Advances in the diagnosis of primary solid small bowel tumors by contrast-enhanced multislice spiral CT / 中国辐射卫生

@#Primary small bowel tumors have low incidence and contain predominantly solid components, and the lesions are similar and difficult to be detected and distinguished with multislice spiral CT (MSCT) plain scans. In this article we describe contrast-enhanced MSCT technique and imaging characteristics for solid small bowel tumors or small bowel tumors containing predominantly solid components, including the type and use of contrast agents. In contrast-enhanced MSCT, small bowel imaging with CT has the advantages of determining the true extent of intestinal wall lesions, the possible extent of wall penetration, the degree of mesenteric involvement, and distant metastases, as well as easiness to detect and identify the blood supply vessels of small bowel tumors and assessment of the corresponding complications. Contrast-enhanced MSCT has become the best noninvasive imaging technique for the diagnosis, evaluation, and staging of solid small bowel tumors or small bowel tumors containing predominantly solid components. CT texture analysis (CTTA) is a new research hotspot and can be useful for the correct diagnosis of primary small bowel tumors containing predominantly solid components.

Clinical analysis of 180 cases of primary small intestinal tumor / 中华消化杂志

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

Neurofibroma del mesenterio en un paciente sin enfermedad de Von Recklinghausen / Mesenteric neurofibroma seen in a patient without Von Recklinghausen´disease

Los neurofibromas son tumores benignos del sistema nervioso que pueden ser solitarios o múltiples: la neurofibromatosis o enfermedad de Von Recklinghausen. Estos tumores en general son de consistencia blanda, frecuentes a nivel de partes blandas, su localización en el aparato digestivo es infrecuente y no son encapsulados. El objetivo del presente trabajo fue presentar el caso de una paciente con neurofibroma mesentérico sin enfermedad de Von Recklinghausen. Se presenta el caso de una paciente de 41 años que fue ingresada por dolor abdominal y una tumoración palpable en la región entre flanco e hipocondrio izquierdo. En los estudios imaginológicos realizados se informó como quiste del mesenterio, lo que fue confirmado en el acto quirúrgico. Se realizó exéresis de la tumoración informada por Anatomía Patológica como neurofibroma secundariamente enquistado benigno. El neurofibroma mesentérico es una tumoración que puede verse en pacientes sin enfermedad de Von Recklinghausen.

Neurofibromas are benign tumors of the nervous system that can be solitary or multiple, the neurofibromatosis or Recklinghausen's disease. In general, these tumors are soft, non-encapsulated, more frequent in soft parts of the body and infrequent in the digestive system. The objective of the present paper was to present a female patient with mesenteric neurofibroma and without Von Recklinghausen disease. Here is a 41 years-old female patient who was admitted to the hospital because she suffered abdominal pain and a palpable tumor at the region between left flank and hypochondrium. The imaging studies revealed a mesenteric cyst, which was confirmed in surgery. The tumor was classified as a benign cyst neurofibroma by pathological anatomy and finally removed. The mesenteric neurofibroma is a tumor that can be found in patients without Von Recklinghausen disease.

Gastrointestinal bleeding caused by epitheloid sarcoma: A case report

Epithelioid sarcoma (ES) of the small bowel is a rare gastrointestinal tumour. We report a case of gastrointestinal bleeding secondary to small bowel ES in a 55-year-old gentleman. After gastroscopy and colonoscopy failed to identify the source of bleeding, we proceeded with computed tomography angiogram of the mesentery, which revealed intraluminal blood clot in the distal jejunum with features of obstruction. This is a rare cause of obscure gastrointestinal bleeding and emphasises the need for additional evaluation in the presence of negative endoscopic findings.

Value of the use of balloon-assisted enteroscopy in diagnosis and treatment of small bowel tumor / 解放军医学杂志

Objective To study the value of the use of balloon-assisted enteroscopy (BAE) in the diagnosis and treatment of small bowel tumor. Methods From May 2007 to September 2014, a total of 126 patients with suspected small bowel tumor were enrolled. BAE was performed in all the patients. Of them, abdominal CT scan were performed in 80 patients, gastrointestinal barium radiography in 22, and capsule endoscopy in 24. The positive detection rate, sensitivity, specificity, and the rates of missed diagnosis and misdiagnosis of different examinations were compared. Balloon-assisted endoscopic treatment was conducted in some patients, and its safety and feasibility were assessed. Results The positive rate, sensitivity, and specificity of BAE for suspected small bowel tumor were significantly higher than that of abdominal CT scan, gastrointestinal barium radiography and CE (The positive rates of balloon-assisted enteroscopy, abdominal CT, gastrointestinal barium, capsule endoscopy were 92.9%, 47.5%, 68.2%, 91.7% respectively; their sensitivity 100%,71.1%, 66.7%, 100%, and specificity 100%, 82.9%, 28.6%, 22.2%), respectively (P<0.01), while the rates of diagnostic failure and misdiagnosis were remarkably lowered (The rates of diagnostic failure of balloon assisted enteroscopy, abdominal CT, gastrointestinal barium, capsule endoscopy were 0%, 28.9%, 33.3%, 0%, and the rates of misdiagnosis from these 0%, 17.1%, 71.4%, 77.8% respectively) (P<0.0l). In a certain number patients with intestinal neoplasm, removal of the tumor could be performed with the aid of BAE. Conclusion With the aid of BAE, the rate of positive diagnostic rate of small bowel tumor is significantly elevated, and it is safe and reliable for endoscopic removal for some small bowel tumors, thus it is valuable in clinical application.

Adenocarcinoma del intestino delgado asociado al síndrome de Lynch / Adenocarcinoma of the small intestine associated with Lynch syndrome

El síndrome de Lynch (SL) es una enfermedad autosómica dominante causada por una mutación en los genes de reparación del ADN que predispone al cáncer colorrectal (CCR) y a otros tumores extracolónicos. Entre estos predominan los del endometrio, estómago, tracto urinario alto y ovario. La incidencia de los tumores de intestino delgado (TID) si bien es baja (0,4-2,9%), supera en más de 25 veces a la de la población general. El objetivo de este trabajo es presentar un caso de carcinoma del duodeno en un paciente masculino de 47 años con criterios de Amsterdam II, y discutir las características de los TID en el SL.

Lynch Syndrome (LS) is an autosomal dominant condition caused by mutations in the mismatch repair genes that predispose to colorectal cancer (CRC) and other extracolonic tumors. Among these, endometrial, gastric, ovarian, and urinary tract tumors are the commonest. The incidence of small bowel tumors (SBT), although low (0.4-2.9%), exceeds in more than 25 times that of the general population. The purpose of this paper is to communicate a case of carcinoma of the duodenum in a 47 years old male with Amsterdam II criteria, and discuss the characteristics of SBT in LS.

Single Incision Laparoscopic Surgery for Small Bowel Tumor

PURPOSE: For exact diagnosis and treatment, exploratory laparotomy is usually needed. The aim of this study was to verify the usefulness of single incision laparoscopic surgery for small bowel resection. METHODS: Five patients who underwent single incision laparoscopic surgery for small bowel tumor at our hospital from April 2010 to September 2011 were analyzed retrospectively. RESULTS: There were three m ale and two female patients. The mean age of patients was 55 years. The mean body mass index was 23.6 kg/m2. The largest diameter of the tumor ranged from 1.2 to 7.7 cm. The length of incision ranged from 3 to 6.5 cm (mean, 4.3 cm). The Octoport (Dalim, Seoul, Korea) was used in three cases, and a glove-port or SILS port was used in the other cases. After the whole abdominal exploration and localization of the tumor, the small bowel, including the tumor, was resected and end to end anastomosis was made extracorporeally. The mean operation time was 111.8 minutes. The mean length of hospital stay was 7.2 days. There was no occurrence of postoperative complication. Histologically, two tumors were diagnosed as gastrointestinal stromal tumors, and the other three patients were diagnosed as heterotopic pancreas, lipoma, and diffuse large B cell lymphoma, respectively. CONCLUSION: Single incision laparoscopic surgery is very useful for localization and resection of small bowel tumors. Compared to conventional laparoscopic surgery, it can reduce the number of trocars without increased difficulty. Small bowel tumor can be a suitable indication for single-incision laparoscopic surgery.

CT Findings of Gastrointestinal Stromal Tumor versus Lymphoma of the Small Intestine

PURPOSE: To compare CT features of gastrointestinal stromal tumors (GIST) with those of lymphomas in the small intestine. MATERIALS AND METHODS: CT findings of 11 pathologically confirmed GIST patients and 10 lymphoma patients were retrospectively reviewed. CT findings were analyzed with regard to location, size, margin, growth patterns, internal character, enhancement, invasion, vascular encasement, lymphadenopathy, intestinal obstruction and ascites. RESULTS:An extraluminal mass was present in 82% (9/11) of the GIST patients versus 30% (3/10) of the lymphoma patients. Circumferential wall thickening was observed in 80% (8/10) of the lymphoma patients (p.05). CONCLUSION: Features revealed by CT scans are highly useful in differentiating GIST from lymphoma of the small intestine. Extraluminal growth and internal necrosis or gas are more common in patients with GIST compared with lymphoma. CT features of circumferential wall thickening and associated lymphadenopathy are more common in patients with lymphoma.

Comparative study on diagnostic yield and accuracy of double balloon enteroscopy with barium enteroclysis and capsule endoscopy in patients suspected with small bowel tumors / 中华消化杂志

Objective To investigate the diagnostic yield and accuracy of double balloon enteroscopy, barium enteroclysis and capsule endoscopy in patients with suspicion of small bowel tumors. Methods Double balloon enteroscopy were performed in fifty nine patients with suspicion of small bowel tumors.The route of enteroscopy could be either via mouth or via anus.At the same time,34 and 17 out of 59 subjects received either barium enteroclysis or capsule endoscopy.The results of exams were analyzed independently and final diagnosis of each case was compared thereafter.Results Nineteen of 34 patients undergone the enteroclysis were diagnosed as small bowel tumor.The diagnostic yield was 55.9%.The diagnosis was finally confirmed by the enteroscopy in 12 cases,which indicated the accurate rate of enteroclysis was 63.2%(12/19).Double balloon enteroscopy detected tumors in 3 of 15 subjects with negative enteroclysis finding.The diagnostic yield of capsule endosocpy was 47.1%(8/17),and among the 8 cases diagnosis was comfirmed by the enteroscopy in 4 cases.Small bowel tumors were detected in 2 of 9 cases with negative capsule endoscopy findings.Thirty-six cases of small bowel tumor were detected by double balloon enteroscopy via a route(mouth or anus),and 16 patients were diagnosed after both route procedure.No small bowel tumor was found in 7 paitents.The overall diagnostic yield of enteroscopy was 88.1%.The diagnosis were all finally confirmed by pathological examination.No procedure-related complication were observed.Conclusion Double balloon enteroscopy is superior to enteroclysis and capsule endoscopy in diagnostic yield and accuracy for small bowel tumors.

Surgical Management of Metastatic Small Bowel Cancer with Intussusception: Two case reports

Intussusception in adults, a rare disease, constitutes approximately 5% of all intussusceptions and accounts for 5% of all cases of intestinal obstruction. In the pathologic findings of the causative lesion, metastatic tumors of the small intestine with intussusception are extremely rare. Because of the high prevalence of underlying lesions in intussusception in adults, surgical management is mandatory. We report two cases of intussusception; one was an adult patient who developed an ileo-ileal type, metastasis from lung cancer, and the other patient was an adult who was developed jejuno-jejunal type, metastasis from a malignant melanoma of the thumb.

Primary Neoplasms of the Small Bowel

BACKGROUND: Primary tumor of the small bowel is uncommon less than 6% of all gastrointestinal tumors. Its symptoms and signs are nonspecific and its diagnosis is difficult. METHODS: We analyzed 43 patients with primary small bowel tumor who had undergone operations at the Chungnam National University Hospital from January 1990 to December 1997. RESULTS: 1) In total 43 cases, 19 cases (44.2%) were male and 24 cases (55.8%) were female, benign tumors were 13 cases (30.2%) and malignant tumors were 30 cases (69.8%). The mean age was 51 year. 2) The primary sites of benign tumors were the duodenum in 5, jejunum in 3, ileum in 5 cases. The primary sites of malignant tumors were the duodenum in 13, jejunum in 9, ileum in 8 cases. 3) Polyp was most common benign tumor (30.7%), and leiomyosarcoma was most common malignant tumor (43.3%). 4) The most common symptom was abdominal pain (65.1%), followed by melena (34.9%) and weight loss (20.9%). The most common sign was palpable mass (39.5%) and anemia (39.5%). 5) In the duodenal tumors, the detectabilities of endoscopy and upper gastrointestinal series were 68.8% and 71.4%, respectively. In the jejunal and the ileal tumors, the detectabilities of small bowel series were 62.5% and 71.4%, respectively and those of abdominal computed tomogram were 50.0% and 42.9%, respectively. The accuracy of preoperative diagnosis was 7 cases (53.8%) in benign and 20 cases (66.7%) in malignant tumor. 6) In cases of malignant tumor, curative resection was performed in 18 cases (60.0%), palliative resection was performed in 10 cases (33.3%), and bypass procedure was performed in 2 cases (6.7%). In cases of benign tumor, small bowel resection was performed in 9 cases and excision of duodenal polyp was performed in 2 cases. 7) The mean follow-up period of malignant tumor of 27 cases except 3 hospital mortality cases was 35 months. During this time, 7 cases were dead due to recurrence. The mean survival time of 7 mortality cases was 20.4 months, of them 4 cases were leiomyosarcoma, 2 cases were adenocarcinoma, and 1 case was lymphoma. CONCLUSIONS: Because diagnosis of small bowel tumor is difficult and confirmed in late stage, high degree of suspicion and endeaver to discover it is important.

A Clinical Analysis of 45 Cases of primary Small Bowel Tumors / 第三军医大学学报

Primary tumors of small intestine are rarely eucountered clinically and account about for 1.5-2% of all the gastrointestinal tumors. It is quite difficult to establish the diagnosis preoperatively. In a 25-year-period from January I960 to December 1984, 45 patients with primary small bowel tumors were admitted to this institute, and their clinical data were analyzed. The rate of wrong diagnosis was 68.8% in this series as compared with 65% to 100% reported in the literature. The causes of misdiagnosis were as follows:1. There is usually no characteristic clinical sign.2. No specific diagnostic procedures are available.3. The clinicians do not have enough vigilance with this disease because of their rarity.It is emphasized that clinicians should be familar with the clinical signs and alert on the possibility of the disease.