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  • • Often asymptomatic or subtly symptomatic

    • -Symptomatic tumors are more likely to be malignant

    • Benign tumors are more likely pedunculated and more commonly cause intussusception

    • May be a cause of GI bleeding

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Epidemiology

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Adenoma

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  • • Tubular

    • -Low malignant potential

      -Can cause obstruction or intussusception

    • Villous

    • -Significant malignant potential, associated with inherited colonic polyposis syndromes

    • Brunner gland: No malignant potential

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Stromal Tumors

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  • • Mesenchymal neoplasms

    • The most common symptomatic benign neoplasm

    • Most in the jejunum

    • Associated with ulceration, bleeding, and obstruction

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Lipomas

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  • • Most in the ileum, may cause obstruction

    • No malignant potential

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Hamartomas

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  • • Part of Peutz-Jeghers syndrome

    • Polypoid and may cause intermittent intussusception and bleeding

    • Rare malignant potential

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Hemangiomas

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  • • Small and diffuse or large and isolated, can be a source of recurrent GI hemorrhage

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Symptoms and Signs

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  • • Often asymptomatic

    • Abdominal pain

    • GI bleeding

    • Abdominal distention

    • Abdominal tenderness

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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  • Contrast radiography or enteroclysis: May visualize tumor as a filling defect or mass lesion.

    CT scan: Mass may be visualized after administration of contrast

    Endoscopy

    • -Most lesions are inaccessible

      -Allows direct visualization as well as biopsy for diagnosis

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  • • Most benign tumors of the small intestine are asymptomatic

    • -When symptoms occur, they are often related to obstruction, intussusception, or bleeding

    • Differentiating benign from malignant stromal tumors may be difficult

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Rule Out

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  • • Malignant tumors

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  • • Contrast radiography

    • CT scan

    • Endoscopy if feasible

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When to Admit

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  • • High-grade obstruction

    • Bleeding

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  • • Many benign tumors require no specific treatment if asymptomatic

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Surgery

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  • • Symptomatic lesions require either resection or endoscopic excision

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Indications

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  • • Symptoms (obstruction, bleeding)

    • Tubular or villous adenomas

    • All stromal tumors

    • Large or extensive hemangiomas

    • Large hamartomas

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Complications

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  • • Obstruction

    • Bleeding

    • Intussusception

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Prognosis

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  • • Good after resection of benign lesions

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References

Blanchard DK et al. Tumors of the small intestine. World J Surg. 2000;24:421.  [PubMed: 10706914]
Gore RM et al: Diagnosis and staging of small bowel tumours. Cancer Imaging 2006;6:209.  [PubMed: 17208678]
Hyland R, Chalmers A: CT features of jejunal pathology. Clin Radiol 2007;62:1154.  [PubMed: 17981162]
Miettinen M, Lasota J: Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006;130:1466.  [PubMed: 17090188]

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