Small Intestinal Mass Research Articles

Characteristics and prognosis of small bowel tumors: A retrospective study.

Small bowel tumors (SBTs) are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5% of all gastrointestinal tumors. Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs. However, few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs. To investigate the clinical characteristics, managements and prognosis of SBTs in a medical center in Taiwan. The study enrolled 51 patients aged 58.9 ± 8.8 years (range, 22-93) diagnosed with SBTs from November 2009 to July 2021. We retrospectively recorded clinical characteristics, indications, endoscopic findings, pathological results, management, and outcomes for further analysis. A male preponderance was observed (56.8%). The most common indications were suspected small intestinal tumors (52.9%) and obscure gastrointestinal bleeding (39.2%). The most common tumor location was the ileum (41.2%). The performance of imaging studies (P = 0.004) and the types of findings (P = 0.005) differed significantly between malignant and benign SBTs. The most frequent imaging finding was a small intestinal mass (43.1%). The top three malignant tumor types were gastrointestinal stromal tumors (GISTs), adenocarcinomas, and lymphomas. Moreover, the proportions of benign and malignant tumors were 27.5% and 72.5%, respectively. The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly (P = 0.015). Kaplan-Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups (P = 0.04). All patients with lymphoma underwent chemotherapy (n = 7/8, 87.5%), whereas most patients with GISTs underwent surgery (n = 13/14, 92.8%). Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs. Therefore, a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

PSIV-A-7 Effects of late gestational nutrient restriction of beef heifers on small intestinal crypt depth in neonatal calves

Abstract We hypothesized that late gestational nutrient restriction would impair small intestinal development in neonatal calves, including crypt cell depth and proliferation. Fall-calving crossbred beef heifers [body weight (BW) = 466 ± 30 (SD) kg; BCS: 5.4 ± 0.5] bred to a single sire were individually-fed 100% (control; n = 10) or 70% (nutrient restricted; n = 12) of NASEM metabolizable energy and metabolizable protein requirements for maintenance, pregnancy, and growth from d 160 of gestation to calving. Calves were removed from their dams immediately post-calving and fed artificial colostrum and milk replacer relative to body weight until euthanasia at 48.7 ± 0.4 h of age. The gastrointestinal tract was removed, and proximal jejunum samples were dissected from each calf and immersion-fixed in 10% neutral buffered formalin. Tissues were embedded in paraffin blocks and cut into 5-µm sections that were mounted on glass slides. Slides were incubated with Ki-67 (marker of nuclear proliferation) and counterstained with Hematoxylin using an autostainer. Images were taken at 5× magnification using an upright microscope. QuPath software was used to measure crypt depth, starting at the base of the crypt region and ending at the furthest cluster of Ki-67 positive cells, perpendicular to the base of the mucosa. For each calf, 10 crypt depth measurements were taken from 4 images, resulting in 40 crypt depth measurements that were averaged. Nutritional plane was a fixed effect in the model, and maternal sire, date of study initiation, and calf sex (when P < 0.25) were considered covariates. We previously reported that calves born to nutrient restricted dams weighed less (P ≤ 0.05) at birth and 48 h than calves born to control dams. Small intestinal mass tended to be less (P = 0.11) in offspring of nutrient restricted dams but was not affected (P = 0.58) when expressed relative to body weight. Calves born to nutrient restricted dams also tended to have less (P = 0.11) small intestinal mass relative to brain weight. Maternal nutrient restriction did not affect (P = 0.95) jejunal crypt depth. Additionally, crypt depth relative to body weight was not affected (P = 0.20) by nutrient restriction. Although crypt depth was not affected, further analysis of proliferation and morphology will help to understand the relationship between maternal nutrient restriction and small intestine development in neonatal calves.

Correlates of Plasma Citrulline, a Potential Marker of Enterocyte Mass, among Children with Stunting: A Cross-Sectional Study in Uganda

BackgroundEnvironmental enteric dysfunction (EED) is associated with stunting. Citrulline, produced in mature enterocytes, may be a valuable biomarker of small intestinal enterocyte mass in the context of EED. ObjectivesWe aimed to explore the correlates of plasma citrulline (p-cit) in children with stunting. MethodsIn a cross-sectional study using baseline data from the community-based MAGNUS (milk affecting growth, cognition and the gut in child stunting) trial (ISRCTN13093195), we explored potential correlates of p-cit in Ugandan children with stunting aged 12–59 mo. Using linear regression in univariate and multivariate models, we explored associations with socioeconomics, diet, micronutrient status, and water, sanitation, and hygiene characteristics. The influence of covariates age, fasting, and systemic inflammation were also explored. ResultsIn 750 children, the mean ± standard deviation age was 32.0 ± 11.7 mo, and height-for-age z-score was –3.02 ± 0.74. P-cit, available for 730 children, differed according to time fasted and was 20.7 ± 8.9, 22.3 ± 10.6 and 24.2 ± 13.1 μmol/L if fasted <2, 2–5 and >5 h, respectively. Positive correlates of p-cit were age [0.07; 95% confidence interval (CI): 0.001, 0.15 μmol/L] and log10 serum insulin-like growth factor-1 (8.88; 95% CI: 5.09, 12.67 μmol/L). With adjustment for systemic inflammation, the association with serum insulin-like growth factor-1 reduced (4.98; 95% CI: 0.94, 9.03 μmol/L). Negative correlates of p-cit included food insecurity, wet season (–3.12; 95% CI: –4.97, –1.26 μmol/L), serum C-reactive protein (–0.15; 95% CI: –0.20, –0.10 μmol/L), serum α1-acid glycoprotein (–5.34; 95% CI: –6.98, –3.70 μmol/L) and anemia (–1.95; 95% CI: –3.72, –0.18 μmol/L). Among the negatively correlated water, sanitation, and hygiene characteristics was lack of soap for handwashing (–2.53; 95% CI: –4.82, –0.25 μmol/L). Many associations attenuated with adjustment for inflammation. ConclusionsMany of the correlates of p-cit are characteristic of populations with a high EED prevalence. Systemic inflammation is strongly associated with p-cit and is implicated in EED and stunting. Adjustment for systemic inflammation attenuates many associations, reflecting either confounding, mediation, or both. This study highlights the complex interplay between p-cit and systemic inflammation.

A neurofibromatosis patient with a large appendix and multiple small intestine masses

A neurofibromatosis patient with a large appendix and multiple small intestine masses

327 A Novel, in Vivo Model to Increase Endogenous Pancreatic and Small Intestinal Carbohydrase Activity to Evaluate Limitations of Small Intestinal Starch Digestion in Cattle

Abstract Consumption of high-grain diets by cattle can result in large quantities of starch that flow to the small intestine for potential enzymatic digestion. However, small intestinal starch digestion is potentially limited because of insufficient activity of pancreatic and/or small intestinal carbohydrases. Studies suggest regulation of carbohydrase activity is complex in cattle and perhaps uncoordinated in response to luminal carbohydrate flow. The objective of this experiment was to use postruminal casein infusion and exogenous glucagon-like peptide 2 (GLP-2) administration, known stimulators of pancreatic and small intestinal function, to evaluate their effects on pancreatic and small intestinal carbohydrase activities. Twenty-four Holstein steers [250 ± 23 kg body weight (BW)] were used in a randomized complete block design with a 2 × 2 factorial arrangement of treatments. Steers were fed an alfalfa cube-based diet to limit dietary starch intake. Steers received a continuous abomasal infusion of 4 g/kg of BW of raw corn starch combined with either 0 or 1.33 g/kg of BW of casein for 7 d. Steers received subcutaneous injections in two portions daily of excipient (0.5% bovine serum albumin) or 100 µg/kg of BW GLP-2. This resulted in four treatments: control, casein, GLP-2, and casein + GLP-2. At the end of the 7-d treatment period, steers were slaughtered for pancreatic and small intestinal tissue collection. Data were analyzed using the GLM procedure of SAS. Postruminal casein infusion increased (P ≤ 0.03) pancreatic mass by 12.6%, total pancreatic α-amylase activity by 50%, and postruminal starch disappearance from 96.7% to 99.3%. Exogenous GLP-2 increased (P &amp;lt; 0.01) total small intestinal mass and small intestinal mucosal mass by 1.2 kg and 896 g, respectively. Relative to control, GLP-2 and casein + GLP-2 treatments increased (P = 0.04) total small intestinal α-glucosidase activity (sum of maltase, isomaltase, glucoamylase) by 83.5%. Total small intestinal maltase, isomaltase, and glucoamylase activity was 90%, 100%, and 66.7% greater for GLP-2 and casein + GLP-2 steers compared with control. The use of postruminal casein infusion and exogenous GLP-2 administration resulted in four distinct carbohydrase activity phenotypes. Relative to control, casein increased pancreatic α-amylase activity, GLP-2 increased small intestinal α-glucosidase activity, and the combination of casein and GLP-2 increased both pancreatic α-amylase activity and small intestinal α-glucosidase activity. This approach provides a novel in vivo animal model to selectively increase endogenous carbohydrase activity to overcome complications of coordinating carbohydrase activity with luminal nutrient flows. This model could be useful to understand physiological mechanisms that might improve small intestinal starch assimilation and efficiency of cattle consuming high-grain diets.

Postruminal Casein Infusion and Exogenous Glucagon-Like Peptide 2 Administration Differentially Stimulate Pancreatic α-Amylase and Small Intestinal α-Glucosidase Activity in Cattle

BackgroundIncreasing luminal carbohydrate flow decreases pancreatic α-amylase activity but can increase jejunal maltase activity, suggesting that regulation of carbohydrase activity is perhaps uncoordinated in response to luminal carbohydrate flow. Increasing luminal casein flow increases pancreatic α-amylase activity in cattle, and exogenous glucagon-like peptide 2 (GLP-2) has been shown to increase small intestinal α-glucosidase activity in nonruminants. ObjectivesThe objective was to evaluate the effects of postruminal casein infusion, exogenous GLP-2, or their combination on endogenous pancreatic and small intestinal carbohydrase activity in cattle postruminally infused with starch. MethodsHolstein steers [n = 24; 250 ± 23 kg body weight (BW)] received a continuous abomasal infusion of 3.94 g raw corn starch/kg of BW combined with either 0 or 1.30 g casein/kg of BW. Steers received subcutaneous injections in 2 equal portions daily of excipient (0.5% bovine serum albumin) or 100 μg GLP-2/kg of BW per day. At the end of the 7-d treatment period, steers were slaughtered for tissue collection. Data were analyzed using the MIXED procedure of SAS version 9.4 (SAS Institute Inc.). ResultsPostruminal casein infusion increased (P ≤ 0.03) pancreatic mass by 12.6%, total pancreatic α-amylase activity by 50%, and postruminal starch disappearance from 96.7% to 99.3%. Exogenous GLP-2 increased (P < 0.01) total small intestinal and mucosal mass by 1.2 kg and 896 g, respectively. Relative to control, GLP-2 and casein + GLP-2 increased (P = 0.04) total small intestinal α-glucosidase activity by 83.5%. Total small intestinal maltase, isomaltase, and glucoamylase activity was 90%, 100%, and 66.7% greater for GLP-2 and casein + GLP-2 steers compared with control. ConclusionsCasein increased pancreatic α-amylase activity, GLP-2 increased small intestinal α-glucosidase activity, and the combination of casein and GLP-2 increased both pancreatic α-amylase activity and small intestinal α-glucosidase activity. This novel approach provides an in vivo model to evaluate effects of increasing endogenous carbohydrase activity on small intestinal starch digestion.

Glepaglutide, a novel glucagon-like peptide-2 agonist, has anti-inflammatory and mucosal regenerative effects in an experimental model of inflammatory bowel disease in rats

BackgroundGlucagon-like peptide-2 (GLP-2) enhances intestinal repair and attenuates inflammation in preclinical inflammatory bowel disease (IBD) models, making GLP-2 analogues attractive candidates for IBD therapy. Glepaglutide is a long-acting GLP-2 receptor agonist in clinical development for treatment of short bowel syndrome. Here, we investigated if glepaglutide is therapeutically beneficial in rats with small intestinal inflammation.MethodsSmall intestinal inflammation was induced with indomethacin in naive Wistar rats, followed by glepaglutide administration at different disease stages. Glepaglutide was administered in co-treatment and post-treatment regimens. Small intestinal length and concentrations of inflammatory markers α-1-acid glycoprotein and myeloperoxidase were used to assess anti-inflammatory effects. Small intestinal mass was evaluated to determine intestinotrophic effects.ResultsGlepaglutide co- and post-treatment significantly reduced severity of small intestinal inflammation, evidenced by reversed small intestinal shortening and decreased α-1-acid glycoprotein and/or myeloperoxidase concentration(s). Co- and post-treatment with glepaglutide also significantly increased small intestinal mass, indicating intestinal regenerative effects. Similar effects were observed in naive rats after glepaglutide treatment.ConclusionGlepaglutide has anti-inflammatory and intestinotrophic effects without the need for pre-treatment in a rat model of small intestinal inflammation. Thus, glepaglutide is of potential clinical interest for patients with IBD.

Tissue Protein Turnover is Altered during Catch-Up Growth Following Escherichia coli Infection in Weanling Rats

Infection in young growing animals is manifested by poor tissue protein accretion; during subsequent catch-up growth this is reversed. To account for these changes, protein synthesis and degradation were measured in vivo in skeletal muscle, skin, liver and small intestine in weanling rats during catch-up growth after Escherichia coli infection. Observations were made at d 4, 6, 8, 11 and 14, when infected rats had elevated nitrogen balance. Liver protein mass and turnover were not affected by treatment. Although protein mass of small intestine fell during infection, catch-up was achieved before d 4, suggesting a high priority for protein repletion in this tissue. On d 4, protein mass was lower (P < 0.05) in muscle (-19%) and skin (-23%) in infected vs. control rats. Thereafter growth rates of skeletal muscle and skin were higher (P < 0.001) in infected rats compared with controls. Catch-up growth was most pronounced early, but continued throughout the study. During catch-up growth, protein synthesis (mg/d) in muscle and skin was not different between control and infected animals. Protein synthesis was maintained in muscle because RNA mass was maintained. During catch-up growth in muscle and skin of infected rats, there was lower protein degradation (mg/d) than in controls (P < 0.05). We conclude that alterations in protein turnover during catch-up growth are tissue and time dependent and are different from those described in other hyperanabolic states.

Multinodular gastro intestinal stromal tumor in small intestine with perforation and Meckel’s diverticulitis- An unusual presentation

Gastrointestinal Stromal tumor are rare group of mesenchymal neoplasms originating from the wall of the digestive tract. Outcome strongly dependent on tumor size and mitotic activity. A 60-year male presented with abdominal pain and distention for 3 months. After initial evaluation, emergency laparotomy was done. Intraoperatively found to have multiple small nodules in peritoneum and mesenteric border of small intestine and rupture of a big nodule was observed causing peritonitis. Gross examination-Multiple nodular tumour mass in small intestine along with multiple haemorrhagic nodule of varying size seen in mesentry. Tumor arising from muscular layer arranged in interlacing fascicles, bundles, whorls and sheets. Tumor cells are elongated having spindle to elongated nucleus with vesicular to dense chromatin and inconspicuous nucleoli. Some of the nodules shows areas of haemorrhage and necrosis. Mitotic figure &amp;#62; 5/50 HPF seen. Histological grade-G2 High grade &amp;#62;5/50 HPF, TNM grade-PT4PNxPMx. Immunohistochemistry-Diffusely Positive for CD117. Focally positive for DOG1, CD34 &amp; SMA. Small intestinal GISTs comprise approximately 30% of all GISTs. Tumor size vary from small nodules to complex masses of around 20 cm. GIST is more common in patients with age &amp;#62;40 years. CD117 and DOG1 positivity are used to define these tumors. Novelty: Only few cases has been reported in small bowel GIST with perforation and multiple nodules.

S3440 Malignant Melanoma of Unknown Primary Presenting With Small Intestinal Masses

Introduction: GI melanomas are extremely rare and require thorough investigation. Most GI melanomas are metastatic from an oculocutaneous lesion, however, and if not found, are termed melanoma of unknown primary (MUP.) MUP represents only 2% of all melanomas yet it is a major cause of mortality. Common areas of metastasis involve the lymph nodes, small intestines, and subcutaneous sites. We present a case of MUP that developed large abdominal masses within 7 months. Case Description/Methods: A 68 year old male presented with 1 week of LLQ abdominal pain and constipation. He had undergone a normal colonoscopy 1 year prior. He had normal vitals and labs excluding hemoglobin of 9.5 g/dL, compared to a baseline of 15.2 g/dL. CT scan of the abdomen and pelvis showed: a multi-lobulated heterogeneously enhancing mass centered in the LLQ involving the small bowel measuring 6.8 x 5.6 x 6.5 cm, as well as a 3.5 x 9.0 x 4.1 cm metastatic hilar lymph node encompassing the duodenal bulb. Of note, these findings were not visualized on imaging 7 months prior. Tumor markers were normal. EGD showed an extrinsic mass compressing the duodenal bulb with a superficial ulcer. Colonoscopy was normal. Percutaneous biopsy of the porta hepatis lymph node was done showing evidence of malignant melanoma. The patient had an extensive skin evaluation yielding no skin/ocular findings consistent with melanoma, making a diagnosis of MUP. (Figure) Discussion: GI MUP has rarely been reported in the literature. Diagnosis is typically definitive in the absence of primary cutaneous, ocular, or mucosal melanoma. Melanoma first found in the GI tract requires a thorough investigation to determine the primary lesion. After a GI melanoma is diagnosed, a detailed physical exam of the lymph nodes. nasopharynx, eyes, anus, and skin must be performed. If no primary lesion is discovered, a PET scan should be done to determine if the GI melanoma is primary, metastatic, or of unknown origin.Figure 1.: (A) Axial view of contrast-enhanced CT showing a partially cystic heterogeneous mass in the hilar region encompassing the duodenal bulb measuring 3.5x 9.0x 4.1 cm (Red Arrow). (B) Coronal view showing RUQ mass causing duodenal bulb compression(Red Arrow), as well as partially visualizing LLQ mass (Yellow Arrow.) (C) Sagittal view of multi-lobulated heterogeneously enhancing mass centered in the LLQ involving the small bowel measuring 6.8 x 5.6 x 6.5 cm (Yellow Arrow.)

The effect of feed efficiency classification on visceral organ mass in finishing steers

Individual feed intake of crossbred beef steers (one contemporary group/year, 2 years) was recorded during finishing to investigate visceral organ mass in steers divergent for feed efficiency. Based on residual feed intake (RFI), the 20% most efficient (HE, n = 8/year) and 20% least efficient (LE; n = 8/year) steers with 12th rib fat ≥1.02 cm were slaughtered. High efficiency steers had less DM intake ( P &lt; 0.001), greater G:F ( P &lt; 0.001), and similar ADG and hot carcass weight (HCW). High efficiency steers tended to have less ( P ≤ 0.10) small intestinal mass (actual and relative to BW and HCW) in year 1. In year 2, HE steers tended to have greater ( P ≤ 0.10) large intestinal actual and relative masses. Low efficiency steers tended to have greater ( P = 0.06) actual omasum mass and had greater ( P ≤ 0.03) relative omasum masses compared with HE. Stomach complex, total gastrointestinal tract, liver, and kidney masses tended to be greater ( P ≤ 0.10) relative to BW, and were greater ( P ≤ 0.05) relative to HCW, in LE. Data suggest that visceral organ mass, especially of the gastrointestinal tract, plays a role in overall metabolic efficiency of finishing steers.

Comparative digestive morphology and physiology of five species of Peromyscus under controlled environment and diet

Digestive morphology and physiology differ across animal species, with many comparative studies uncovering relationships between animal ecology or diet, and the morphology and physiology of the gastrointestinal tract. However, many of these studies compare wild-caught animals feeding on uncontrolled diets and compare broadly related taxa. Thus, few studies have disentangled the phenotypic consequences of genetics from those potentially caused by the environment, especially across closely related species that occupy similar ecological niches. Here, we examined differences in digestive morphology and physiology of five closely related species of Peromyscus mice that were captive bred under identical environmental conditions and identical diets for multiple generations. Using phylogenetic generalized least squares (PGLS) of species means to control for body size, we identified a phylogenetic signal in the mass of the foregut and length of the small intestine across species. As proportions of total gut mass, we identified phylogenetic signals in relative foregut and small intestine masses, indicating that the sizes of these structures are more similar among closely related species. Finally, we detected differences in activities of the protease aminopeptidase-N enzyme across species. Overall, we demonstrate fine-scale differences in digestive morphology and physiology among closely related species. Our results suggest that Peromyscus could provide a system for future studies to explore the interplay between natural history, morphology, and physiology (e.g. ecomorphology and ecophysiology), and to investigate the genetic architecture that underlies gut anatomy.

Computed tomographic findings of peritoneal lymphomatosis in a cat: a case report

A 12-year-old castrated male Persian cat presented with abdominal distension, anorexia, and no defecation. The radiography revealed ascites, pleural effusion, and a cranioventral mediastinal mass. Ultrasonography showed a well-defined mass lesion within a thickened ileal segment with a transmural loss of layering and multiple hyperechoic nodules arising from the peritoneum. Computed tomography showed peritoneal thickening with contrast enhancement, a bulky heterogeneous ileal mass, and mesenteric involvement with diffuse nodules. An alimentary lymphoma was confirmed by fine needle aspiration of the small intestinal mass. Peritoneal lymphomatosis is rarely reported as a metastatic manifestation in veterinary medicine. This report describes the imaging features of lymphoma with peritoneal lymphomatosis in a cat.

Effect of calcium propionate level on the growth performance, carcass characteristics, and meat quality of feedlot ram lambs

This study aimed to evaluate the effect of three oral doses of the glucogenic precursor calcium propionate (CaPr) on the growth performance, blood metabolites, carcass characteristics, and meat quality of finishing lambs, during 42-day feeding trial. Basal diet contained 16.3 % crude protein (CP) and 5.4 MJ/kg NEg. Thirty-six (35 ± 0.6 kg BW) Dorper × Katahdin lambs (9 lambs per treatment) were randomly assigned to treatments (CaPr levels at 0, 10, 20, and 30 g/lamb/day). The final weight, average daily gain (ADG), dry matter intake (DMI), and gain to feed ratio (G:F) were improved by CaPr supplementation, being optimal at the dose of 10 g/lamb/day (quadratic component, P < 0.01). Most blood metabolites were unaffected (P> 0.05), but BUN and BUN:Cr showed a quadratic tendency (P = 0.08) to increase with a supplementation level of 20 g/lamb/day. The CaPr supplementation increased empty body weight (EBW) (P < 0.03), reduced cooling loss (P < 0.05), and tended (P < 0.09) to increase quadratically cold (CCW) and hot (HCW) carcass weights at a dose of 20 g/lamb/day. Lambs fed CaPr had greater (P = 0.03) heart and small intestine mass (g/kg of EBW) and tended (P = 0.07) to have a greater liver mass without affecting other organs. Purge loss, cook loss, and water holding capacity (WHC) were unaffected (P> 0.05), but the shear force (WBSF) increased quadratically (P < 0.04) with maximal value at a dose of 20 g/lamb/day. The increase in the CaPr dose affected (P < 0.05) the meat color values ​​(L *, a * and b *), which was paler at a dose of 30 g/lamb/day. Results indicate that CaPr can be included in a dose of 10 g/lamb/day to improve growth performance and up to 20 g/lamb/day to maximal effects on carcass characteristics.

1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain

Abstract Background Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare Case Summary we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma. Discussion Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin. Conclusions Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.

S2972 Primary Squamous Cell Carcinoma of the Ileum - A Rare Entity

Introduction: The small intestine is the most common site for metastatic spread in the gastrointestinal tract. Squamous cell carcinoma (SCC) from a wide variety of sites can metastasize to the small intestine. Primary SCC of the small intestine are rare. We present a rare case of primary SCC of the ileum. Case Description/Methods: A 70-year-old male presented with complaints of abdominal pain for 5 days. Physical exam revealed tenderness on palpation on the right lower quadrant. Labs significant for WBC count of 13k/ul and lactic acid of 10.9 mmol/l. CT Abdomen revealed small bowel obstruction and suspected perforated mass within the ileum. (figure A). Mesenteric lymphadenopathy concerning for metastasis. Laparoscopy revealed an ileal perforation with a matted mass of the distal small intestine which was resected and ileocolonic anastomosis was performed. Gross exam revealed a 6.8*4.7cm ill-defined mass, irregular in appearance with tan pink and nodular texture with areas of necrosis. The mass was submucosal in location, extending to the adjacent mesenteric soft tissue. Histology revealed an invasive poorly differentiated SCC with perforation and invasion of the mesenteric lympho-vascular spaces (figure B). Neoplastic cells were positive for p40(figure C), p63(figure D), ck5/6 and pancytokeratin while negative for ck7, ck20, cdx2, ttf1, synaptophysin, chromogranin, cd45 and S100. The patient had a prolonged postoperative course with multi organ failure, was made palliative on postoperative day 14 and he expired on the same day. Discussion: Several mechanisms have been proposed for primary SCC of the small bowel. Some of which include submucosal squamous epithelium undergoing malignant transformation, aberrant transformation of stem cells into squamous cells with subsequent malignant change. It is difficult to differentiate between primary versus metastatic squamous cell carcinoma of the small bowel. In our patient, imaging studies, immune-histochemical staining and histology results points towards a primary SCC of the ileum. We believe that our patient had primary SCC of the terminal ileum without underlying adenoma, inflammatory disease, or duplication. Optimal treatment and the prognosis are unknown because of the rarity of this condition. Surgery is the mainstay in the management of the disease. Due to the small number of cases available in the literature, the effects of chemotherapy and radiotherapy on the survival and recurrence are unknown.Figure 1.: A CT abdomen axial view showing irregular configuration of a loop of small bowel with adjacent air bubbles suspicious for a perforated mass located within the ileum. B Histology demonstrating tumor nests, composed of large cells with hyperchromatic, pleomorphic nuclei and eosinophilic cytoplasm infiltrating the muscularis propria. Neoplasm is diffusely positive for P40 (C) and p63 (D)-indicating squamous cells

Intestinal upregulation and specific dynamic action in snakes – Implications for the ‘pay before pumping’ hypothesis

Animals which feed infrequently and on large prey, like many snake species, are characterized by a high magnitude of gut upregulation upon ingesting a meal. The intensity of intestinal upregulation was hypothesized to be proportional to the time and energy required for food processing (Specific-Dynamic-Action; SDA); hence, a positive correlation between the scope of intestinal growth and SDA response can be deduced. Such a correlation would support the so far not well established link between the intestinal and metabolic consequences of digestion. In this study I tested this prediction using an interspecific dataset on snakes gleaned from published sources. I found that SDAduration and SDAscope were positively correlated with post-feeding factorial increase in small intestine mass, but not with microvillar elongation. This indicates that a wide range of whole intestine remodelling (up- but potentially also downregulation) may temporarily prolong meal processing and that a greater magnitude of intestinal growth requires a stronger metabolic elevation. However, these effects do not seem large enough to drive the variation in the entire energetic costs of digestion, because SDAexpenditure was not affected either by intestinal or microvillar growth. I therefore propose that intestinal upregulation elicits non-negligible costs, but that these costs are a fairly small component of the whole SDAexpenditure.

PSIX-7 Grazing toxic endophyte-infected tall fescue does not influence pancreatic or small intestinal digestive enzyme activities in beef steers

Abstract The objective of this experiment was to determine the influence of toxic endophyte-infected tall fescue exposure on pancreatic and small intestinal digestive enzyme activities in steers. Twelve fescue-naive beef steers [693 ± 42.7 kg of body weight (BW)] were stratified by BW and randomly assigned within BW ranks to graze non-toxic endophyte-infected tall fescue (NTE, n = 6; 0.01 ± 0.009 mg ergovaline + ergovalinine/kg) or toxic endophyte-infected tall fescue (TE, n = 6; 0.50 ± 0.048 mg ergovaline + ergovalinine/kg) pastures for 84 d. After the grazing period, steers were weighed and then slaughtered in three groups for tissue collection. A 1-m segment of the small intestine was collected 5-m distal to the pyloric sphincter. Subsamples of the small intestinal mucosa and pancreas were collected, homogenized in saline, and assayed for protein concentration. Pancreatic and small intestinal digestive enzyme activities were assayed. Data were analyzed using the GLM procedure of SAS as a randomized complete block design for effects of treatment and slaughter group (blocking factor). Steers grazing NTE pastures had a greater (P &amp;lt; 0.001) average daily gain (0.282 vs -0.631 kg/d) and final BW at slaughter (739 vs 620 kg) than steers grazing TE pastures. Small intestinal segment mass and mucosal density (P ≥ 0.16) were not influenced by treatment. Grazing TE pasture did not influence (P ≥ 0.21) pancreatic or small intestinal protein concentrations. Pancreatic α-amylase and trypsin activity per gram pancreas (P ≥ 0.21) or per gram pancreatic protein (P ≥ 0.30) were not influenced by fescue treatment. Small intestinal glucoamylase, isomaltase, and maltase activities did not differ between steers grazing NTE or TE pastures when expressed per gram of intestinal tissue (P ≥ 0.47) or per gram of intestinal protein (P ≥ 0.60). These data indicate that decreased gains observed in cattle consuming TE are not a result of decreased pancreatic or small intestinal digestive enzyme activities.

Glucagon-like Peptide-2 (GLP-2) Treatment Reduces Gvhd-Related Mortality in a Pre-Clinical Transplant Model Via Expansion of Macrophages with Tolerogenic Potential

The gastrointestinal (GI) tract is a major target in GVHD. Conditioning-induced damage and mucosal barrier disruption are important factors in GVHD, however therapies targeting these processes have not been identified. Glucagon-like-peptide 2 (GLP-2) is an enterocyte-specific growth factor produced by L cells that has regenerative potential in models of GI damage. Its impact on the mucosal immune system has not been elucidated. We sought to examine the therapeutic and immunologic effect of GLP-2 in murine GVHD. We employed a major MHC-mismatched GVHD model (C57BL/6J → BALB/cJ). Mice were treated with 800nmol/kg/day of Elsiglutide (a GLP-2 analogue, provided by Helsinn) or vehicle beginning on D+1 for 30 days. Treatment with GLP-2 significantly improved survival and GVHD scores (Fig. 1A), while increasing small intestine mass and villi length (Fig 1B). GLP-2 also reduced T-cell infiltration into the jejunum (Fig. 1C). Analysis of intestinal immune cells by 28-color flow cytometry revealed dramatic differences between treatment groups in both myeloid- and T-cells. On D+14, GLP-2 led to an increased proportion of donor CSF-1R+ macrophages in the lamina propria (LP) (Fig. 2A) - cells that support the maintenance of the intestinal stem cell niche (Sehgal, Nat Commun, 2018). On D+21 the LP donor myeloid compartment was further altered, especially in MHC IIlow F4/80+ CD64+ macrophages (Fig. 2B, C). Here GLP-2 treatment expanded macrophages with lower expression of the co-stimulatory molecules CD80 and CD86 as well as the phagocytic marker CD206, whilst increasing the inhibitory molecule SIRPα, consistent with a tolerogenic phenotype. GLP-2 treatment also increased CX3CR1 expression on MHC IIlow macrophages with reduced Ly6C - a phenotype associated with physiologic macrophage maturation and linked to the resolution of colitis (Zigmond, Immunity, 2012). Vehicle-treated mice, conversely, had predominance of Ly6Chigh MHC IIlow LP macrophages reminiscent of an early infiltrating phenotype and near absence of mature macrophages, suggesting an impaired monocyte-macrophage transition that was restored by GLP-2. In addition, GLP-2 treatment led to significant changes in donor intraepithelial lymphocytes on D+21 (Fig. 2D), where CD8 T cells exhibited decreased CD27, CD103 and CXCR3 expression but higher PD-1, suggesting less activation. To assess potential mechanisms for the differences in macrophage and T-cell phenotype, we examined the impact of GLP-2 on the intestinal microbiota. A syngeneic BALB/cJ model was used to explore the effects of GLP-2 independent of GVHD. Stool samples from D+0, D+14, and D+28 were subjected to 16S rRNA sequencing. Vehicle-treated mice had distinct β-diversity clusters at all time-points, showing a transplant effect on the microbiota (Fig. 3A). GLP-2-treated mice had near-complete cluster overlap between D+0 and D+14, suggesting attenuation of the impact of conditioning. GLP-2 treated mice were significantly enriched for Akkermansia muciniphila and Bacteroidales S24-7 family at D+14 and D+28 (Fig. 3B). These taxa have been associated with anti-inflammatory properties and A. muciniphila abundance is linked to epithelial mucin production, which is increased by GLP-2. We then assessed the role of microbial communities in the protective effect of GLP-2 by conducting an allogeneic transplant with 3 caging conditions; 1) vehicle and GLP-2 treated mice caged together, 2) caged separately, or 3) caged separately plus oral antibiotics. We observed a clear cage effect where co-housing the treatment groups improved the survival of vehicle treated mice (Fig. 3C), suggesting transferal of the therapeutic effect via the microbiome. Antibiotic administration also dampened the beneficial effect of GLP-2. Finally, we conducted a GvL experiment by co-transplanting Luc-A20 and monitoring tumor progression via bioluminescence imaging. Both GLP-2 and vehicle-treated mice eliminated the tumor, whereas mice receiving T-cell depleted bone marrow showed tumor progression (Fig. 3D). In summary, our results demonstrate high therapeutic potential of GLP-2 in GVHD. GLP-2 administration led to reduced mortality, modified the microbiome and altered the intestinal immune response to a more tolerogenic state. This novel mechanism sheds light on the role of the enteroendocrine system in maintaining gut homeostasis and sets the stage for therapeutic clinical trials. Figure 1 Disclosures Uhlemann: Allergan: Research Funding; GSK: Research Funding; Merck: Research Funding. Reshef:Gilead: Consultancy; Magenta: Consultancy; Novartis: Consultancy; Monsato: Consultancy; Atara: Consultancy; BMS: Consultancy.

Influence of dietary fructose supplementation on visceral organ mass, carbohydrase activity, and mRNA expression of genes involved in small intestinal carbohydrate assimilation in neonatal calves

The hypothesis of this experiment was that dietary fructose would influence visceral organ mass, carbohydrase activity, and mRNA expression of carbohydrases and nutrient transporters in the small intestine in neonatal calves. Therefore, our objective was to use the neonatal calf as a model to evaluate the effects of postruminal fructose supply on small intestinal carbohydrate assimilation. Ten calves (<7 d of age; 41.2 ± 1.46 kg of body weight) were fed milk replacer at 2.0% of body weight daily (816 ± 90.5 g/d; 272 ± 30.1 g/L; dry-matter basis) in 2 equal portions and assigned to the following dietary treatment groups: (1) milk replacer (control; n = 6) or (2) milk replacer + 2.2 g of fructose/kg of body weight (fructose; n = 4). Calves were fed dietary treatments for 28 d, with jugular blood sampled every 7 d before and after the morning feeding. Calves were slaughtered, and visceral weights were recorded. Postruminal carbohydrase activities were assayed. Quantitative real-time PCR was conducted for small intestinal mRNA expression of nutrient transporters [solute carrier family 2 member 5 (GLUT5), solute carrier family 2 member 2 (GLUT2), and solute carrier family 5 member 1 (SGLT1)], carbohydrases (lactase, maltase-glucoamylase, and sucrase-isomaltase), and ketohexokinase (KHK). Data were analyzed using MIXED procedures in SAS version 9.4 (SAS Institute Inc, Cary, NC). Dietary fructose supplementation decreased serum glucose concentration. Small intestinal mass was greater in calves supplemented with fructose. Dietary fructose supplementation did not influence pancreatic α-amylase, small intestinal isomaltase, or maltase activities. Sucrase activity was undetected in the small intestine. Dietary fructose supplementation increased small intestinal glucoamylase activity per gram of tissue by 30% and increased maltase-glucoamylase mRNA expression by 6.8-fold. Dietary fructose supplementation did not influence mRNA expression of GLUT5, SGLT1, GLUT2, or KHK. Dietary fructose supplementation increased small intestinal lactase mRNA expression by 3.1-fold. Sucrase-isomaltase mRNA expression in the small intestine decreased 5.1-fold with dietary fructose supplementation. Dietary fructose supplementation does not induce sucrase activity in neonatal calves; however, sucrase-isomaltase may be transcriptionally regulated by dietary fructose in neonatal calves. More research is needed to compare glucose and fructose at isocaloric intakes to examine effects of dietary fructose at equal metabolizable energy intake.