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1–99.2), 82.2% (95%CI: 57.6–93.3), 40.0% (95%CI: 16.5–82.8) and 25.9% (95%CI: 4.5–55.7%), respectively. NET (HR 6.1; 95%CI: 2.1–17.2) and GIST (HR 24.4; 95%CI: 3.0–19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. ConclusionsMalignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

A165 MALIGNANT TUMORS OF THE SMALL BOWEL DIAGNOSED BY DOUBLE BALLOON ENTEROSCOPY: A FIFTEEN-YEAR EXPERIENCE OF A MEDICAL CENTER IN MID-TAIWAN

Abstract Background The malignant tumors of the small bowel are relatively rare, and their pre-operative diagnosis is usually difficult Aims This study was aimed to investigate the clinical characteristics of patients with malignant small bowel tumors who underwent double balloon enteroscopy. Secondary end points were to evaluate the usefulness and safety of double balloon enteroscopy for the diagnosis of patients with suspected small bowel tumors derived from other previous procedures. Methods From January 2008 to June 2023, we retrospectively analyzed consecutive patients who underwent double balloon enteroscopy at a medical center in mid-Taiwan over a 15-year period (Figure 1). Results Double balloon enteroscopy were performed in 1001 patients. Small bowel tumors were diagnosed in 141 patients (141/1001; 14.1%), of which 76 patients (53.9%) (43 males, a mean age of 61.89 years) had malignant tumors : 37 had gastrointestinal stromal tumors (49.4%), 16 had adenocarcinoma (20.8%), 10 had metastatic cancer (13.1%), 7 had lymphoma (9.2%), 3 had angiosarcoma (3.9%), 2 had carcinoid (2.6%), and 1 had desmoid tumor (1.3%) (Figure 2). The indications for double-balloon enteroscopy in patients with malignant small bowel tumors were obscure gastrointestinal bleeding (68.4%). The concordance rate of diagnoses based on double balloon enteroscopy with diagnoses based on small bowel barium study, computed tomography, and capsule endoscopy among patients with small bowel tumors was 54.1%, 65.9% , and 76.9%, respectively. (Figure 3, 4) . Therapeutic plans were changed to surgery in 67.1 % of patients with malignant small bowel tumors. Additionally, treatment was added on chemotherapy in 25.6% of patients with malignant small bowel tumors after the results of double-balloon enteroscopy. Conclusions Approximately 14.1% of patients who underwent double balloon enteroscopy had small bowel tumors, 53.9% of small bowel tumors are malignant. The most common indication for double balloon enteroscopy in patients with malignant small bowel tumors was obscure gastrointestinal bleeding. Double balloon enteroscopy is a very useful modality in diagnosing malignant small bowel tumors and has an important impact on therapeutic plans and clinical results. Figure 1. The Prevalence Rate of Small Bowel Tumor Figure 2. Malignant tumor Figure 3. Location Distribution of Small Bowel Tumors Figure 4. The clinical manifestations of Malignancy Tumors Funding Agencies None Intestinal Disorders

Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile

BackgroundSmall bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AimTo describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. MethodsRetrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. ResultsA total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1–99.2), 82.2% (95%CI: 57.6–93.3), 40.0% (95%CI: 16.5–82.8) and 25.9% (95%CI: 4.5–55.7%), respectively. NET (HR 6.1; 95%CI: 2.1–17.2) and GIST (HR 24.4; 95%CI: 3.0–19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. ConclusionsMalignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

Imaging of Small Bowel Tumors and Mimics

AbstractSmall bowel tumors are rare with nonspecific and protean clinical presentation. Early diagnosis of small bowel tumors is desirable as they can be associated with significant morbidity. In malignant small bowel tumors, delayed diagnosis may result in dissemination and metastasis leading to poor clinical outcomes. Imaging evaluation of small bowel can be challenging due to unpredictable luminal distension, peristalsis, and motion. In addition, the lack of distinction between the intraluminal lesions and intraluminal contents can be difficult at times. Computed tomography (CT) and magnetic resonance (MR) enterography are the most common imaging techniques for the evaluation of small bowel tumors. While these techniques may not be able to detect small tumors, they provide comprehensive evaluation of lumen, wall, and extramural structures in tumors more than 2 cm. Acquaintance of imaging appearance of common benign and malignant small bowel tumors may allow improved detection during evaluation of CT and MR enterography studies. In this review, we discuss the imaging appearances, approach, and differential diagnosis of small bowel tumors on cross-sectional imaging studies.

Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy.

Double-balloon enteroscopy (DBE) allows for the diagnoses and treatment of small bowel tumors (SBTs). This study aimed to evaluate the utility of DBE for the diagnosis and treatment of SBTs. Patients diagnosed with SBTs who underwent DBE were included in this study. According to their endoscopic appearances, they were categorized as polyps or masses, and according to their histological characteristics, they were categorized as benign or malignant SBTs. A total of 704 patients were retrospectively analyzed, and 90 (12.8%) were diagnosed with SBTs. According to their endoscopic appearance, 48 (53.3%) had polyps and 42 (46.7%) had masses. Additionally, 53 (58.9%) and 37 (41.1%) patients had malignant and benign SBTs, respectively, depending on their histological characteristics. Patients diagnosed with polyps were younger than those diagnosed with masses (p<0.001). Patients diagnosed with benign SBTs were younger than those diagnosed with malignant SBT (p<0.001). Overall, histological diagnosis was determined using DBE in 73 (81.1%) patients. DBE is a useful method for diagnosing SBTs. Additionally, the histological type of the lesion can be determined using DBE.

Ileal leiomyosarcoma as a cause of small bowel obstruction

Introduction. Ileal leiomyosarcoma is unusual form of malignant gastrointestinal tumor. Often insidious in clinical presentation, it frequently presents a diagnostic challenge. Occasionally, a correct diagnosis is finally established due to an emergency situation. The aim of this study was to present the role of magnetic enterography in determining the precise cause of small bowel dilation. Case outline. A 59-year-old female patient presented with small bowel obstruction. Erect abdominal radiograph identified the presence of small bowel obstruction and excluded pneumoperitoneum. A non-contrast computed tomography of the abdomen and pelvis noted transitional zone in the region of terminal ileum with collapsed bowel lumen distal to the transitional point, without determined underlying cause. Magnetic resonance enterography observed obstructive intraluminal soft-tissue mass with fatty component sized up to 4 cm in the terminal ileum, with mesenteric involvement. The abdominal surgeon revealed ileal intraluminal tumor which affected the locoregional mesentery and serosa of the adjacent bowel. Histological and immunohistochemical analysis confirmed the diagnosis of ileal leiomyosarcoma with involvement of wall serosa and mesenteric fat tissue. Conclusion. Magnetic resonance enterography is a reliable diagnostic tool for detection and diagnosis of malignant small bowel tumors. Sometimes, tumors manifest clinically as bowel obstruction. Surgical treatment is necessary, while histology and immunohistochemistry are crucial to confirm the diagnosis of small bowel leiomyosarcoma.

Development of a Deep Learning Model for Malignant Small Bowel Tumors Survival: A SEER-Based Study.

Background This study aims to explore a deep learning (DL) algorithm for developing a prognostic model and perform survival analyses in SBT patients. Methods The demographic and clinical features of patients with SBTs were extracted from the Surveillance, Epidemiology and End Results (SEER) database. We randomly split the samples into the training set and the validation set at 7:3. Cox proportional hazards (Cox-PH) analysis and the DeepSurv algorithm were used to develop models. The performance of the Cox-PH and DeepSurv models was evaluated using receiver operating characteristic curves, calibration curves, C-statistics and decision-curve analysis (DCA). A Kaplan–Meier (K–M) survival analysis was performed for further explanation on prognostic effect of the Cox-PH model. Results The multivariate analysis demonstrated that seven variables were associated with cancer-specific survival (CSS) (all p < 0.05). The DeepSurv model showed better performance than the Cox-PH model (C-index: 0.871 vs. 0.866). The calibration curves and DCA revealed that the two models had good discrimination and calibration. Moreover, patients with ileac malignancy and N2 stage disease were not responding to surgery according to the K–M analysis. Conclusions This study reported a DeepSurv model that performed well in CSS in SBT patients. It might offer insights into future research to explore more DL algorithms in cohort studies.

Study of clinical outcome of patients undergoing intestinal anastomoses with single layer extramucosal technique and double layer anastomoses

Background: Intestinal anastomosis is one of the common surgeries for cases like bowel obstruction, incarcerated hernias, benign and malignant tumours of small and large bowel. The ideal intestinal anastomosis does not leak and allow normal function of the gastrointestinal tract. This study compared single layer versus double layer intestinal anastomosis in terms of duration, postoperative complications like anastomotic leak.Methods: A total of 100 patients admitted in Hamidia hospital, based on history and clinical examinations and radiological examinations, placed in two groups, group A (single layer anastomosis) and group B (double layer anastomosis) and were operated by a qualified surgical specialist. Data analysis of anastomotic time, anastomotic leak was done and statistical tests of significance were applied. A p value less than 0.05 is considered as significant.Results: In group A (single layer) the time required to perform in 30 (60%) patients is between 16-20 minutes. In double layer, maximum were done in between 26 to 30 minutes, 32 (64%). In our study of 100 patients, there were 6 anastomotic leaks, of which four of them were in group A (single layer) and 2 of them in group B (double layer).Conclusions: In our study, the duration required to perform a single layer intestinal anastomosis is significantly lesser when compared to double layer. There is no significant difference in anastomotic leak between two groups. Less time with no difference in complications, a move towards single layer anastomosis should be preferred.

Clinical characteristics of small bowel tumors diagnosed by double-balloon endoscopy: Experience from a Chinese tertiary hospital.

To determine the characteristics of small bowel tumors (SBTs) in patients underwent double balloon endoscopy (DBE) and to compare the clinical value of DBE with other diagnostic tools. A retrospective study was conducted in patients underwent DBE procedures from March 2008 to April 2017.The demographic, clinical and pathological characteristics of patients with SBTs were recorded, while the diagnosis of SBTs was achieved either by DBE biopsy or surgical specimens. One thousand one hundred and two patients (761 males, range 3-85 years) were enrolled in this study, with 1140 procedures completed in total. 99/1102 patients (9.0%) had SBTs, including benign polyps (20, 20.2%), gastrointestinal stromal tumors (GISTs) (24, 24.2%), lymphomas (13, 13.1%), adenocarcinoma (39, 39.4%), and neuroendocrine tumors (3, 3.0%). The most common clinical symptom for benign polyps was obscure gastrointestinal bleeding (OGIB) (75.0%). But among patients with malignant SBTs, the main indication for DBE was chronic abdominal pain (43.8%), followed by OGIB (36.3%), vomit (10.0%), abnormal images (6.3%) and diarrhea (3.8%) (P<0.001). Moreover, SBTs were primarily located in the jejunum alone (40/99, 40.4%). DBE had better sensitivity (89.2%), specificity (95.2%), positive predictive value (PPV) (90.0%), and negative predictive value (NPV) (94.8%) than other tools for suspected SBTs. Small bowel tumor is mainly located in jejunum and with OGIB and abdominal pain as major complaints. DBE is a reliable method for the diagnosis of SBTs compared with other diagnostic tools.

2559 Adenosquamous Carcinoma of the Ileum: A Rare Entity Found Incidentally

INTRODUCTION: Primary small bowel malignancy accounts for 0.6% of all new cancer cases in the U.S. and 1-3% of gastrointestinal tract neoplasms. The common subtypes of malignant small bowel tumors include carcinoid (44%), adenocarcinoma (33%), lymphoma, (15%) and sarcoma (8%). Adenosquamous carcinoma (ASC) is even more rare with only a few cases reported in the literature. The infrequency with which this malignancy is diagnosed and it's late and nonspecific clinical presentation contribute to delayed diagnosis and consequently worse prognosis. CASE DESCRIPTION/METHODS: A 58-year-old African American male presented for a surveillance colonoscopy. His initial screening colonoscopy at 53 years of age showed six polyps, of which, one was a 1 cm sized tubular adenoma. He had no history of gastrointestinal symptoms. During the colonoscopy and routine terminal ileum (TI) intubation, a 4 cm sized mass with central ulceration was visualized. The rest of the colonoscopy was significant only for two small hyperplastic polyps in the rectum. Endoscopic biopsies of the mass showed atypical epithelium. Further, abdominal computed tomography (CT) scan showed no lymphadenopathy or evidence of metastatic disease. He underwent exploratory laparotomy with ileocecectomy and pathology of the mass revealed poorly differentiated, high grade adenocarcinoma with areas of squamous differentiation, arising from a villous adenoma and extending into the muscularis propria (pT2). DISCUSSION: ASC can involve any organ including lungs, pancreas, liver, gallbladder and the gastrointestinal (GI) tract. ASC of ileum is an extremely rare diagnosis. Published case reports show that metastases of small intestinal ASC is common at the time of diagnosis. Our patient was fortuitous enough to have been diagnosed with ileal ASC in an early stage without evidence of metastasis, due to TI intubation during a routine colonoscopy. Surgical resection was likely curative for this patient. To our knowledge, no study has been published to evaluate the prevalence of TI malignant tumors during routine colonoscopy. In addition, intubation of the TI is currently not required during routine colonoscopy. This raises the question if there is utility in measuring TI intubation rates as a potential quality indicator for colonoscopists in the future.

Multimodality imaging of small bowel neoplasms.

Although the small intestine accounts for over 90% of the surface area of the alimentary tract, tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Common small bowel tumors typically are well evaluated with cross-sectional imaging modalities such as CT and MR, but accurate identification and differentiation can be challenging. Differentiating normal bowel from abnormal tumor depends on imaging modality and the particular technique. While endoscopic evaluation is typically more sensitive for the detection of intraluminal tumors that can be reached, CT and MR, as well as select nuclear medicine studies, remain superior for evaluating extraluminal neoplasms. Understanding the imaging characteristics of typical benign and malignant small bowel tumors is critical, because of overlapping features and associated secondary complications.

Malignant Small Bowel Tumor - Case Series and Literature Review

Introduction: The diagnosis of malignant small bowel tumors is difficult due to the rarity of these lesions and the lack of presenting signs and symptoms. This fact may delay the treatment and therefore worsen the outcome. Material and methods: This article describes 6 cases of this rare disease, reviewing the literature on its clinic, pathological and treatment aspects. Discussion: Malignancies involving the small intestine are rare and account for less than 3% of the gastrointestinal tract cancers. When the different regions of the intestine are considered, adenocarcinomas are mostly found in the duodenum while stromal tumors are usually spread throughout the entire small bowel. Adenocarcinoma represents 33% of MSBT and is best managed with wide segmental surgical resection and primary and regional node lymphadenectomy. Sarcomas represent 17% of MSBT and are treated with en bloc segmental resection with tumor-free margins, with preservation of the tumor’s pseudocapsule. Secondary neoplastic involvement of the small intestine is more common than primary small neoplasia and its treatment is palliative. Conclusion: MSBT have a rare incidence, however attention and investigation of persistent symptoms may lead to an early diagnosis and treatment.

Small bowel tumors: A digestive endoscopy society of Taiwan (DEST) multicenter enteroscopy-based epidemiologic study.

Small bowel (SB) accounts for the majority of gastrointestinal tract but its tumors are rare and always overlooked. In this study, we aimed to evaluate the epidemiology of SB tumors. This multicenter retrospective study utilized endoscopy database from 2006/11 to 2016/07. Baseline demographic characteristics, clinical, radiologic and endoscopic findings were collected. Totally 103 (34 benign, 69 malignant lesions) patients with SB tumors in 1070 enteroscopic examinations were enrolled. There were male preponderance (56.3% males, 43.7% females), both in benign (52.9%, 49.1%) and malignant (58.0%, 42.0%) lesions, except for subtype gastrointestinal stromal tumors (GISTs) (31.6%, 68.4%). The age (mean±SD) at diagnosis in malignant SB tumors (62.2±15.6) was older than those with benign tumors (50.7±21.4) (p<0.01). Bleeding (43.7%), abdominal pain (40.8%) and ileus (10.7%) were the most common clinical presentations. Hamartoma (32.4%) and adenoma (14.7%) were the most common benign histology. Four major malignant histological subtypes were lymphomas (29.0%), GISTs (27.5%), adenocarcinomas (26.1%) and metastatic cancers (14.5%). SB adenocarcinoma patients (>60-year-old, 77.8%) were older than lymphomas (60%) and GISTs (50%). Proximally location rates of lymphomas, GISTs, adenocarcinomas were 25.0% (5/20), 84.2% (16/19), and 88.9% (16/18), respectively. This endoscopy-based study revealed the most common histology of benign SB tumors were hamartoma and adenoma, and malignant ones were lymphomas, GISTs, adenocarcinomas and metastatic cancers. Most of them were male gender, except for GISTs, and with proximal location, except for lymphomas. Further large-scale investigation efforts are warranted to elucidate the epidemiology of SB tumors.

Progression of diagnosis and treatment in primary malignant small bowel tumor

Primary malignant small bowel tumor as a rare kind of intestinal tumor is associated with a poor prognosis. The pathological types were various and complicated, such as adenocarcinoma, neuroendocrine tumor, malignant lymphoma, and malignant stromal tumor. The atypical early stage symptom resulted in difficult diagnosis at early stage, high misdiagnosis rate and lack of standard therapy schemes and means. In the past, X-ray, CT, MRI, and PET-CT were the main examination methods for primary small bowel tumor. However, with the development of radiology, a series of new diagnosis methods, including electronic enteroscopy, capsule endoscopy, multi-slice spiral CT enteroclysis and so on, promotes the diagnosis accurate rate. Surgery is still the most important method in the small bowel tumor treatment, and the alternative of the surgical method should depend on the tumor location, size and relationship with the adjacent organs. Application of the laparoscopic surgery for the small bowel tumor is still in the initial stage. Besides, some researches have confirmed that chemotherapy, radiotherapy, target therapy and endocrinotherapy have effects on the specific kind of small bowel tumor. Therefore this article will review the epidemiology, pathology, diagnosis and treatment of the primary malignant small bowel tumors.

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis.

Despite being rare entities, the incidence of malignant small bowel tumors seems to be rising. The development of capsule endoscopy and balloon assisted enteroscopy provided an advance in the assessment of small bowel lesions. We aim to describe the clinical and pathological characteristics of patients with small bowel cancer and ascertain what roles these endoscopic techniques currently have. A retrospective study of patients diagnosed with small bowel cancer, from January 2010 to October 2014, was performed. The data was submitted to statistical analysis. Of the 28 diagnosed patients, 54% were female. The mean age at diagnosis was 61 years. Adenocarcinoma was the most frequent tumor (n = 11), followed by sarcoma (n = 6), lymphoma (n = 6) and neuroendocrine tumors (n = 3). The main form of presentation was related to blood loss or intestinal obstruction. By the time of diagnosis, 46% of patients had distant metastasis/ unresectable cancer. Most of the tumors were diagnosed by endoscopic (41%) or imaging techniques (35%). In the first year after diagnosis, 29% of patients died. In multivariate analysis, adenocarcinoma remained an independent factor for worse survival. Patients with adenocarcinoma presented at late stages and with unresectable tumors, contributing to a worse outcome. A high degree of clinical suspicion for the diagnosis of small bowel cancer is necessary. The characteristics of the patients were generally consistent with those described in the literature. Capsule endoscopy and balloon assisted enteroscopy are useful in the diagnosis, management and surveillance of small bowel cancer.

Role of double-balloon enteroscopy in malignant small bowel tumors.

To assess the double-balloon enteroscopy (DBE) role in malignant small bowel tumors (MSBT). This is a retrospective descriptive study performed in a single center. All consecutive patients who underwent a DBE with final diagnosis of a malignant neoplasm from 2004 to 2014 in our referral center were included. Patient demographic and clinical pathological characteristics were recorded and reviewed. MSBT diagnosis was achieved either by DBE directed biopsy with multiple tissue sampling, endoscopic findings or histological analysis of surgical specimen. We have analyzed double-balloon enteroscopy impact in outcome and clinical course of these patients. Of 627 patients, 28 (4.5%) (mean age = 60 ± 17.3 years) underwent 30 procedures (25 anterograde, 5 retrograde) and were diagnosed of a malignant tumor. Patients presented with obscure gastrointestinal bleeding (n = 19, 67.9%), occlusion syndrome (n = 7, 25%) and diarrhea (n = 1, 3.6%). They were diagnosed by DBE biopsy (n = 18, 64.3%), histological analysis of surgical specimen (n = 7, 25%) and unequivocal endoscopic findings (n = 2, 7.1%). Gastrointestinal stromal tumor (n = 8, 28.6%), adenocarcinoma (n = 7, 25%), lymphoma (n = 4, 14.3%), neuroendocrine tumor (n = 4, 14.3%), metastatic (n = 3, 10.7%) and Kaposi sarcoma (n = 1, 3.6%) were identified. DBE modified outcome in 7 cases (25%), delaying or avoiding emergency surgery (n = 3), modifying surgery approach (n = 2) and indicating emergency SB partial resection instead of elective approach (n = 2). DBE may be critical in the management of MSBT providing additional information that may be decisive in the clinical course of these patients.

Tumours in the Small Bowel

Small bowel tumours are rare and originate from a wide variety of benign and malignant entities. Adenocarcinomas are the most frequent primary malignant small bowel tumours. Submucosal tumours like gastrointestinal stromal tumours (GIST) or neuroendocrine tumours (NET) may show a central umbilication, pathologic vessels, bridging folds or an ulceration of the overlying mucosa. These signs help to differentiate them from harmless bulges caused by impression from outside, e.g. from other intestinal loops. Sarcomas of the small bowel are rare neoplasias with mesenchymal origin, sometimes presenting as protruding masses. Benign tumours like lipoma, fibrolipoma, fibroma, myoma, and heterotopias typically present as submucosal masses. They cannot be differentiated endoscopically from those with malignant potential as GIST or NET. Neuroendocrine carcinomas may present with diffuse infiltration, which may resemble other malignant tumours. The endoscopic appearance of small bowel lymphomas has a great variation from mass lesions to diffuse infiltrative changes. Melanoma metastases are the most frequent metastases to the small bowel. They may be hard to distinguish from other tumours when originating from an amelanotic melanoma.

Incidence patterns of small bowel cancer in a population-based study in Sweden: Increase in duodenal adenocarcinoma

BackgroundIncreasing incidences of malignant small bowel tumours have been reported, but data from European populations are limited. This study aimed to clarify the incidence patterns of malignant small bowel tumours in Sweden. MethodsPatients with a first and primary malignant small bowel tumour were identified from the Swedish Cancer Register during the study period 1960–2009. Sex-specific and age-standardised incidence rates of these tumours were calculated by their anatomical location and histological type in different time periods. Figures were plotted to show the proportions and incidence rates over time, and joinpoint loglinear regression models were estimated to assess any time trends. ResultsA total of 6604 patients with malignant small bowel tumours were identified. The age-standardised incidence of all malignant small bowel tumours increased from 14.2 to 19.7 per 1,000,000 person-years during the study period. The incidence of duodenal cancer increased more than 3-fold (from 1.6 to 5.4 per 1,000,000 person-years), which was mainly expained by a dramatical rising trend of adenocarcinoma of the duodenum (from 0.7 to 4.2 per 1,000,000 person-years). Malignant tumours of small bowel with unspecified anatomical locations showed a slight increase (from 7.0 to 7.9 per 1,000,000). The incidence of small bowel tumours in other locations or of other histological types was more stable. ConclusionsThe incidence of small bowel malignancies has increased during the period 1960–2009. Among the specific types of small bowel cancer, a particularly rapid increase was found for duodenal adenocarcinoma.

Small bowel tumors: spectrum of findings on 64-section CT enteroclysis with pathologic correlation

Improvements in helical technology have made detection of benign and malignant small bowel tumors easier so that they are now frequently detected at an early stage. Sixty-four-section CT enteroclysis provides suggestive features that help determine the actual nature of a small bowel tumor in a large number of cases. Specific diagnosis of small bowel tumor is based on a combination of findings that are depicted owing to the use of the multiple capabilities of 64-section CT enteroclysis, allowing optimal planning prior to endoscopic or surgical resection.

Rare Entity Favourable Prognosis: MALT Lymphoma of Colon

Purpose: Primary gastrointestinal non Hodgkin's lymphoma is a rare entity accounting for 13-18% of malignant tumors of small bowel and 1% of large bowel. These MALT Lymphomas arise from sites normally devoid of lymphoid tissue and are thought to be secondary to antigenic stimulation. MALT lymphomas of colon have not been studied in comparison to MALT lymphomas of stomach. There is paucity of literature with only few case reports mostly from Japan and only a handful from United States. Here we present two cases of MALT lymphoma of colon that were diagnosed early and were managed with surgical resection and adjuvant chemotherapy with CHOP-R. Follow up with colonoscopies and serial PET scans after 18 months have failed to show any recurrence. Case One: A 63-year-old Asian man with past medical history of hypertension, dyslipidemia was admitted to our hospital ICU with 3 episodes of rectal bleeding for one day.He did not report any abdominal pain, nausea or vomiting, any similar episodes in the past or weight loss. Subsequent day colonoscopy revealed a large firm 6 cm rounded mass near ileocecal valve. Although biopsies revealed non specific inflammation and granulation tissue, patient underwent exploratory laprotomy based on high index of suspicion for malignancy. On laprotomy a polypoid mass measuring 6 cms was found and patient underwent right hemicolectomy. Histology of the specimen revealed diffuse large B cell lymphoma, arising in the setting of MALT Lymphoma. Case Two: A 79-year-old male with a history of right sided colon adenocarcinoma treated with right hemicolectomy without chemotherapy presented with history of painless bright red blood per rectum and black tarry stools for 3 days. A colonoscopy was performed which revealed multiple large heaped up ulcers throughout the entire length of the colon, biopsies revealed markedly atypical proliferation of large atypical lymphoid cells effacing the architecture. CD 20 and LCA stains were positive and CD 3 and Keratin AE1/AE3 were negative consistent with Diffuse Large B cell Lymphoma. Discussion: MALT Lymphomas were first described by Issacson and Wright in 1983. These primary colonic lymphomas constitute a relatively small proportion of all colonic malignancies (less than 0.5%) but are important because of the substantial differences in treatment and prognosis, 5-year survival being 27-55%. Therapy involves resection of the affected colon and regional lymphovascular structures, if the disease is localized and without dissemination, followed by adjuvant chemotherapy and radiation is reserved for selected cases. The choice and response to chemotherapy is not well investigated.