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  • • Often symptomatic

    • -Abdominal pain most common presenting complaint

    • Circumferential luminal growth results in progressive obstruction

    • Bleeding is a feature of ulcerated tumors

    • Besides primary neoplasms, the small bowel may be a site of metastatic disease

    • Diagnosis usually radiographic by contrast study or CT scan

    • Resection indicated for cure and palliation

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Epidemiology

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Adenocarcinoma

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  • • 50% of cases

    • Risk factors include:

    • -Crohn disease

      -Polyposis syndromes

      -Villous adenomas

      -Family history of nonpolyposis colorectal cancer

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Lymphoma

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  • • 15-20% of cases

    • Most common extranodal lymphoma

    • May be primary or part of disseminated disease

    • Most are non-Hodgkin B-cell

    • More common in the ileum

    • Risk factors include:

    • -Malabsorption

      -Inflammatory intestinal disease

      -Immunosuppression

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Stromal Tumors

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  • • 10-20% of cases

    • Distinction between benign and malignant difficult

    • Tumors are extraluminal and subserosal

    • Metastases present in 30% at presentation

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Metastatic Tumors

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  • • Affect small bowel by direct extension, carcinomatosis, or hematogenous spread

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Symptoms and Signs

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  • • Abdominal pain

    • GI bleeding

    • Malabsorption (lymphoma)

    • Weight loss

    • Abdominal distention

    • Abdominal tenderness

    • Palpable abdominal mass (stromal tumor)

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Laboratory Findings

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  • • Anemia

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Imaging Findings

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Adenocarcinoma

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  • Radiographic contrast study

    • -Annular with ulcerated mucosa

      -"Apple core" appearance

    CT scan: Detection of metastases and staging

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Lymphoma

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  • Radiographic contrast study: Thickened mucosa, ulceration, submucosal nodules

    CT scan

    • -Diffuse bowel wall thickening, mesenteric adenopathy, mass lesion

      -Detection of metastases and staging

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Stromal Tumors

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  • Radiographic contrast study

    • -Extraluminal mass

      -Central necrosis with contrast filling

    CT scan

    • -Extraluminal mass with vascularity and central necrosis

      -Detection of metastases and staging

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  • • Most small intestinal tumors are not accessible by endoscopy and diagnosis relies on symptoms, radiographic appearance, and clinical suspicion

    • Differentiating benign and malignant stromal tumors based on mitotic frequency, nuclear atypia, cellularity, size of tumor, and central necrosis

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Rule Out

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  • • Benign tumors of the small intestine

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  • • CBC

    • GI contrast radiograph study

    • CT scan

    • Endoscopy and biopsy (if lesion is accessible)

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When to Admit

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  • • High-grade obstruction

    • Bleeding

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Surgery

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  • • All malignant tumors require wide segmental resection

    • Even if not curative, resection may palliate obstruction and bleeding

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Indications

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  • • All malignant tumors

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Medications

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  • • Chemotherapy and radiation therapy have proved beneficial for lymphoma

    • Imatinib mesylate for stromal tumors

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Complications

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  • • Obstruction

    • Perforation

    • Bleeding

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Prognosis

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Adenocarcinoma

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