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Two patients with gastrointestinal (GI) tract bleeding underwent preoperative selective visceral arteriography that demonstrated small-bowel tumors compatible with leiomyoma. A review of the material indicates that 42% of patients with small-bowel leiomyomas also have GI tract bleeding. Arteriography is valuable in obtaining a preoperative diagnosis.
We treated a patient with adenocarcinoma complicating long-standing Crohn's disease; this brings the total number of reported cases to 38. Review of the previously published cases suggests that adenocarcinoma complicating chronic Crohn's disease is a separate pathologic entity, as compared with carcinoma de novo of the small bowel.
A predictable and progressive experimental intestinal obstruction, simulating a malignancy but without neoplastic change has been produced by application of a silicone rubber ring around the bowel of 20 rats, seven dogs, and five monkeys. Serosal reaction produced fibrous tissue that resulted in an "apple core" obstruction. An easily assembled extraluminal balloon device of silicone rubber can be used to produce acute and progressive experimental obstruction, especially of the large bowel.
Of 1573 consecutive patients with endometriosis diagnosed at laparoscopy or celiotomy, 85 patients (5.4%) had gastrointestinal involvement and 11 patients (0.7%) required bowel resection due to recurrent gastrointestinal symptoms (usually obstructive in nature) and/or suspicion of malignancy. Of 63 patients with gastrointestinal involvement at sites other than the appendix, who did not undergo bowel resection, only two patients had gastrointestinal symptoms at the time of diagnosis (neither patient had obstructive symptoms); follow-up has revealed that only one patient subsequently developed significant gastrointestinal symptoms. Fifteen patients had appendiceal endometriosis, but none had symptoms suggestive of appendicitis. Indications for resection of gastrointestinal endometriosis include the presence of clear-cut obstructive symptoms or the inability to exclude malignancy. The absence of gastrointestinal symptoms appears to be predictive of the absence of clinically significant intestinal endometriosis, and bowel resection is not indicated in the asymptomatic patient. Appendiceal endometriosis appears to be an incidental finding and one that is not clinically important.
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We encountered an unusual case of carcinoid tumor of the terminal ileum with intermittent recurrent small bowel obstruction of seven years' duration rather than the usual presentation of chronic progressive obstruction.
BACKGROUND: Small bowel adenocarcinoma (SBA) accounts for 2% of gastrointestinal (GI) tumors and 1% of GI cancer deaths. The objective of this study was to review the National Cancer Data Base (NCDB) to identify case-mix characteristics, patterns of treatment, and factors influencing survival of patients with SBA. METHODS: NCDB data from patients diagnosed with primary SBA between 1985-1995 were analyzed. Chi-square statistics were used to compare differences between groups. Disease specific survival (DSS) was calculated using the life table method for patients diagnosed between 1985-1990; univariate differences in survival were compared using the Wilcoxon statistic, and multivariate analyses were performed using a Cox regression model. RESULTS: There were 4995 SBA cases reported to the NCDB between 1985-1995, 55% of which occurred in the duodenum, 18% in the jejunum, 13% in the ileum, and 14% in nonspecified sites. The overall 5-year DSS was 30.5%, with a median survival of 19.7 months. By multivariate analysis, factors significantly correlated with DSS included patient age, tumor site, disease stage, and whether cancer-directed surgery was performed. CONCLUSIONS: SBA is found most commonly in the duodenum, and patient DSS is reduced at this site compared with those patients with jejunal or ileal tumors. This reduction in survival was associated with a lower percentage of cancer-directed surgery. Patients age > 75 years had a reduced DSS and more duodenal tumors, and were less frequently treated by cancer-directed surgery than their younger counterparts. This study reflects the experience with SBA from a large cross-section of U.S. hospitals, allowing for the identification of prognostic factors and providing a reference with which results from single institutions may be compared.
BACKGROUND: It remains unclear whether the presence of mucosa-associated lymphoid tissue (MALT) lymphoma has prognostic implications for patients with primary small intestine lymphoma. METHODS: The clinicopathologic features of 80 patients with primary small intestine lymphoma were examined retrospectively in relation to the presence of MALT lymphoma. Survival was compared univariately and multivariately among the groups divided by clinicopathologic findings. RESULTS: Twenty-one cases (26%) were diagnosed as low grade B-cell lymphoma (15 marginal zone B-cell lymphoma of MALT type, 2 mantle cell lymphoma, and 4 follicle center lymphoma), 46 cases (58%) were diagnosed as high grade B-cell lymphoma (19 secondary large cell lymphoma with a low grade MALT component, 17 diffuse large cell lymphoma without MALT features, 7 Burkitt lymphoma, and 3 lymphoblastic lymphoma), and 13 cases (16%) were diagnosed as T-cell lymphoma. A significantly better survival was noted for patients without colorectal and/or gastric involvement, diffuse infiltration under macroscopy, high grade histology, and perforation. Those patients with MALT type tumors, less advanced stage of disease, B-cell phenotype, benign lymphoid follicular hyperplasia, and radical tumor resectability appeared to have a better survival rate. Based on Cox multivariate analysis, early stage disease and MALT-derived tumors were determined to be independent prognostic factors (P < 0.05). CONCLUSIONS: The presence of MALT-derived lymphoma appears to have a favorable prognosis among patients with primary small intestinal lymphoma.
To investigate the role of tobacco and alcohol use and dietary factors in the etiology of small intestinal adenocarcinoma, we analyzed data from a large population-based case-control study of multi-site cancers conducted in Los Angeles County between 1975 and 1984. The present analysis included interview information on 36 small intestinal adenocarcinoma patients and 998 population controls. After adjusting for age and ethnicity, men who smoked more than 100 cigarettes during their lifetimes were at a non-significantly 3-fold increased risk for small intestinal adenocarcinoma; this association was substantially weaker in women. In men and women combined, a significant 3-fold increased risk in heavy drinkers (80+ g ethanol/day) relative to more moderate drinkers and non-drinkers was observed. Although frequent (>6 times vs. less than 2 times of intake a week) intake of foods rich in heterocyclic aromatic amines (based on the combined intake of fried bacon and ham, barbecued and/or smoked meat and smoked fish) was associated with a significant 4.5-fold increased risk of small intestinal adenocarcinoma in men; this association was not present in women. Based on 2 questions that provided a crude assessment of sugar intake, risk of small intestinal adenocarcinoma in men and women appeared to be associated with adding sugar regularly in coffee or tea and daily intake of non-diet carbonated soft drinks. When we computed total sugar intake from tea, coffee and non-diet carbonated soft drinks, there was a consistent and significant trend of increasing sugar intake and risk of small intestinal adenocarcinomas. Compared with the lowest intake level a day (<5 g), medium (5-25 g) and high intakes (>25 g) were associated with ORs of 2.5 and 3.8, respectively.
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Four cases of carcinoma of the small bowel following chronic regional enteritis are presented. Search of the medical literature revealed 31 other cases reported up to the present. We must entertain the possibility that chronic regional enteritis may predispose to the development of cancer of the small bowel.