The clinical pathological features, diagnosis, treatment and prognosis of small intestine primary malignant tumors

Abstract

The aim of the study was to describe and analyze the clinicopathological features and diagnosis of Chinese patients with small intestine primary malignant tumors and to explore the best therapy to small bowel adenocarcinoma (SBA). More than 26,000 patients with digestive tract malignant tumors received treatment in PLA hospital from 2000 to 2011, and among them, there were 887 patients who had small intestine primary malignant tumors, and 666 of 887 patients had the completed basic clinical documents. We retrospectively analyzed the correlation between clinical and pathological features of the 666 patients and analyzed the survival and prognosis of 173 SBA patients with follow-up data. Both the number of patients with primary malignant tumors of the small intestine and the number of patients who received chemotherapy showed an increasing trend. The ratio of male to female was 1.58:1. The male patients significantly exceed the female patients with tumors of non-ampullary duodenum, jejunum and duodenal ampulla; and most of the patients are over 60 years of age. For patients burdened with either of the pathological types of tumors, the males exceeded the females, but there was no significant difference. Abdominal pain was the main clinical manifestation for patients with tumors of non-ampullary duodenum, jejunum and ileum, and the most common clinical manifestations were jaundice and abdominal pain for patients with ampullary duodenal tumors, adenocarcinoma, neuroendocrine tumors and sarcoma. In addition, patients with stromal tumors were prone to gastrointestinal bleeding. Gastrointestinal endoscopy was the most common examinational procedure. Patients under 60 years of age were prone to surgery and chemotherapy after surgery, and patients over 60 years of age were prone to supportive treatment and chemotherapy without surgery. The medium overall survival of patients who received surgery without chemotherapy, chemotherapy after surgery, chemotherapy without surgery and supportive treatment were 40.0, 35.0, 9.0 and 7.5 months, respectively. For the 173 SBA patients with follow-up data, treatment, age and distant metastasis were important prognostic factors; 149 of 173 SBA patients received only surgery, and the depth of tumor invasion, lymph node metastasis and surgical approach were important prognostic factors. Adjuvant chemotherapy had not provided significant benefit to prolong OS in patients with adenocarcinoma. The incidence of small intestine primary malignant tumors is very low, and it is difficult to diagnose. The patients should be aggressively treated and regularly followed up with related clinical and pathological features. Currently, surgery is the most effective treatment, and the role of chemotherapy needs further large-scale clinical studies.

Pattern and risk factors for distant metastases in gastrointestinal neuroendocrine neoplasms: a population‐based study

“…Therefore, we suppose that small intestine NENs should be divided into duodenal and jejunal/ileal subtypes, which have different embryonic origin and showed different biological behaviors in our study. This conclusion is consistent with some retrospective studies [22][23][24]. The risk factors for metastasis presented in our study suggested that tumor grade, histology, T-stage, and N-stage do not affect the metastatic status in some primary sites, such as the esophagus and stomach.…”

Adult jejunojejunal intussusception in the face of jejunal adenocarcinoma: two infrequently encountered entities

“…Patients may remain asymptomatic for months or even years. Most common clinical manifestations in patients with jejunal adenocarcinoma are abdominal pain and gastrointestinal bleeding resulting in anaemia 14. In a study by Goh et al ,6 anaemia represented an independent preoperative predictor of malignancy in patients presenting with intussusception.…”

“…Despite the fact that small bowel comprises 90% of the length of the alimentary tract, malignancies of the small bowel represent a rare clinical entity 14. They are predominantly of the adenocarcinoma subtype.…”

Primary adenocarcinoma arising from ileo-cecal junction presented with a component of ileo-ileal intussusception

“…Complicated cases usually land up to general surgeon necessitating emergency laparotomy. 8 Duodenal growth near to ampulla of Vater may present with obstructive jaundice. 9 Plain X-ray erect abdomen will show the pattern of small bowel obstruction.…”

“…Final diagnosis is established only by histology after surgical excision. 8 Right hemicolectomy is indicated the terminal ileum and ileocecal growth with end bloc dissection of lymph nodes followed by chemo radiation. Duodenal malignancies will require pancreaticoduodenectomy.…”