Small Intestine Tumors, Benign

• • 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

Epidemiology

Adenoma

• • Tubular

  • -Low malignant potential

    -Can cause obstruction or intussusception

  • Villous

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

  • Brunner gland: No malignant potential

Stromal Tumors

• • Mesenchymal neoplasms

  • The most common symptomatic benign neoplasm

  • Most in the jejunum

  • Associated with ulceration, bleeding, and obstruction

Lipomas

• • Most in the ileum, may cause obstruction

  • No malignant potential

Hamartomas

• • Part of Peutz-Jeghers syndrome

  • Polypoid and may cause intermittent intussusception and bleeding

  • Rare malignant potential

Hemangiomas

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

Symptoms and Signs

• • Often asymptomatic

  • Abdominal pain

  • GI bleeding

  • Abdominal distention

  • Abdominal tenderness

Laboratory Findings

• • Anemia

Imaging Findings

• • 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

• • 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

Rule Out

• • Malignant tumors

• • Contrast radiography

  • CT scan

  • Endoscopy if feasible

When to Admit

• • High-grade obstruction

  • Bleeding

• • Many benign tumors require no specific treatment if asymptomatic

Surgery

• • Symptomatic lesions require either resection or endoscopic excision

Indications

• • Symptoms (obstruction, bleeding)

  • Tubular or villous adenomas

  • All stromal tumors

  • Large or extensive hemangiomas

  • Large hamartomas

Complications

• • Obstruction

  • Bleeding

  • Intussusception

Prognosis

• • Good after resection of benign lesions

References