PRIMARY TUMORS OF THE SMALL INTESTINE (ANALYSIS OF 102 PATIENTS)

Primary tumors of the small intestine are uncommon and a correct preoperative diagnosis is extremely difficult. From 1964 to 1983, 102 cases of this disease were detected surgically at our hospital. In order to investigate the problems involved in diagnosis and treatment, a comprehensive analysis of small intestinal tumors is made in this paper.

Clinical analysis of primary anaplastic carcinoma of the small intestine

Primary anaplastic carcinoma is a rare variant of small intestinal cancer. Most reports of primary anaplastic carcinoma of the small intestine are isolated case reports, therefore the clinicopathological features, therapeutic management, and surgical outcome of this tumor type remain unclear. This review analyzes the available clinical characteristics of primary anaplastic carcinoma of the small intestine and investigates key differences from differentiated adenocarcinoma of the small intestine. A Medline search was performed using the keywords ＇small intestine＇ and ＇anaplastic carcinoma＇ or ＇undifferentiated carcinoma＇. Additional articles were obtained from references within the papers identified by the Medline search. The literature revealed a poor prognosis for patients who underwent surgical resection for anaplastic carcinoma of the small intestine, which gave a 3-year overall survival rate of 10.8% and a median survival time of 5.0 mo. The literature suggests that anaplastic carcinoma~ is markedly more aggressive than differentiated adenocarcinoma of the small intestine. Surgical resection with the aim of complete tumor removal provides the only beneficial therapeutic option for patients with anaplastic carcinoma of the small intestine, because chemotherapy and radiation therapy have no significant effect on the rate of survival. However, despite complete tumor resection, most patients with anaplastic carcinoma of the small intestine are at great risk of disease recurrence. Multicenter clinical trials are expected to provide additional therapeutic strategies and establish the efficacy of multimodality adjuvant therapy. This report also highlights the importance of a systematic diagnostic approach for anaplastic carcinoma of the small intestine.

Clinical and ultrasound features of small intestinal stromal tumors in woman pelvic cavity

Objective： The purpose of this study was to search the ultrasound features of small intestinal stromal tumor （SIST） in women by reviewing their clinical data. Methods： The study group consisted of 18 female patients with pathologically proven SIST in our hospital from 2000 to 2009. Medical records were reviewed for clinical information such as manifestation, findings of ultrasonography and immunohistochemical phenotype. Results： The average age of 18 female patients with SIST was 55.2 years （ranged, 39-84 years）. Seventeen cases of them had abnormal hypogastric masses, no mass in one case. The shapes of masses were round or Iobulate beside tightly uterus or ovary. The echo of masses was low. It＇s borders were clear and sometimes irregular. The sizes of the masses varied from 6.89-193.05 cm3, the diameter ranged from 24 tom-110 ram, 85.3% of which 50 mm-110 mm. There were rare color flow signals under color Doppler velocity mode or color Doppler power mode. Exploratory laparotomy confirmed that 16 cases of the tumors originated from small intestine, and 2 cases from the ileocecat. The positive rate of the immunohistochemical phenotype of CDl17 was 88.2%, and CD34 was 76.5%. The examination of pathology confirmed that 16 cases were malignant and 2 cases borderline tumors. Eighteen cases underwent radical surgical resection. Conclusion： The characteristics of SISTs in women pelvic cavity are： age 〉 40 years, a mass （proven not from productive system by ultrasonography） in pelvic cavity, melena, positive findings in pathology and CD117/CD34, especially notice masses which diameter is more than 50 mm and possess potential malignant. Ultrasonography is a convenient and effective tool of screening SISTs.

Multiple metastases to the small bowel from large cell bronchial carcinomas

AIM: Metastases from lung cancer to gastrointestinal tract are not rare at postmortem studies but the development of clinically significant symptoms from the gastrointestinal metastases is very unusual. METHODS: Formalin-fixed, paraffin-embedded tissues were cut into 5 urn thick sections and routinely stained with hematoxylin and eosin. Some slides were also stained with Alcian-PAS. Antibodies used were primary antibodies to pancytokeratin, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, vimentin, smooth muscle actin and CD-117. RESULTS: We observed three patients who presented with multiple metastases from large cell bronchial carcinoma to small intestine. Two of them had abdominal symptoms (sudden onset of abdominal pain, constipation and vomiting) and in one case the tumor was incidentally found during autopsy. Microscopically, all tumors showed a same histological pattern and consisted almost exclusively of strands and sheets of poorly cohesive, polymorphic giant cells with scanty, delicate stromas. Few smaller polygonal anaplastic cells dispersed between polymorphic giant cells, were also observed. Immunohistochemistry showed positive staining of the tumor cells with cytokeratin and vimentin. Microscopically and immunohistochemically all metastases had a similar pattern to primary anaplastic carcinoma of the small intestine. CONCLUSION: In patients with small intestine tumors showing anaplastic features, especially with multiple tumors, metastases from large cell bronchial carcinoma should be first excluded, because it seems that they are more common than expected.

Gastrointestinal neuroendocrine tumors in 2020

Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological,biological,and clinical characteristics that have increased in incidence and prevalence within the last few decades.They contain chromogranin A,synaptophysin and neuron-specific enolase which are necessary for making a diagnosis of neuroendocrine tumor.Ki-67 index and mitotic index correlate with cellular proliferation.Serum chromogranin A is the most commonly used biomarker to assess the bulk of disease and monitor treatment and is raised in both functioning and non-functioning neuroendocrine tumors.Most of the gastrointestinal neuroendocrine tumors are non-functional.World Health Organization updated the classification of neuroendocrine tumors in 2017 and renamed mixed adenoneuroendocrine carcinoma into mixed neuroendocrine neoplasm.Gastric neuroendocrine tumors arise from enterochromaffin like cells.They are classified into 4 types.Only type I and type II are gastrin dependent.Small intestinal neuroendocrine tumor is the most common small bowel malignancy.More than two-third of them occur in the terminal ileum within 60 cm of ileocecal valve.Patients with small intestinal neuroendrocrine tumors frequently show clinical symptoms and develop distant metastases more often than those with neuroendocrine tumors of other organs.Duodenal and jejunoileal neuroendocrine tumors are distinct biologically and clinically.Carcinoid syndrome generally occurs when jejuno-ileal neuroendocrine tumors metastasize to the liver.Appendiceal neuroendocrine tumors are generally detected after appendectomy.Colonic neuroendocrine tumors generally present as a large tumor with local or distant metastasis at the time of diagnosis.Rectal neuroendocrine tumors are increasingly being diagnosed since the implementation of screening colonoscopy in 2000.Gastrointestinal neuroendocrine tumors are diagnosed and staged by endoscopy with biopsy,endoscopic ultrasound,serology of biomarkers,imaging studies and functional somatostatin scans.Various treatment options are available for curative and palliative treatment of gastrointestinal neuroendocrine tumors.

Small intestinal hemolymphangioma with bleeding:A case report

Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestinal hemolymphangioma with bleeding in a 57-year-old woman.She presented with persistent gastrointestinal bleeding and endoscopy revealed a small intestinal tumor.Partial resection of the small intestine was thus performed and the final pathological diagnosis was hemolymphangioma.We also highlight the difficultly in making an accurate preoperative diagnosis in spite of modern imaging techniques.To arrive at a definitive diagnosis and exclude malignancy,partial resection of the small intestine was considered to be the required treatment.

Double contrast-enhanced ultrasonography of a small intestinal neuroendocrine tumor:a case report of a recommendable imaging modality

A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to theWest China Hospital.The diagnosis remained unclear after colonoscopy and computed tomography.Double contrast-enhanced ultrasonography was then performed and a neoplasm in the small intestine was suspected,supported by a thin-section computed tomography and positron emission tomography/computed tomography.This was confirmed pathologically after surgery to be a small intestinal G1 neuroendocrine tumor.Surgery was performed to remove approximately 25 cm of small bowel and a 3-cm solid mass located in the mesentery.The patient had a complete recovery and was tumor-free at the final follow-up.Small intestinal tumors including neuroendocrine tumors have always posed a diagnostic challenge.This case indicated that double contrastenhanced ultrasonography is feasible in detection of small intestinal neuroendocrine tumors,and it may be an advisable approach assisting diagnosis of small intestinal tumors.