Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects

Anzidei, Michele; Napoli, Alessandro; Zini, Chiara; Kirchin, Miles A.; Catalano, Carlo; Passariello, Roberto

doi:10.1259/bjr/20673379

Cited by 79 publications

(45 citation statements)

References 57 publications

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“…Computed tomography and magnetic resonance imaging techniques can be useful in detecting those lesions, particularly with the advent of high-resolution images. 8,36 Despite this, they cannot provide precise data about the intestinal mucosa and can miss some lesions, particularly if small and flat. Endoscopic methods such as upper endoscopy and colonoscopy can be appropriate if the lesion is located as close as the proximal duodenum or as far as the terminal ileum, but the rest of the small bowel cannot be accessed.…”

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confidence: 99%

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

et al. 2015

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adenocarcinoma (n = 11), seguido do sarcoma (n = 6), linfoma (n = 6) e tumores neuroendócrinos (n = 3). A principal forma de apresentação esteve relacionada com perdas hemáticas ou obstrução intestinal. Ao diagnóstico, 46% dos doentes tinham metástases distantes/tumor irressecável. A maioria dos tumores foi diagnosticada por técnicas endoscópicas (41%) ou imagiológicas (35%). No primeiro ano após o diagnóstico, 29% dos doentes faleceram. Na análise multivariada, o adenocarcinoma permaneceu fator independente para pior sobrevida. Discussão: Os doentes com adenocarcinoma apresentaram-se em estádios tardios e com tumores irressecáveis, contribuindo para um pior prognóstico. É necessário um elevado grau de suspeita clínica para o diagnóstico de cancro do intestino delgado. Conclusão: As características dos doentes foram globalmente consistentes com o descrito na literatura. A cápsula endoscópica e a enteroscopia assistida por balão são úteis no diagnóstico, gestão e vigilância do cancro do intestino delgado. Palavras-chave: Endoscopia por Cápsula; Neoplasias Intestinais; Portugal.ABSTRACT Purpose: Despite being rare entities, the incidence of malignant small bowel tumors seems to be rising. The development of capsule endoscopy and balloon assisted enteroscopy provided an advance in the assessment of small bowel lesions. We aim to describe the clinical and pathological characteristics of patients with small bowel cancer and ascertain what roles these endoscopic techniques currently have. Material and Methods:A retrospective study of patients diagnosed with small bowel cancer, from January 2010 to October 2014, was performed. The data was submitted to statistical analysis. Results: Of the 28 diagnosed patients, 54% were female. The mean age at diagnosis was 61 years. Adenocarcinoma was the most frequent tumor (n = 11), followed by sarcoma (n = 6), lymphoma (n = 6) and neuroendocrine tumors (n = 3). The main form of presentation was related to blood loss or intestinal obstruction. By the time of diagnosis, 46% of patients had distant metastasis/ unresectable cancer. Most of the tumors were diagnosed by endoscopic (41%) or imaging techniques (35%). In the first year after diagnosis, 29% of patients died. In multivariate analysis, adenocarcinoma remained an independent factor for worse survival. Discussion: Patients with adenocarcinoma presented at late stages and with unresectable tumors, contributing to a worse outcome. A high degree of clinical suspicion for the diagnosis of small bowel cancer is necessary. Conclusion:The characteristics of the patients were generally consistent with those described in the literature. Capsule endoscopy and balloon assisted enteroscopy are useful in the diagnosis, management and surveillance of small bowel cancer.

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confidence: 99%

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

et al. 2015

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“…Advances in endoscopy, double balloon enteroscopy computed-topography (CT) and magnetic resonance imaging (MRI) have improved our ability to detect and clinically stage SBC. [17][18][19][20][21][22] Upper gastrointestinal series (UGIS)/small-bowel follow-up through (SBFT) remain a mainstay in the evaluation of SB tumors due to its simplicity, diagnostic value and cost. The utilization of double contrast method of enteroclysis has increased the detection sensitivity to almost 90%; however, it is only used in 50 to 60% patients being evaluated for SB pathology due to limitations such as lack of visualization of a luminal lesion and the need for a highly-skilled radiologist.…”

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confidence: 99%

Impact of Nodal Staging for Small Bowel Carcinoid: More is Better!

Tran

Reich

Leung

et al. 2013

World Journal of Endocrine Surgery

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Current guidelines for small bowel carcinoid (SBC) do not specify the extent lymph node (LN) staging required. Our aim was to determine whether analyzing more LNs in patients who undergo surgical resection for SBC correlated with improved survival. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients undergoing surgical resection for histologically confirmed SBC from 1988-2009. The number of LNs examined was categorized into 0, 1 to 6, 7 to 11 and 12+ nodes. Patient demographics and tumor characteristics were assessed by Logrank and Cox regression analysis. The median number of LNs examined for all 2796 patients was 4.00 (mean 6.83). For all stages of jejunal and ileal tumors examined, increased nodal sampling was associated with significantly improved survival (p < 0.001). On regression analysis, older age, non-white race, larger tumor size, higher T-stage and number of LNs examined were predictive of worse survival. For jejunal and ileal SBC, adequate lymphadenectomy, consisting of 12 lymph nodes, correlates with significantly improved survival. Presently, no guideline exists for SBC LN staging, but it is critical to ensure adequate surgical staging in patients who undergo resection for jejunal and ileal SBC.

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“…Carcinoid tumors are more common in the ileum (most within 60 cm of the ileocecal valve) than in the jejunum or duodenum, and lesions may be multiple and/or metastatic (liver and lungs) at the time of diagnosis because one fourth of carcinoid tumors in the small intestine are multiple [7]. On the guideline, by far the majority of small intestinal neuroendocrine tumors (NETs, including carcinoid) are malignant in nature.…”

Section: Discussionmentioning

confidence: 99%

Multiple carcinoid tumors of the small intestine preoperatively diagnosed by double-balloon endoscopy

et al. 2012

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SummaryBackgroundMultiple carcinoid tumors of the small intestine are rare and are very difficult to detect preoperatively.Case ReportA 75-year-old woman in whom the bleeding focus could not be found by upper and lower endoscopy and abdominal CT was admitted for evaluation of anemia. We examined the patient with total double-balloon endoscopy (DBE) and located multiple submucosal tumors. The multiple carcinoid tumors were resected successfully under laparoscopy.ConclusionsWe report a case of a successful laparoscopic operation for multiple carcinoid tumors in the small intestine without intraoperative endoscopy. Total digestive tract observation using DBE is very useful for laparoscopic operation for multiple tumors in the small intestine.

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Malignant tumours of the small intestine: a review of histopathology, multidetector CT and MRI aspects

Cited by 79 publications

References 57 publications

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis

Impact of Nodal Staging for Small Bowel Carcinoid: More is Better!

Multiple carcinoid tumors of the small intestine preoperatively diagnosed by double-balloon endoscopy

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