Prognostic Factors in Resected Primary Small Bowel Tumors

Brücher, Björn L.D.M.; Roder, J. D.; Fink, U.; Stein, H. J.; Busch, R.; Siewert, J. R.

doi:10.1159/000018585

Cited by 41 publications

(21 citation statements)

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“…[1][2][3] Surgeons and physicians are challenged by this tumor because of its infrequency, unspecific symptoms and typically delayed diagnosis. 1,[3][4][5] Prognostic factors are the residual tumor (R category), tumor stage according to the UICC, lymph node metastasis, lymphatic vessel invasion and vascular invasion. [4][5][6] Mucosal contact time with bile acid solutions seems to be one important factor in the development of adenocarcinoma of the small bowel, 7 implicating bile as a potential carcinogen.…”

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confidence: 99%

“…1,[3][4][5] Prognostic factors are the residual tumor (R category), tumor stage according to the UICC, lymph node metastasis, lymphatic vessel invasion and vascular invasion. [4][5][6] Mucosal contact time with bile acid solutions seems to be one important factor in the development of adenocarcinoma of the small bowel, 7 implicating bile as a potential carcinogen. Other predisposing conditions are small bowel adenomas, familial adenomatous polyposis, celiac disease, cystic fibrosis, peptic ulcer disease 8 and Crohn's disease.…”

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confidence: 99%

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Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel

Brücher

Geddert

Langner

et al. 2006

Intl Journal of Cancer

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Small bowel adenocarcinoma (SB-AC) is a very rare tumor entity. Epigenetic alterations, including hypermethylation of DNA mismatch repair genes and tumor suppressor genes, seem to be important for carcinogenesis in tumors of the gastrointestinal tract, but have not yet been investigated in SB-AC. In the current study, the prevalence of hypermethylation in a panel of genes involved in gastrointestinal carcinogenesis (hMLH1, HPP1, p14 ARF , p16 INK4A , APC) was determined in a series of SB-AC. Paraffin-embedded tumor samples from 56 patients with SB-AC who underwent surgical resection between January 1985 and December 2003 were investigated for hypermethylation by means of methylation-specific real-time PCR, and compared with our findings in a previously investigated series of 50 gastric adenocarcinomas. In comparison with adenocarcinomas of the stomach, SB-AC revealed a significantly higher rate of hypermethylation of HPP1 (86% versus 54%, p 5 0.0003), p16 INK4A (32% versus 10%, p 5 0.0006), and a significantly lower rate of hypermethylation of APC (48% versus 84%, p 5 0.0001). Hypermethylation of hMLH1 and p14 ARF was present in 23% and 9% of SB-AC, respectively. Locally advanced tumor categories (pT3/4) showed a higher rate of hypermethylation of HPP1 (90%) than did early tumor categories (pT1/2 categories, 40%; p 5 0.0036). This was also reflected by the correlation between the HPP1 hypermethylation and high UICC stage (p 5 0.02). No correlation was found between hypermethylation and other clinicopathologic parameters such as age, tumor grade and nodal status. Our findings suggest that hypermethylation of hMLH1, HPP1, p16 INK4A and APC is frequent in primary adenocarcinomas of the small bowel. The differences in the hypermethylation spectrum of small bowel and stomach cancer indicate significant epigenetic differences between these tumors. ' 2006 Wiley-Liss, Inc.Key words: small bowel carcinoma; hypermethylation; methylationspecific real-time PCR; gastric cancer Primary adenocarcinomas of the small bowel (SB-AC) are rare. 1-3 Surgeons and physicians are challenged by this tumor because of its infrequency, unspecific symptoms and typically delayed diagnosis. 1,3-5 Prognostic factors are the residual tumor (R category), tumor stage according to the UICC, lymph node metastasis, lymphatic vessel invasion and vascular invasion. [4][5][6] Mucosal contact time with bile acid solutions seems to be one important factor in the development of adenocarcinoma of the small bowel, 7 implicating bile as a potential carcinogen. Other predisposing conditions are small bowel adenomas, familial adenomatous polyposis, celiac disease, cystic fibrosis, peptic ulcer disease 8 and Crohn's disease. 9 Cases occurring in association with ulcerative colitis and backwash ileitis have also been described. 10 An important epigenetic mechanism for silencing tumor suppressor genes during carcinogenesis is the hypermethylation of CpG islands. 11 In certain cancer types, such as colorectal and endometrial cancers, loss of function of the DNA mis...

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Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel

Brücher

Geddert

Langner

et al. 2006

Intl Journal of Cancer

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“…Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results [9][10][11][12].…”

Section: Resultsmentioning

confidence: 99%

"Segmental Resection of Duodenal Adenocarcinoma: Case Report"

Alaswad¹

2017

BJSTR

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Case presentation50-year-old women presented with an acute attack of vomiting endoscopy done and the cause was found to be a sub mucosal tumor located in the third part III of the duodenum, 5 cm distal of the papilla of Vater An emergency laparotomy after admission and correction of fluid and electrolyte was done. Ligation of tumor-feeding vessels with primary, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Feeding jujeunostomy was done also to supply enteral feeding postoperative. Histology revealed an Adenocarcinoma with a diameter of 2.5 cm after that the patient recover smothly and went home after 10 days to be followed on outpatient basis [6][7][8]. ConclusionTumors of the duodenum are a rare cause of upper gastrointestinal obstruction. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results [9][10][11][12].

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“…So adenocarcinoma is the most common malignant entity in the small intestine, which according to the literature occurs in 45-53.3% of cases [14,15]. It is followed by neuroendocrine tumors (29-35.2%), lymphoma (7.4-15%) and sarcoma/GIST (approx.…”

Section: Malignant Lymphomasmentioning

confidence: 99%

Guidelines – malignant tumors of the small intestine

Häuser

2006

Eur Surg

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Zusammenfassung. Grundlagen: Die seltenen malignen Dünndarmtumore stellen eine heterogene Gruppe von Neubildungen dar, wobei es sich am häufigsten um Adenokarzinome, gefolgt von neuroendokrinen Tumoren, Lymphomen, gastrointestinalen Stromatumoren und Leiomyosarkomen handelt. Aufgrund ihrer Seltenheit sind die Erfahrungen mit dem diagnostischen wie auch mit dem therapeutischen Management dieser Tumorgruppe in Einzelinstitutionen oft gering.Methodik: Auf Basis der Literatur werden Inzidenz, Risikofaktoren, Klassifikation und Symptome dieser Tumoren dargestellt. Weiters werden der diagnostische Allgorithmus und die derzeitige Therapie von malignen Tumoren des Dünndarms aufgezeigt.Ergebnisse: Aufgrund der unspezifischen Symptomatik werden diese Tumore meist sehr spät diagnostiziert. Neben Endoskopie und Dünndarmkontrastmitteldarstel-lung kommt heute der Kapselendoskopie ein hoher Stellenwert in der Diagnose dieser Tumore zu. Gute Langzeitüberlebensergebnisse bei Patienten mit Dünndarmkarzi-nom lassen sich nur durch radikale chirurgische Sanierung mit regionaler Lymphadenektomie erreichen. Für das chirurgische Vorgehen bei neuroendokrinen Dünndarmtu-moren sind Tumorgröße-und Lokalisation ausschlaggebend. Lymphome des Dünndarms werden multimodal behandelt. Bei Vorliegen von Multilokalität bzw. präoperativ nachgewiesenem Lymphknotenbefall stellt das primär systemische Vorgehen die Therapie der Wahl dar. Die sehr seltenen Dünndarmsarkome werden chirurgisch behandelt. Für gastrointestinale Stromatumoren des Dünn-darms hat sich zusätzlich die medikamentöse Therapie mit STI-571 (Imatinib, Glivec ® ) etabliert.Schlussfolgerungen: Eine präoperative Diagnose ist nur in etwa 50% aller malignen Dünndarmtumoren mög-lich. Dementsprechend erfolgt die Diagnose in vielen Fäl-len erst durch die Laparotomie und nachfolgende histologische Untersuchung des entfernten Tumors. In der Behandlung dieser Tumoren kommt dem radikalen chirurgischen Vorgehen eine entscheidende Bedeutung zu. Eine hoffnungsvolle neue sehr erfolgreiche Therapieoption konnte in die Behandlung der gastrointestinalen Stromatumore eingeführt werden.Schlüsselwörter: Dünndarm, bösartige Tumoren, Diagnose, Behandlung.Summary. Background: The rare malignant tumors of the small intestine comprise a heterogeneous group. Adenocarcinomas are the most frequent, followed by neuroendocrine tumors, lymphomas, gastrointestinal stromal tumors (GIST) and leiomyosarcomas. Because of their rarity, individual institutions often have little experience with diagnostic and therapeutic management of this tumor group.Methods: On the basis of the literature, incidence, classification, risk factors and symptoms of these tumors are presented. Furthermore, diagnostic algorithms for malignant small-intestinal tumors, as well as recent therapeutic modalities, are shown.Results: Due to their unspecific symptoms, these tumors are usually diagnosed late. Along with endoscopy and contrast studies, capsule endoscopy has become an important tool in the diagnosis of these tumors. Good long-term survival c...

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Prognostic Factors in Resected Primary Small Bowel Tumors

Cited by 41 publications

References 20 publications

Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel

Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel

"Segmental Resection of Duodenal Adenocarcinoma: Case Report"

Guidelines – malignant tumors of the small intestine

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Prognostic Factors in Resected Primary Small Bowel Tumors

Cited by 41 publications

References 20 publications

Hypermethylation of hMLH1, HPP1, p14ARF, p16INK4A and APC in primary adenocarcinomas of the small bowel

Hypermethylation of hMLH1, HPP1, p14ARF, p16INK4A and APC in primary adenocarcinomas of the small bowel

"Segmental Resection of Duodenal Adenocarcinoma: Case Report"

Guidelines – malignant tumors of the small intestine

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Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel

Hypermethylation of hMLH1, HPP1, p14^ARF, p16^INK4A and APC in primary adenocarcinomas of the small bowel