[Enteroscopy in the diagnostics of the jejunum and ileum tumors].

Small bowel tumors are very uncommon and account for 3% to 6% of all gastrointestinal neoplasms. Practical application of videocapsule endoscopy and balloon-assisted enteroscopy have allowed to investigate and reveal neoplasmatic leasions in deep parts of gastrointestinal tract which earlier were hard to access. The modern techniques allow to evaluate the macroscopic picture of tumors more clearly, to determine its nature and location, take biopsy sample, to prescribe reasonable chemotherapy, to remove a tumor endoscopically or define indications for a planned surgical intervention. This article presents a widely overview over epidemiology, classification, clinical aspects, methods and diagnostic possibilities of different diagnostic techniques of revealing small bowel tumors, and own results of diagnosis and treatment of patients (n = 48) with small bowel tumors (2003-2010).

The influence of mutation site and age on the severity of duodenal polyposis in patients with familial adenomatous polyposis.

BACKGROUND: The present study was undertaken to identify factors affecting the severity of the duodenojejunal polyposis in patients with familial adenomatous polyposis. METHODS: Duodenojejunal polyposis was evaluated in 41 consecutive patients with familial adenomatous polyposis (mean age 41 years, range 21-63 years), 33 (80%) with known APC mutation, by using a standardized endoscopic protocol. The severity of the polyposis was graded with the Spigelman scoring system (0-12 points), the Spigelman score/age ratio, and the presence or absence of advanced adenomas (>1 cm in diameter and/or high-grade dysplasia). RESULTS: The Spigelman score (median 8, range 3-12) was higher in patients older than 50 years (median 10, range 3-12) as compared with younger patients (median 7.5, range 3-11; p = 0.043). A significant association between age and the presence of advanced adenomas was also observed. Patients with a mutation in the central part of the APC gene (codons 279-1309) had a higher Spigelman score and Spigelman score/age ratio as compared with patients with other mutations: median Spigelman score/age ratio 0.21 (range 0.14-0.40) versus 0.10 (range 0.06-0.20) (p < 0.001). CONCLUSIONS: Older age and APC mutation in the central part of the gene are risk factors for the development of severe duodenojejunal polyposis.

Prognostic value of the TNM-classification for small bowel cancer.

BACKGROUND/AIMS: To examine the relationship between the pathological stage and survival for adenocarcinoma of the small bowel. MATERIALS AND METHODS: The medical records of 99 patients with small bowel cancer, diagnosed between January 1984 and December 1993, were reviewed retrospectively. Lymphomas and carcinomas of the ampulla of Vater were excluded from this study. All operated patients with adenocarcinomas were staged by the TNM-classification using pathological and surgical reports. RESULTS: Sixty-four adenocarcinomas, 24 carcinoid tumours and 11 sarcomas were analysed. The cancer-specific 5-year survival rate for patients with adenocarcinoma, carcinoid tumours and sarcomas was 22%, 39% and 55%, respectively. Twenty-eight patients with adenocarcinoma underwent radical tumor resection: segmental resection in 20, pancreaticoduodenectomy in 7 and ileocoecal resection in one patient. In the remaining 34 patients "curative" resection was not feasible and none of them survived for more than 3 years. The 5-year survival rate of the curatively resected patients was 46%. Actuarial 3-year survival rate for stage I was 38%, 70% for stage II and 0% for stage III. CONCLUSION: Our results demonstrate that survival is poor for patients with lymph node metastasis, despite apparently curative surgery.

Dendritic cell phenotype in localized malignant histiocytosis of the small intestine.

We studied a unique case of a localized non-Hodgkin's lymphoma of the pleomorphic large-cell type arising in the small intestine to determine its phenotype. Immunohistochemical staining for S100 protein, lysozyme, alpha 1-antitrypsin, and Leu-M1 was performed. Many lymphoma cells were positive for S100 protein and were negative with the other antibodies. These findings indicate a probable dendritic cell origin for this lymphoma similar to that seen in histiocytosis X and some cases of malignant histiocytosis, but apparently quite distinct from the S100 protein-negative, lysozyme-positive, alpha 1-antitrypsin-positive cells seen within the mononuclear phagocytic system.