Nature of the mucosal changes associated with malignant neoplasms in the small intestine.

Lee, F D

doi:10.1136/gut.7.4.361

Cited by 17 publications

(4 citation statements)

References 12 publications

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“…In some patients, villous atrophy has been found in association with a jejunal carcinoma, but there is little or no evidence of a malabsorption syndrome preceding the onset of malignancy. The reports of Joske (1960) and Blackwell (1961) and Lee (1966) fall into this group. In other reports the duration of malabsorption before the diagnosis of the carcinoma is too short to warrant a diagnosis of preceding coeliac disease, despite some supporting evidence.…”

Section: Discussionmentioning

confidence: 98%

“…This was in marked contrast to the fifteen cases of abdominal lymphoma where unequivocal evidence of malabsorption was found in thirteen, and villous changes in all but one of these. Lee (1966) reviewed the surgically resected primary malignant tumours of the small intestine over a similar period from the Western Infirmary Glasgow. Of the lymphoid tumours, only two of nine cases showed a normal mucosa, but in only one of nine cases of adenocarcinoma was there subtotal villous atrophy.…”

Section: Introductionmentioning

confidence: 99%

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Coeliac disease and small bowel carcinoma

Kenwright

1972

Postgraduate Medical Journal

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Summary Small bowel carcinoma can occur in association with villous atrophy in the jejunum. In most reported cases there is doubt as to which of these represents the primary lesion. These cases are reviewed here. A further case is reported in which a carcinoma developed in a patient known to be suffering from coeliac disease for some years, although he was not on a gluten-free diet for the time preceding the diagnosis of carcinoma. On dietary restriction he remains well at 2-year follow-up. Possible aetiological factors are discussed.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Coeliac disease and small bowel carcinoma

Kenwright

1972

Postgraduate Medical Journal

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“…Observation of the changes described may be particularly useful in clarifying aetiology in the patient suffering from idiopathic steatorrhoea whose clinical state and steatorrhoea do not improve on a gluten-free diet. Such measurements may also be of value in elucidating the nature of jejunal mucosal changes in patients who have other disease (Townley, Cass, and Anderson, 1964;Johnstone and Adams, 1964;Creamer, 1964 andGjone, Myren, and Refsum, 1965;Lee, 1966;Fry and McMinn, 1966;Marks, Shuster, and Watson, 1966;Shuster, Watson, and Marks, 1968 The biopsies were taken in three treatment periods, I, II, and III, as well as in the pretreatment period, P, andin the gluten loading period, G. The changes in the mucosa were analysed for the intervals from P to each of I, II, III, and G; from I to II; and from III to G. None of the patients had a biopsy in every one of the five periods and some patients had more than one biopsy in a given period. These replicates were deleted so that, at most, one biopsy was recorded in each period, the dates being chosen so as to equalize the time intervals as much as possible.…”

Section: Uicknessmentioning

confidence: 99%

The effect on jejunal mucosa of withdrawing and adding dietary gluten in cases of idiopathic steatorrhoea

Pollock¹,

Nagle²,

Jeejeebhoy³

et al. 1970

Gut

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“…At laparotomy for intestinal obstruction two years later, an adenocarcinoma of the ileum was resected, and jejunal biopsy several months later showed partial villous atrophy. Lee (1966) reports a man of 53 years without a history of malabsorption, who had an adenocarcinoma of the jejunum and subtotal villous atrophy.…”

Section: Discussionmentioning

confidence: 99%

Carcinoma, villous atrophy, and steatorrhoea.

Brzechwa-Ajdukiewicz¹,

McCarthy²,

Austad³

et al. 1966

Gut

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EDITORIAL SYNOPSIS There appears to be an increased incidence of carcinoma of the fore and mid gut in patients with villous atrophy of the small intestine.Intestinal reticulosis may arise as a complication of idiopathic steatorrhoea (Gough, Read, and Naish, 1962). Creamer (1964) has suggested that malignancy anywhere in the body may be accompanied by villous atrophy of the small intestinal mucosa. In this paper, seven patients with steatorrhoea and accompanying carcinoma are presented and the possible reasons for this association are discussed.CASE REPORTS CASE 1 A man aged 50 years was in good health until April 1961, when he complained of pain in the right buttock and was treated with phenylbutazone. He afterwards developed watery diarrhoea, passing six to 10 motions daily, which lasted a fortnight. Subsequently his bowels opened four times a day and the stools weie clay coloured and offensive. His appetite was good. Apart from pallor, physical examination was normal.Investigations showed that haemoglobin was 47 % with evidence of iron deficiency. A small intestinal barium meal showed the features of steatorrhoea. Faecal fat was 90 g. in three days. Xylose absorption was normal. A glucose tolerance test (50 g.) produced a rise of 40 mg./100 ml. The patient refused to have a jejunal biopsy.He was followed up in the Out-patient Department and the iron-deficiency anaemia was treated with oral and parenteral iron. When a gluten-free diet was prescribed his weight increased by 8 lb. and a subsequent three-day faecal fat estimation was 26 g. As anaemia persisted in spite of treatment, he was admitted for transfusion during the summer of 1962. A 51Cr-labelled red cell study was carried out and showed an average daily blood loss of 39 4 ml. Faecal fat was 23-9 g. in three days.In December 1962 he was admitted as an emergency because of upper abdominal pain, and after a blood transfusion a laparotomy was carried out, at which an ulcerated annular tumour was found 10 cm. below the duodeno-jejunal flexure. The tumour and 15 cm. of jejunum were resected. Histological examination showed the tumour to be an adenocarcinoma with no lymph node metastases. The jejunum showed partial villous atrophy.He has been in good health since the operation with bowels opening once a day. Haemoglobin has risen to 97%.CASE 2 A man, aged 70 years at the time of death, had had attacks of diarrhoea and lower abdominal pain since 1946. Idiopathic steatorrhoea and megaloblastic anaemia were diagnosed in 1954. He was treated with a gluten-free diet and improved. He was admitted again in 1960 because of diarrhoea and weight loss. On examination he was small, wasted, and pale. Clubbing was present as were abdominal distension and dorsal kyphosis.Investigations revealed 36 g. of fat in a 24-hour stool collection and only 1-7 g. of 25 g. of d-xylose was excreted in the urine in five hours. A glucose tolerance test revealed a maximum rise of 10 mg./100 ml. A jejunal biopsy showed subtotal villous atrophy. Serum albumin was 2-2 g./100 ml. and serum y gl...

show abstract

Nature of the mucosal changes associated with malignant neoplasms in the small intestine.

Cited by 17 publications

References 12 publications

Coeliac disease and small bowel carcinoma

Coeliac disease and small bowel carcinoma

The effect on jejunal mucosa of withdrawing and adding dietary gluten in cases of idiopathic steatorrhoea

Carcinoma, villous atrophy, and steatorrhoea.

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