Occult small-bowel tumours: Their diagnostic features and management

Aim: Small bowel tumors are rare tumors originating from the gastrointestinal tract. In this study, we aimed to determine the clinical characteristics and prognostic factors effecting survival in patients with small bowel cancer. Material and Methods: Eighty patients with small bowel malignancy between February 2002 and December 2016 were evaluated retrospectively. Clinical characteristics, pathological features, laboratory results, progression-free and overall survival rates were determined. The effect of the evaluated parameters on survival was examined.Results: The incidence of small bowel tumors was 0.36% in patients admitted to our clinic. The median age of the patients was 55 and 68.8% of the patients were male. The most common histologic subtype was adenocancer (42.5%), and the most common localization site (37.5%) was duodenum. 27 of patients (33.8%) had metastasis at the time of diagnosis. The most common site of metastasis was liver. Overall survival rate was 59.1% in the third year and 52.9% in the fifth year. The median disease-free survival (DFS) rate was 78% in the third year and 68% in the fifth year. Conclusion: Information about these tumors is limited in the literature and was presented in retrospective case series. In our study, the most common localization site was found as duodenum and the most common histological type was adenocancer. Prognosis of patients undergoing curative surgical resection was found to be better.

Primary cystadenocarcinoma of the mesentery is an extremely rare malignant cystic epithelial tumor and represents the malignant spectrum of mesenteric mucinous cystic neoplasms. Due to its rarity, fewer than 25 cases have been reported in the literature, and the clinical characteristics, diagnostic features, and optimal management strategies remain poorly defined. Patients usually present with nonspecific symptoms related to mass effect, including abdominal pain, abdominal distension, nausea, vomiting, constipation, or a palpable abdominal mass, often mimicking ovarian or gastrointestinal tumors. Preoperative diagnosis is particularly challenging because radiological findings are not pathognomonic and tumor markers have limited diagnostic value. We report a rare case of primary mesenteric cystadenocarcinoma in a 20-year-old female who presented with progressive abdominal distension, abdominal pain, nausea, vomiting, constipation, and exertional shortness of breath. Clinical examination revealed a large abdominal mass. Contrast-enhanced positron emission tomography–computed tomography demonstrated a large lobulated abdominopelvic mass with internal septations and heterogeneous enhancement, producing significant mass effect including bilateral ureteric dilatation and hydronephrosis. However, the exact origin of the lesion could not be determined preoperatively. Exploratory laparotomy revealed a large cystic mass arising from the mesentery with dense adhesions to the colon. Complete surgical excision was performed without rupture. Histopathological examination confirmed papillary mucinous cystadenocarcinoma of mesenteric origin. This case highlights the diagnostic difficulty associated with mesenteric cystic malignancies and emphasizes that complete surgical excision remains essential for definitive diagnosis and management.

To investigate the clinical characteristics of metastatic tumors in small intestine. The clinical manifestations, imaging and endoscopic findings, treatment methods and follow-up of patients with small bowel metastatic tumors admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2022 were retrospectively analyzed. A total of 10 patients were included, including 7 males and 3 females, aged 33-77 (56.4±12.6) years. The main clinical manifestations were intestinal obstruction (8 cases), such as abdominal pain, abdominal distension, nausea, vomiting, and reduced defecation. Some patients had intussusception (abdominal pain, vomiting, black stool and other symptoms, 1 case) or gastrointestinal bleeding (1 case) with early symptoms imperceptible. The primary tumors include gastric cancer (3 cases), malignant melanoma (2 cases), ovarian cancer (2 cases), colon cancer (1 case), rectal cancer (1 case), and lung cancer (1 case). Most of the primary tumors were poorly differentiated (6 cases) or moderately to poorly differentiated (2 cases). The median time from primary tumor surgery to detection of small bowel metastasis [M (Q1, Q3)] was 22 (18, 28) months.The metastatic lesions were single (6 cases) or multiple (4 cases), in both jejunum and ileum. Positron emission tomography-computed tomography (PET-CT, 3 cases) and endoscopy (2 cases) were helpful for detection of small intestinal metastases. The main treatment methods were surgical resection (9 cases), supplemented by radiotherapy, targeted drugs, immunotherapy, etc. Postoperative recurrence and metastasis occurred in some patients (5 cases). Most patients died within 4 to 29 months after diagnosis. Metastatic tumors in small intestine are rare in clinical practice with atypical early symptoms. The patients often present with complications such as intestinal obstruction, which is prone to delayed diagnosis and poor prognosis.

To investigate the clinical, endoscopic and pathological features in primary colorectal non-Hodgkin lymphoma. Twenty-four cases of primary colorectal non-Hodgkin lymphoma were studied retrospectively. The main clinical symptoms were abdominal pain, abdominal mass, loss of weight, fever, bloody stools and altered bowel habits. There were 6 cases (25.0%) involving two or more lesion sites, including three cases showing continuous skip-distribution from sigmoid colon to ascending colon, one case showing the homologous manifestation from rectum to cecum, one case involving ascending colon and rectum, and the last one involving sigmoid colon and rectum. There were 18 cases involving single lesion site and the caecum was the most frequently affected site (44.4%, 8 cases). The major endoscopic phenotypes were ulcer (39.1%), bossing (43.5%) and infiltrating (17.4%). The major pathology types were diffuse large B-cell lymphoma (11/24, 45.8%), intestinal T-cell lymphoma (8/24, 33.3%), and mucosa-associated lymphoid tissue lymphoma (MALT) (3/24, 12.5%). 2 of 24 cases (8.3%) were not decided. Twenty-one patients were treated surgically, containing fifteen radical excisions, one local excision, four palliative excisions and one exploratory laparotomy. Sixteen postoperative patients accepted CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or COP (cyclophosphamide, vincristine, prednisone) chemotherapy, and three patients abandoned treatment. Twenty-one patients were followed up and the 5-year survival rate was 37.7%. The clinical features of primary colorectal non-Hodgkin's lymphoma have no specificity. Ulcer and bossing are the two major morphologic manifestations of endoscopic. Diffuse large B-cell lymphoma and intestinal T-cell lymphoma are the main pathological types. Comprehensive treatment of surgery and chemotherapy are effective methods for primary colorectal non-Hodgkin lymphoma.

Whipworm infection resulting in eosinophilic colitis with occult intestinal bleeding

Stool specimens of 104 primary schoolchildren (mean+/-SD age = 8.2+/-0.3 years) were examined for helminth eggs and for occult blood to investigate the possibility that trichuriasis causes occult intestinal bleeding in the absence of the overt Trichuris dysentery syndrome. A commercially available guaiac test was used to detect fecal occult blood. Sixty-one children had Trichuris infection, 11 of whom had heavy infections (> 10,000 eggs per gram of feces [epg]), and 53 had Ascaris infections. No hookworm infection was detected. Baseline screening yielded only one weakly positive occult blood test result in a child with a light (800 epg) Trichuris infection. Serial stool occult blood testing on the 11 subjects with heavy trichuriasis and 8 uninfected controls yielded a single weakly positive result in the control group. The results provide no evidence that trichuriasis predisposes to significant occult gastrointestinal bleeding in children in the absence of the dysenteric syndrome.

Úlceras estenosantes, múltiples, recurrentes y crónicas del intestino delgado: una entidad propia como causa de dolor abdominal, anemia ferropénica y enteropatía pierde proteínas

OCCULT INTESTINAL BLEEDING AS A CAUSE OF ANÆMIA IN ELDERLY PEOPLE

Intestinal Tuberculosis (ITB) presents a significant diagnostic challenge due to its nonspecific clinical presentation and the lack of comprehensive local data to guide diagnostic strategies. This study aims to fill the gap by conducting a twelve-year retrospective cross-sectional analysis at a tertiary hospital in Cebu, Philippines. Electronic records of 209 patients aged 18 years old and above were first reviewed, focusing on clinical features, laboratory results, endoscopic findings, and CT scan of the abdomen. Initial screening identified 54 patients meeting the predefined criteria for gastrointestinal tuberculosis (GITB). In addition, statistical analyses, including logistic regression models, were employed to identify significant predictors of ITB which can further enhance the ITB diagnosis and management in the region. Clinical manifestations observed include: symptoms and signs resembling those observed in malignancies and inflammatory bowel diseases, such as abdominal pain (92.6%), ascites (57.4%), fever (51.9%), hematochezia (25.9%), abdominal mass (24.1%) and intestinal obstruction (5.6%). The findings from CT scans of the abdomen were consistent with other studies, including the presence of matted mesenteric lymph nodes (79.6%), concentric mural thickening (57.4%), ileocecal involvement (44.4%). However, dilated bowel loops (20.4%), intestinal perforation (5.4%) and strictures (3.7%) were observed in only a few cases. Ileocecal involvement was found to be a dependable predictor among all the variables when logistic regression analysis was employed, emphasizing its diagnostic utility. Our findings highlight the importance of local epidemiological insights in improving diagnostic strategies and patient outcomes. Consolidating the clinical profiles and diagnostic markers contributes to evidence-based strategies tailored to the Philippine context. This localized approach can further help medical professionals in making more informed decisions. Future studies could validate these findings to develop region-specific predictive tools, for a more time sensitive management of ITB. Keywords. Intestinal Tuberculosis, Clinical features, Indicators, Ileocecal involvement.

Objective To summarize the clinical features of neuroblastoma (NB) with bone metastasis, and preliminarily to analyze the relationship between clinical features, treatment effects and prognosis of NB with bone metastasis and further studying why children with NB would have bone metastasis happened.As such, this paper was seek for more effective therapy to improve patients′survival rates. Methods The retrospective research was carried out to analyze the medical records of 130 patients with bone metastasis of NB from March 2007 to July 2013 who were diagnosed and systematically treated in Beijing Children′s Hospital(BCH) Affiliated to Capital Medical University accor-ding to BCH-NB-2007 protocol.The data were reviewed for the medical history, clinical features and laboratory examination results before treatment.The research evaluated the treatment outcome and overall survival rate of the 88 cases treated and followed up all along at BCH.The deadline for follow-up was December 31, 2014. Results One hundred and thirty children of NB with bone metastasis were included in the research.There were 87 boys and 43 girls; the age was between 8-147 months, the median age was 41 months, 94(72.3%) children′s age was less than 5 years old.The main primary site was retroperitoneal and adrenal region(106 cases, 81.5%) and mediastinum(17 cases, 13.1%). The main clinical symptoms were fever(81 cases, 62.3%), bone pain(51 cases, 39.2%), abdominal pain(29 cases, 22.3%), and abdominal mass(14 cases, 10.8%). A total of 88 cases got systemic treatment and follow-up at BCH.Only 1 infant with NB, at 8 months old with a retroperitoneal mass, with bone marrow and bone metastasis, but no MYCN gene amplification, was given carboplatin plus etoposide and cyclophosvnamide, vincristine and doxorubicin according to European neuroblastoma risk grouping for alternating 8 times, he received tumor resection after 4 courses of chemotherapy and was followed up for 20 months, and the condition was now in stable.The remaining 87 patients as high risk(HR)-NB, were treated regularly by BCH-NB-2007 protocol, with the median follow-up time of 23 months, 52 cases(59.1%) turned out to have tumor progression or relapse.Forty cases died of tumor related diseases and 1 case died of measles infection.The expected overall survival rates were 49.5% in 3 years and 41.3% in 5 years. Conclusions NB with bone metastasis was very common in children over 18 months, and their common clinical symptoms are fever, bone pain and anemia.More than 80% of primary tumor was located in retroperitoneal and adrenal gland area, most of the patients with bone marrow metastasis.Since the overall prognosis is poor in these children, continuous clinical and further study is needed to investigate the causes of bone metastasis in children with NB, and to provide a basis for more effective treatment. Key words: Neuroblastoma; Bone metastasis; Clinical features; Prognosis

The symptoms of small bowel malignancies are mild and frequently nonspecific, thus patients are often not diagnosed until the disease is at an advanced stage. Moreover, the lack of sufficient studies and available data on small bowel cancer makes diagnosis difficult, further delaying proper treatment for these patients. In fact, only a small number of published studies exist, and there are no studies specific to Thailand. Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes. To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand's Siriraj Hospital. This retrospective analysis included 185 adult patients (97 men, 88 women; mean age = 57.6±14.9) with pathologically confirmed small bowel cancer diagnosed between January 2006 and December 2013. Clinical, radiologic, and endoscopic findings were collected and compared between each subtype of small bowel cancer. Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Adenocarcinoma was the second most common (25.9%, n = 48), while lymphoma and all other types were identified in 24.3% (n = 45) and 10.3% (n = 19) of cases, respectively. The most common symptoms were weight loss (43.2%), abdominal pain (38.4%), and upper gastrointestinal bleeding (23.8%). Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST. Obstruction and ulcerating/circumferential masses were findicative of adenocarcinoma, as revealed by radiology and endoscopy, respectively. Finally, no specific symptoms were related to lymphoma.

Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.

Small intestinal stromal tumors (SIST) with skeinoid fibers (SF) are reported in four patients with neurofibromatosis. SF appeared as intercellular eosinophilic globules that stained positively on periodic acid-Schiff stain and bluish on Masson trichrome stain, like those reported previously. Electron microscopic confirmation of SF was carried out on tissue retrieved from paraffin blocks, which revealed diagnostic ultrastructural features of SF. The association of SIST with SF and neurofibromatosis enhances the diagnostic value of SF as a marker of neurogenic spindle cell tumors. This study also underscores the importance of electron microscopy for differentiation of SF from pseudoskeinoid structures, which may mimic SF on light microscopic examination.

To evaluate the clinical, laboratory, and diagnostic features in women with abdominal tuberculosis that resembled advanced ovarian malignancy. A retrospective review of women with abdominal tuberculosis who were managed at GCRI Ahmedabad from 1996 to 2001 was undertaken. Fifteen patients (3.06%) with suspected ovarian cancer cases, finally diagnosed as abdominal tuberculosis over a 6-year period (1996-2001), are analyzed. During this period, 492 patients were operated for suspected ovarian malignancy. Pre-operatively, ultrasound-guided biopsies were inconclusive in 14 cases and hence, exploratory laparotomy was planned. They underwent laparotomy and biopsy for final diagnosis. Frozen sections-of peritoneal/omental biopsies in 11 cases and ovarian tumour in three cases-were indicative of tuberculosis in all the 14 cases. The data of this study indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intra-operatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.

Purpose: For exact diagnosis and treatment, exploratory laparotomy is usually needed. The aim of this study was to verify the usefulness of single incision laparoscopic surgery for small bowel resection. Methods: Five patients who underwent single incision laparoscopic surgery for small bowel tumor at our hospital from April 2010 to September 2011 were analyzed retrospectively. Results: There were three m ale and two female patients. The mean age of patients was 55 years. The mean body mass index was 23.6 kg/㎡. The largest diameter of the tumor ranged from 1.2 to 7.7 cm. The length of incision ranged from 3 to 6.5 cm (mean, 4.3 cm). The Octoport (Dalim, Seoul, Korea) was used in three cases, and a glove-port or SILS port was used in the other cases. After the whole abdominal exploration and localization of the tumor, the small bowel, including the tumor, was resected and end to end anastomosis was made extracorporeally. The mean operation time was 111.8 minutes. The mean length of hospital stay was 7.2 days. There was no occurrence of postoperative complication. Histologically, two tumors were diagnosed as gastrointestinal stromal tumors, and the other three patients were diagnosed as heterotopic pancreas, lipoma, and diffuse large B cell lymphoma, respectively. Conclusion: Single incision laparoscopic surgery is very useful for localization and resection of small bowel tumors. Compared to conventional laparoscopic surgery, it can reduce the number of trocars without increased difficulty. Small bowel tumor can be a suitable indication for single-incision laparoscopic surgery.