Stomach Bowel Research Articles

CT FINDINGS OF MALIGNANT NEOPLASTIC MASSES OF SMALL AND LARGE INTESTINE WITH HISTOPATHOLOGICAL CORRELATION: A CROSS SECTIONAL STUDY

AIMS AND OBJECTIVES: To formulate an appropriate scanning protocol technique to evaluate malignant neoplasm of small and large intestine. To dene various CT ndings in malignant bowel neoplasm. To stage bowel neoplasm. To accurately characterize the tumour by histologic type as far as possible. Materials And Methods: In our cross-sectional study, 76 cases of small and large bowel carcinoma were referred to radiology department. After taking informed consent, CECT abdomen of the patients was done. All these patients went for surgical excision of the neoplastic mass; and the mass were sent for HPE examination. Epidemiological data, clinical features, CECT abdominal features were correlated with HPE type of the mass were found out. P-Value<0.05 was considered to be statistically signicant. Results: In Small bowel, ileum was the commonest site of involvement (5.26%), whereas sigmoid colon and rectum (18.42%) was commonest site of involvement in large bowel. Adenocarcinoma was the commonest histological subtype seen in 54 patients (71.05%), followed by lymphoma in 14 patients (18.42%), Mucinous Adenocarcinoma seen in 5 patients (57.5%). and gastrointestinal stromal tumor [GIST] seen in 3 patients(3.94%). Conclusion: Common CT imaging features in malignant bowel neoplasm are bowel Wall thickening >2cm,short Segment Involvementand heterogeneous mixed pattern. Although CT has a high specicity for detection of a metastatic lymph nodes, sensitivity is low.Liver is the commonest site of distant metastasis in malignant bowel neoplasm. Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from bowel malignant.

The role of microvesicles as biomarkers in the screening of colorectal neoplasm.

BackgroundColorectal cancer (CRC) is the second cause of cancer death worldwide. The role of circulating microvesicles as a screening tool is a novel, yet effective approach that warrants prioritised research.MethodsIn a two‐gate diagnostic accuracy study, 35 patients with benign colorectal polyps (BCRP) (n = 16) and colorectal cancer (CRC) (n = 19) were compared to 17 age‐matched healthy controls. Total annexin‐V positive microvesicles and sub‐populations positive for selected biomarkers relevant to bowel neoplasm were evaluated in patients' plasma using flow cytometry. Statistical methods including factor analysis utilising two component factors were performed to obtain optimal diagnostic accuracy of microvesicles in identifying patients with colorectal neoplasms.ResultsTotal plasma microvesicles, and sub‐populations positive for CD31, CD42a, CD31+/CD42a‐, EPHB2, ICAM and LGR5 (component factor‐1) were able to identify patients with BCRP and CRC with a receiver operator curve (AUC) accuracy of a 100% (95% CI: 100%–100%) and 95% (95% CI: 88%–100%), respectively. To identify patients with BCRP, a cut‐off point value of component factor‐1761 microvesicles/μl demonstrated a 100% sensitivity, specificity and negative predictive value (NPV) and a 93% positive predictive value (PPV). To identify patients with CRC, a cut‐off value of component factor‐1 3439 microvesicles/μl demonstrated a 100% sensitivity, specificity and NPV and a 65% PPV. CEA+ microvesicles sub‐population were significantly (p < 0.02) higher in CRC in comparison to BCRP.ConclusionsMicrovesicles as biomarkers for the early and accurate detection of CRC is a simple and effective tool that yields a potential breakthrough in clinical management.

Synchronous Neoplasms of the Small Bowel: A Diagnostic Challenge.

Small bowel tumours are rare, representing about 0.5% of all tumours and about 3% of gastrointestinal tract tumours. The low prevalence contrasts with the vast surface area of the small intestine, which accounts for over 90% of the surface area of the digestive tract. The frequency of small tumours decreases from proximal to distal, and therefore from the duodenum to the ileum. The histological types differ in terms of prevalence according to the affected segment, with adenocarcinoma being the most frequent in the duodenum and jejunum and carcinoid tumour in the ileum. Diagnosis is challenging due to clinical non-specificity, low prevalence and a low level of suspicion.Schwannomas are typically benign tumours that arise from Schwann’s cells and are rarely found in the small intestine. It is even more rare to find them together with another histological type, namely adenocarcinoma. No cases have been reported in the literature of these lesions occurring in the small intestine simultaneously. Further studies are needed to clarify the underlying pathophysiology of these synchronous tumours.The authors present the case of an 86-year-old female patient admitted for high intestinal subocclusion, with refractory vomiting and involuntary weight loss. Two synchronous lesions in the digestive tract were identified: an adenocarcinoma in the duodenum and a schwannoma in the ileum. The patient underwent surgical resection of both lesions.A high level of suspicion combined with a multidisciplinary approach is necessary for timely diagnosis and surgical resolution.LEARNING POINTSSmall bowel neoplasms are rare and clinically non-specific; in addition, diagnosis is difficult due to imaging artifacts and tumour inaccessibility for biopsy for definitive histological diagnosis.Gastrointestinal schwannomas are rare and the pathophysiology of synchrony with other histological subtypes remains to be clarified.A multidisciplinary approach from the beginning is important for a timely diagnosis and better outcome.

Malignant Small Bowel Neoplasms:a review of post-contrast multiphasic multidetector computed tomography.

Small bowel neoplasms are rare and account for 3-6% of all gastrointestinal neoplasms. For the diagnosis of small bowel neoplasms, differentiating normal bowel tissue from tumor is critical and depends on imaging modality and scanning techniques. The detection and characterization of small bowel neoplasms have recently improved with the advance of computed tomography (CT) technology. Post-contrast multiphasic CT is an aid to detection and recognition of the vascular nature of small bowel neoplasms. Understanding the typical post-contrast multiphasic CT features of small bowel neoplasms is important because of overlapping features and the necessity of evaluating associated complications and metastases to lymph node and other organs. However, accurate classification of pathologies is still challenging in clinical practice. Texture analysis can quantify complex mathematical patterns within the gray-level distribution of the pixels and voxels of digital images, and texture analysis of the post-contrast multidetector CT data of various tumors has been attracting attention in recent years. The aim of this article is to provide a comprehensive guide to the relevant imaging features for different types of malignant small bowel neoplasms. J. Med. Invest. 69 : 19-24, February, 2022.

Determining the etiology of small bowel obstruction in patients without intraabdominal operative history: a retrospective study.

Most of the causes of small bowel obstruction (SBO) in patients without a history of abdominal surgery are unclear at initial assessment. This study was conducted to identify the etiology and clinical characteristics of SBO in virgin abdomens and discuss the proper management. A retrospective review involving operative cases of SBO from a single institute, which had no history of abdominal surgery, was conducted between January 2010 and December 2020. Clinical information, including radiological, operative, and pathologic findings, was investigated to determine the etiology of SBO. A total of 55 patients were included in this study, with a median age of 57 years and male sex (63.6%) constituting the majority. The most frequently reported symptoms were abdominal pain and nausea or vomiting. Neoplasm as an underlying cause accounted for 34.5% of the cases, of which 25.5% were malignant cases. In patients aged ≥60 years (n=23), small bowel neoplasms were the underlying cause in 12 (52.2%), of whom 9 (39.1%) were malignant cases. Adhesions and Crohn disease were more frequent in patients aged <60 years. Coherence between preoperative computed tomography scans and intraoperative findings was found in 63.6% of the cases. There were various causes of surgical cases of SBO in virgin abdomens. In older patients, hidden malignancy should be considered as a possible cause of SBO in a virgin abdomen. Patients with symptoms of recurrent bowel obstruction who have no history of prior abdominal surgery require thorough medical history and close follow-up.

Intestinal obstruction after trauma laparotomy: a rare case due to colon cancer

The causes of intestinal obstruction are diverse with tissue adhesion, incarcerated hernia, and large bowel neoplasm being the most common causes. Cancer is not easy to diagnose in patients with a history of intestinal obstruction after the intraperitoneal operation following blunt trauma. Herein, we report the case of a patient who was diagnosed with colon cancer after undergoing adhesiolysis due to intestinal obstruction.

S3056 Small Bowel Neuroendocrine Tumor

Introduction: Neuroendocrine tumors (NETs) are epithelial tumors that arise from neuroendocrine cells of the digestive system. Within the digestive system, the majority occur in small intestine (45%). Diagnosis is usually made accidentally during a routine workup or from the patient experiencing symptoms from the tumor. We report a difficult-to-diagnose unsuspected NET of the ileum in a young, otherwise healthy individual. Case Description/Methods: A 57-year-old female with a history of hypertension and hyperlipidemia presented to the emergency department with multiple episodes of dark stools one day prior to admission. A CT angiogram showed high density fluid in the small bowel with no active bleeding. Overnight, the patient had a near syncopal episode. A repeat CT angiogram showed active bleeding within the small intestine. However, on angiogram, no active bleeding was noted. The following day, an MR enterography showed thickening of the segment of the small intestine that had shown active bleeding on the repeat CT angiogram. During laparoscopy, the surgeon identified what felt to be a tumor in the distal ileum. Pathology revealed a well-differentiated neuroendocrine tumor (Figure 1). Discussion: NETs are the most common type of small bowel neoplasms. They are divided into duodenal NETs and distal NETs of the jejunum and ileum. Lymph node metastasis occurs in about 60% of cases of duodenal NET. Liver metastasis occurs in less than 10% of duodenal NET cases and about 20% of cases of distal NET of the jejunum and ileum. The stage of the disease has a large impact on prognosis. The 10-year survival rate is 95% for patients with localized NETs and 10% for those with distant metastasis. Distal NETs of the jejunum and ileum have a poorer prognosis because of their tendency to metastasize. The annual incidence of NETs has increased over the past five years to forty to fifty cases per million, largely due to better diagnostic tools. For duodenal NETs, upper gastrointestinal endoscopy with biopsy is the most sensitive diagnostic test. Several genetic markers are being evaluated as diagnostic tools. Treatment depends on the size of the NET. Small (≤ 1 cm) duodenal NETs can be resected endoscopically. Larger duodenal NETs (≥ 2 cm) or lymph node metastasis should be treated surgically. Systemic chemotherapy is not recommended for well-differentiated NETs. In conclusion, this case describes difficulties in diagnosing NETs of the ileum and highlights the need for improvements in diagnosis and management of NETs.Figure 1.: Ulcerated submucosal mass in distal small bowel measuring 2.8x1.8 cm.

S2302 From an Unproved Venous Thromboembolism to a Jejunal Cancer: An Unmasking Prompted by Overt Small Bowel Bleeding

Introduction: Of all patients diagnosed with a venous thromboembolism, 2 to 25% will subsequently be diagnosed with malignancy. When considering possible malignancies, a primary small bowel neoplasm is not likely at the top of the list. Small bowel neoplasms may present with nonspecific signs or symptoms such as gastrointestinal bleeding. But even when bleeding does occur diagnosis can be challenging, as the initial work-up for with upper and lower endoscopy may not necessarily visualize the affected region. Small bowel bleeding can be categorized as occult or overt, with the former defined as a positive FIT result with no evidence of visible blood, and the latter implying a clear presentation with melena, hematochezia, or hematemesis. In this case we describe how treating an unprovoked DVT helped in the diagnosis a jejunal adenocarcinoma. Case Description/Methods: This is the case of a 69 year old male who presented to ER with a chief complaint of dark stools 2 weeks prior. Upon further questioning, patient mentioned a history of a fall from standing secondary to associated dizziness. He also noted he had been taking warfarin chronically for a prior diagnosis of a DVT. On initial evaluation patient was found severely anemic and orthostatic, thus admitted for further management. Throughout hospitalization, upper and a lower endoscopy were performed without evidence to explain known anemia. Small bowel bleeding was then suspected, and a pill endoscopy was performed, demonstrating multiple friable and ulcerated lesions distal to the duodenum. Given these findings, a push enteroscopy was subsequently performed and a biopsy was taken from a jejunal lesion with a resultant pathology of a poorly differentiated adenocarcinoma. Discussion: The diagnosis of an uncomplicated unprovoked VTE warrants age-appropriate cancer screening, which in this patient would have included a colonoscopy. If this patient had undergone a screening or surveillance colonoscopy under normal circumstances, this patient’s diagnosis could have gone unnoticed. We believe the use of warfarin for treating the venous thromboembolism was the likely detonator of gastrointestinal bleeding, which ultimately prompted further clinical investigation. The above case presentation not only denotes the classic step-by-step process required to identify a relatively rare small bowel malignancy, but also demonstrates how treating patients sometimes help us “unmask” other diagnoses.Figure 1.: Large, ulcerated, friable, circumferential lesion at proximal jejunum.

Synchronous small bowel and colonic tumours in the absence of Lynch syndrome.

Synchronous small bowel and colonic tumours in the absence of Lynch syndrome.

Overall survival in elderly patients with acute complications of colorectal cancer

AIM: to assess risk factors affecting the five-year overall survival in patients ≥ 70 years old who underwent emergency surgery for complicated colorectal cancer.PATIENTS AND METHODS: a cohort retrospective study included 268 patients with complicated colorectal cancer for the period from January 10, 2010 to March 03, 2020, operated on in hospitals in Smolensk. Inclusion criteria: 1) patients underwent emergency surgery for decompensated bowel obstruction or tumor perforation with peritonitis; 2) histological type of tumor: adenocarcinoma, signet ring cell carcinoma, undifferentiated cancer; 3) age ≥ 70 years. Non-inclusion criteria: 1) subcompensated bowel obstruction, paratumoral inflammation, intestinal bleeding; 2) non-epithelial malignant tumors; 3) age &lt; 70 years.RESULTS: the significant differences were revealed in overall survival rates depending on the type of surgery. In complicated colon cancer, overall survival after one-stage surgeries was 15.35%, after tumor removal at the first stage — 21.51%, and after surgeries with tumor removal at the second stage — 46.59% (p &lt; 0.00001). For complicated rectal cancer: 1.03%, 1.6%, and 16.49%, respectively (p = 0.00402). The main factors that had an unsatisfactory effect on overall survival: surgery type — one-stage and multi-stage with tumor removal at the first stage (risk ratio (RR) 1.34; 95% coincidence interval (CI) 1.17–1.56; p &lt; 0.0001); tumor perforation (OR 1.46, 95% CI: 1.36–1.55; p &lt; 0.0001); disease stage (OR 1.61, 95% CI: 1.45–1.69; p &lt; 0.0001), tumor site (OR 1.24, 95% CI: 1.29–1.72; p = 0.004); tumor histological type — poorly differentiated adenocarcinoma (OR 1.5, 95% CI: 1.24–1.62; p &lt; 0.0001), the number of lymph nodes examined &lt; 12 (OR 0.69, 95% CI: 0.59–0.63; p &lt; 0.0001), presence of positive resection margins (R1 and/or CRM+) (OR 1.29, 95% CI: 1.14–1.47; p &lt; 0.0001); severe comorbidity (OR 1.95, 95% CI: 1.62–1.98; p = 0.003), no adjuvant treatment (OR 0.57, 95% CI: 0.49–0.63; p &lt; 0.0001).CONCLUSION: staged procedures with a minimal volume in an emergency and the second — main stage, performed in a specialized hospital, are the most appropriate in patients ≥ 70 years old.

Computed Tomographic Findings of Malignant Bowel Neoplasms: A Retrospective Study

Introduction: Malignant neoplasms of bowel particularly colorectal carcinomas are third commonest cause of death all over world. Computed Tomography (CT) plays a very important role in evaluation of malignant bowel neoplasms. CT examination for gastrointestinal tract evaluates the intestinal lumen along with demonstration of intestinal wall, adjacent tissues and solid viscera. Aim: To evaluate malignant neoplasms of small and large intestine and also to define the various CT findings in malignant bowel neoplasms, extra-intestinal involvement to stage intestinal neoplasms and to accurately characterise the tumour histologically as far as possible. Materials and Methods: A retrospective descriptive study included 38 patients who were proven to have malignancy of bowel on biopsy, underwent CT abdomen in major public hospital in a period of from November 2014 to May 2017 and evaluated for various CT findings in malignant bowel neoplasms in terms of involved intestine, length of diseased intestinal segment, degree of intestinal wall thickening, extra-intestinal involvement to stage bowel neoplasms and to accurately characterise the tumour histologically as far as possible. Data were tabulated and presented as frequency (n) and precentage (%). Results: In small intestine, ileum is the commonest site of involvement seen in 5 cases (13%), whereas rectum 10 cases (26.3%) was the commonest site of involvement in large intestine. Short segment involvement of bowel is more common 27 cases (71.1%) than long segment involvement 11 cases (28.9%). Circumferential wall thickening is more common in 33 cases (86.8%) than eccentric wall thickening 5 cases (13.2%). Lymph nodal involvement was seen in 17 cases (44%) and metastasis to liver was also seen in 11 cases (28.9%). Local invasion with involvement of surrounding structures was seen in 4 cases (10.5%). Adenocarcinoma was the commonest histological subtype seen in the highest number of 23 cases (60.5%), followed by lymphoma in 9 cases (23.6%), mucinous adenocarcinoma in 4 cases (10.5%) and few cases of about 2 cases (5.2%) were Gastrointestinal Stromal Tumour (GIST). Conclusion: Computed Tomography (CT) imaging findings like involved intestine, length of diseased intestinal segment, degree of intestinal wall thickening, extra intestinal involvement with respect to involvement of surrounding structures, lymph nodal involvement, distant metastasis along with histological type in most cases could be found, thus permitting tumour characterisation which can provide very useful guide in diagnosis of malignant neoplasms of small and large intestine.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study.

During a surgical procedure, patients are often subjected to fasting for times that are more prolonged than the ideal, which may lead to complications. To evaluate the duration of perioperative fasting and its association with postoperative complications, length of hospital stay (LOS) and mortality among gastric and colorectal cancer patients. Cohort study developed in a surgical oncology hospital in the city of Natal (Rio Grande do Norte, Brazil). Patients aged over 18 years were included. The Clavien-Dindo surgical complication scale was used to evaluate occurrences of postoperative complications. LOS was defined as the number of days for which patients stayed in the hospital after surgery, or until the day of death. Seventy-seven patients participated (59.8 ± 11.8 years; 54.5% females; 70.1% with bowel tumor). The incidences of postoperative complications and death were 59.7% and 3.9%, respectively. The duration of perioperative fasting was 59.0 ± 21.4 hours, and it was higher among non-survivors and among patients with prolonged hospital stay (≥ 6 days). For each one-hour increase in the durations of perioperative and postoperative fasting, the odds of prolonged hospitalization increased by 12% (odds ratio, OR = 1.12; 95% confidence interval, CI 1.04-1.20) and 5% (OR = 1.05; 95% CI 1.02-1.08), respectively. Prolonged perioperative fasting, especially in the postoperative period, was observed in a sample of patients with gastric and colorectal cancer, and this was an independent predictor of LOS.

S2777 Metastatic Cervical Adenocarcinoma: A Rare Cause of Upper GI Bleeding

INTRODUCTION: Primary small bowel neoplasms are rare, accounting for 1–5% of all gastrointestinal (GI) tract malignancies. Metastatic small bowel lesions are more common than primary and typically arise from malignant melanoma and adenocarcinomas from the lung, kidney and colon. Distant metastasis from cervical adenocarcinoma is extremely rare, most often seen with advanced stages. We report the case of a young female with known cervical cancer presenting with acute abdominal pain and melena secondary to metastatic ulcerated duodenal mass. CASE DESCRIPTION/METHODS: 43-year-old female with stage IIIB cervical adenocarcinoma status post pelvic radiation, human immunodeficiency virus (HIV) on antiretroviral therapy, and right upper extremity deep vein thrombosis on Eliquis presented with mild diffuse abdominal pain and intermittent melena over four weeks. On admission, she was afebrile and hemodynamically stable. Laboratory findings were significant for acute blood loss anemia with hemoglobin 3.3 g/dL (7.6 g/dL two months prior). Computed tomography abdomen and pelvis showed a heterogenous cervical mass near the sigmoid colon without signs of obstruction or perforation. Three units of packed red blood cells were transfused, proton pump inhibitor drip was initiated, and anticoagulation was held. Esophagogastroduodenoscopy revealed a large, infiltrative, ulcerated and friable mass within the second portion of the duodenum (Figure 1), occupying 50% of the luminal circumference with stigmata of recent bleeding. Duodenal mass biopsies confirmed metastatic cervical adenocarcinoma (Figures 2 and 3). She had no further bleeding throughout her course and was discharged home with palliative oncology care. DISCUSSION: Cervical cancer is the second most common gynecologic malignancy. Up to half of stage III cervical cancer patients present with distant metastases, most often to liver, lungs and bone marrow; however, only approximately 8% have GI tract metastases, often to the rectosigmoid secondary to local extension. Isolated metastases to the small bowel are exceedingly rare. Clinical presentations include small bowel obstruction, anemia, abdominal pain and, less commonly, overt GI bleeding. Early diagnosis of such an unusual pattern of metastasis related to cervical cancer is vital for optimal therapeutic management and prediction of prognosis.Figure 1.: Ulcerated mass at second portion of the duodenum.Figure 2.: Medium-power view demonstrating reactive duodenal mucosa on the top and poorly-differentiated carcinoma growing up from the submucosa (H&E, 100x).Figure 3.: High-power view demonstrating marked pleomorphism, 'bubbly' cytoplasm, apoptotic bodies and numerous atypical mitotic figures (H&E, 400x).

CT Imaging of Small Bowel Neoplasms

Primary neoplasms of the small bowel are rare, accounting for less than 3% of all gastrointestinal tumors.1 Diagnosis of SB malignancy is difficult, as signs and symptoms are typically nonspecific including anemia, abdominal pain, gastrointestinal bleeding, weight loss, diarrhea, nausea, and vomiting.2 Many patients remain asymptomatic or are not diagnosed until at an advanced stage of disease or severe complications arise, such as bowel obstruction, bleeding, or perforation.2

CT Imaging of Small Bowel Neoplasms

CT Imaging of Small Bowel Neoplasms

Surgery and Perioperative Management in Small Intestinal Neuroendocrine Tumors

Small-intestinal neuroendocrine tumors (SI-NETs) are the most prevalent small bowel neoplasms with an increasing frequency. In the multimodal management of SI-NETs, surgery plays a key role, either in curative intent, even if R0 resection is feasible in only 20% of patients due to advanced stage at diagnosis, or palliative intent. Surgeons must be informed about the specific surgical management of SI-NETs according to their hormonal secretion, their usual dissemination at the time of diagnosis and the need for bowel-preserving surgery to avoid short bowel syndrome. The aim of this paper is to review the surgical indications and techniques, and perioperative and postoperative management of SI-NETs.

Small Bowel Neoplasms: A Pictorial Review.

Small bowel tumors are rare and account for approximately 3% of all gastrointestinal tumors in the United States. The incidence of small bowel neoplasms is rising-in particular, there is a rising incidence of small bowel carcinoid tumors. This may in part be due to small bowel lesion identification in an increasing number of cross-sectional imaging studies performed for other indications as well as increased use of advanced imaging techniques to assess specifically for small bowel disease. Diagnosis is a challenge owing to nonspecific clinical manifestation, rare occurrence, and low index of clinical suspicion. Yet, various small bowel neoplasms have characteristic imaging features at CT and MRI when optimal distention of the small bowel is achieved, correlating well with features seen in gross specimens. Understanding the imaging features of small bowel neoplasms is important to improve the radiologist's ability to diagnose and characterize small bowel neoplasms. Most small bowel tumors are clinically silent for long periods, and nearly half of the benign tumors are found incidentally during surgery or at cross-sectional imaging performed for other reasons. The authors review the imaging features of common benign and malignant small bowel neoplasms to aid the radiologist in diagnosis of small bowel tumors. ©RSNA, 2020.

Metastatic pleomorphic dermal sarcoma to small bowel – A case report

Pleomorphic dermal sarcoma (PDS), a dermal based tumour that is related to atypical fibroxanthoma with overlapping morphological and immunohistochemical features but with subcutaneous invasion, necrosis, perineural or vascular invasion. PDS has low malignant potential with risk of local recurrence and metastases. Reported sites of metastases are distant skin, lymph nodes and lung. We report a case of a male aged 65 who presented with gastrointestinal bleeding due to haemorrhage from a small bowel lesion. His medical history included Muir-Torre syndrome, stage IV colon cancer (with liver metastases) and PDS of the lower lip (resected February 2018) with known lung metastases. He underwent a segmental resection of small bowel in June 2019; macroscopically a solitary 39 mm lesion was noted. Histopathology showed a tumour composed of sheets and nests of pleomorphic, mitotically active, epithelioid and spindle cells. Immunohistochemically the malignant cells showed positive for CD10 and negative staining for cytokeratins, CD117 and melanoma markers. The morphology and immunophenotype were the same as his previously diagnosed lip PDS. This is the first reported case of metastatic PDS to small bowel, and highlights the importance of clinical-pathological correlation. Although rare, metastatic sarcoma should be considered in the differential of pleomorphic epithelioid/spindled small bowel neoplasms.

Safety and efficacy of an enteroscopy-based approach in reducing the polyp burden in patients with Peutz-Jeghers syndrome: experience from a tertiary referral center.

Background:Patients with Peutz–Jeghers syndrome develop hamartomatous polyps in the small bowel, possibly causing anemia, intussusception, and obstruction. We aimed to evaluate the impact of an enteroscopy-based approach, including both device-assisted and intraoperative enteroscopy, on the reduction of the polyp burden in a cohort of adult Peutz–Jeghers syndrome patients.Materials and methods:A retrospective study was conducted at Azienda Ospedaliero-Universitaria Città della Salute e della Scienza in Turin, Italy. Consecutive Peutz–Jeghers syndrome patients eligible for device-assisted or intraoperative enteroscopy, between January 2003 and November 2019, were included. Enteroscopy technical issues and complications were recorded. At the time of index enteroscopy, the patients’ clinical records were retrospectively reviewed, and clinical data were recorded until November 2019.Results:Overall, 24 patients were included. Before inclusion, 16/24 patients (66.7%) underwent small bowel surgery for polyp-related complications, 13 of which (81.2%) in an emergent setting. Two patients had a history of small bowel neoplasms. During the timeframe, 47 device-assisted enteroscopies and 9 intraoperative enteroscopies were performed, and 247 small bowel polyps were endoscopically removed. The overall complication rate was 12.8% (8.5% for device-assisted enteroscopy, 22.2% for intraoperative enteroscopy). The median observation time was 108 months: in this timeframe, two patients developed small bowel polyp-related complications requiring emergent surgery. No patients developed small bowel cancer, but nine extra-gastrointestinal neoplasms were recorded.Conclusion:An enteroscopy-based approach appears to be well tolerated and effective in decreasing polyp-related complications in Peutz–Jeghers syndrome patients, thus reducing the need for emergent surgery. Although the prevention of small bowel polyp-related complications remains the main goal in these patients, the high incidence of extra-gastrointestinal neoplasms appears to be a rising issue.

Role of multidetector computed tomography enterography in the evaluation of small bowel diseases

Background: Small bowel imaging is technically challenging due to the difficulty in displaying the long and serpentine small bowel in entirety and intrinsic motion peristalsis and positional changes caused by breathing. Multidetector computed tomography (MDCT) enterography with the use of neutral enteric contrast permits an excellent assessment of the small bowel pathologies. Objective: The objective of this study is to determine the radiological features of small bowel diseases with respect to the presence, localization, causes, and associated complications with MDCT enterography. Materials and Methods: This is a single-center, cross-sectional, analytical study, which was carried over a period of 2 years on 43 patients, in a medical institute at department of radiodiagnosis. The study was conducted with Philips Brilliance 64-Slice computed tomography machine with neutral enteric contrast and intravenous contrast agents with arterial and enteric or portal phases. Imaging findings were correlated clinically, surgically, and histopathologically. Results: Out of the 43 cases, nine cases (20.93%) were of malignant pathologies, 20 cases were of nonmalignant mural pathologies (46.51%), and 14 cases were other intraluminal or extraluminal pathologies. The common bowel wall patterns found in nonneoplastic pathologies were segmental (50%), symmetrical (70%), mild-to-moderate wall thickening (70%), homogeneous and stratified attenuation patterns (95%), whereas segmental (80%), asymmetrical (80%), marked wall thickening (100%), and heterogeneous enhancement patterns (60%) with distal bowel involvement in primary malignancy cases. Mean wall thickness in malignant pathologies (21.56 ± 15.68 mm) was statistically significantly higher than mean wall thickness of nonmalignant pathologies (7.85 ± 3.69 mm) with P value of 0.031 ( Conclusion: MDCT enterography is a powerful diagnostic tool for the study of small bowel disorders, including inflammatory disease, small bowel neoplasms, and mechanical obstruction.