68例原发性小肠肿瘤诊治分析

目的探讨原发性小肠肿瘤的临床特点、病理分类及诊治经验。方法回顾性分析近5年收治的68例原发性小肠肿瘤患者的临床、病理资料。结果 68例中良性16例(23.5%),以小肠腺瘤多见,其次为间质瘤。恶性肿瘤52例(76.5%),以小肠腺癌最多见,其次是间质肉瘤和恶性淋巴瘤。肿瘤位于十二指肠24例,空肠24例,回肠20例。常见临床表现为腹痛、消化道出血、腹部肿块及肠梗阻。术前55.9%(38/68)不能明确诊断。结论由于缺乏特异性的临床表现和有效的辅助检查手段,原发性小肠肿瘤的早期诊断较为困难。治疗仍以手术切除为主。     

原发性小肠肿瘤121例临床分析

目的 加强对原发性小肠肿瘤临床表现、诊断技术及病理类型的认识.方法 回顾性分析121例原发性小肠肿瘤患者的临床资料.结果 121例患者主要临床表现依次为腹痛、贫血、消化道出血、黄疸、消瘦、呕吐、腹部包块、发热.原发部位为十二指肠者74例(61.2％)、空肠28例(23.1％)、回肠19例(15.7％).确诊方法包括ERCP和外科手术.121例患者中,恶性肿瘤占85.1％( 103/121),以腺癌、恶性间质瘤常见;良性肿瘤占13.2％( 16/121),腺瘤常见;交界性间质瘤占1.7％ (2/121).结论 原发性小肠肿瘤最常见临床表现为腹痛、贫血,且大部分为恶性肿瘤,ERCP和外科手术可以确诊;加强对其认识有望提高早期诊断率.     

原发性小肠肿瘤12例报告

原发性小肠肿瘤甚为少见[1～3],早期无明显症状,诊断也较为困难。我院外科从1986～1997年共收治原发性小肠肿瘤12例,全部经手术病理证实,特报告如下。1　临床资料男9例,女3例。其中良性4例,恶性8例。年龄28～76岁,平均年龄44岁,病程最短5天,最长2年。肿瘤类型及部位　腺瘤:十二指肠1例,回肠2例。平滑肌瘤:空肠1例。淋巴肉瘤:空肠、回肠各1例。平滑肌肉瘤:空肠2例,回肠1例。腺癌:十二指肠1例,回肠2例。症状　腹痛11例,肠梗阻6例,腹部肿块6例,出血4例。所有病人都伴有不同程度的体重下降,恶心呕吐,发热。通过全消化道气钡双重造影拟诊小肠肿瘤…     

原发十二指肠恶性肿瘤15例报告

本文报道原发十二指肠恶性肿瘤15例;年28～63岁;男10例,女5例。临床表现为十二指肠梗阻者9例,上消化道出血10例,黄疽6例和腹部有肿物4例。钡餐检查皆有不同程度改变。本组病变位于壶腹附近者10例,壶腹上部2例,下部3例。本组8例有大体标本记录,其中5例为溃疡型(常见出血),3例为环形浸润型一(常见梗阻症状)。本组有病理诊断的计腺癌10例、粘液癌、平滑肌肉瘤、淋巴肉瘤和网织细胞肉瘤各1例。8例胰十二指肠切除,5年时2例生存,10年时1例生存。     

原发性小肠恶性肿瘤53例临床病理分析

报告原发性小肠恶性肿瘤53例,其中十二指肠腺癌并血吸虫卵沉着和回肠平滑肌母细胞瘤并肠系膜淋巴结转移各1例。男性39例,女性14例,男女之比为2.8:1。年龄6～71岁,平均43岁;癌的平均年龄49.5岁,恶性淋巴瘤为34.5岁。腺癌43.4％,恶性淋巴瘤32.1％,平滑肌肉瘤20.7％,类癌3.8％。     

原发性小肠肿瘤64例临床分析

目的 探讨原发性小肠肿瘤的临床特点，提高对本病的诊治水平。方法 对我院1985年～2003年手术治疗的64例原发性小肠肿瘤的临床资料进行回顾性分析。结果 64例小肠肿瘤中，良性肿瘤20例(31.2％)，恶性肿瘤44例(68．8％)。良性肿瘤以平滑肌瘤为多，占39％(9／20)；恶性肿瘤以腺癌和淋巴瘤为多，分别占40．9％(18／44)和36．4％(16／44)。腹痛、腹部肿块、肠梗阻、便血及黄疸是小肠肿瘤最常见的临床表现。本组术前确诊23例，仅占35．9％。纤维内镜检查、十二指肠低张造影对十二指肠肿瘤检出率高；小肠分段造影和选择性动脉造影是空、回肠肿瘤的重要诊断方法。结论 原发性小肠肿瘤临床表现无特异性，诊断关键在于提高警惕，并选用合适的影像学检查以确诊。手术是治疗本病的主要方法。     

原发性小肠肿瘤20例临床分析

作者报告原发性小肠肿瘤２０例，其中男性１２例，女性８例，年龄４５岁￣７９岁，平均６２．１岁。２０例中良性５例，恶性１５例。肿瘤分布在十二指肠、空肠各６例，回肠８例。恶性肿瘤以腺癌最多，其次为平滑肌肉瘤和淋巴系统恶性肿瘤。腹痛、上消化道出血和肠梗阻是本组小肠肿瘤的主要症状，不同程度的贫血和腹块是常见体征。本组临床诊断与手术及病理对照，误诊率为５５．０％。除１例未手术外，余１９例均作了手术治疗。作者就     

十二指肠恶性肿瘤的影像诊断

目的回顾性分析十二指肠恶性肿瘤的影像所见。方法原发肿瘤１３例,继发肿瘤３例,１６例病人均行上消化道气钡双重造影。５例病人行ＣＴ检查,２例行血管造影,２例壶腹部癌行Ｂ超检查,其中１例行ＥＲＣＰ检查。结果所有病人均经手术切除,将Ｘ线所见与病理结果对照分析,腺癌７例,平滑肌肉瘤６例,继发性癌３例。结论消化道造影是十二指肠病变的首选检查方法。本组病例均能提示病变部位,其中１３例定性诊断正确,但对一些外生性肿瘤,造影有其局限性,应结合ＣＴ、Ｂ超综合诊断。     

原发小肠肿瘤——附36例报道

 近七年来,处手术切除病理证实的胃肠道肿瘤2000余例,其中36例发生在小肠。36例小肠肿瘤中有16例(44%)在十二指肠,10例(28%)在空肠,10例(28%)在回肠。36例中有33例(90%)为恶性;其中腺癌21例,平滑肌肉瘤5例,恶性淋巴瘤6例,类癌1例;良性肿瘤3例,均为腺瘤。36例小肠肿瘤主要临床表现:腹痛24例(68%),消化道出血18例(50%),腹部肿块15例(41%),肠梗阻12例(33%),29例恶性小肠肿瘤中有26例行手术切除,但只有2例生存5年。     

小肠腺癌内科治疗现状

原发性小肠腺癌(primary small-bowel adenocarcinoma,SBA)是一种十分罕见的消化道恶性肿瘤,约占胃肠道恶性肿瘤的2%,近年来发病率呈上升趋势。其平均发病年龄为50～60岁,最常见的好发部位是十二指肠,其次是空肠、回肠。由于其发病率低,病因尚不完全清楚。目前已知与克罗     

Carcinoid of ampulla of Vater

Carcinoid tumors of ampulla are rare clinical entities. They form 0.35% of all the gastrointestinal carcinoids. So far, only 109 cases have been reported in the literature, mostly as individual case reports. Since the metastatic potential and the tumor size have no correlation, unlike in duodenal carcinoids, pancreatoduodenectomy is considered the treatment of choice. Here we present a case of carcinoid of ampulla presenting to our department.     

Clinical,Radiologic, and Endoscopic Manifestations of Small Bowel Malignancies: a First Report from Thailand

Background: 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. Objective: To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand’s Siriraj Hospital. Materials and Methods: 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. Results: 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%). Conclusions: 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.     

Alveolar soft part sarcoma metastatic to small bowel mucosa causing polyposis and intussuseption

A report of alveolar soft part sarcoma metastatic to the small bowel is presented. Hematogenous metastases to the small bowel from primary tumors outside the abdominal cavity are uncommon, and most remain asymptomatic and are not discovered until autopsy. However, small bowel metastases can lead to intestinal obstruction, intussuseption or even perforation. While metastases to the small bowel have been described for other tumor types, including melanoma and lung cancer, this is extremely uncommon for sarcoma, especially alveolar soft part sarcoma. We describe a 42-year-old male with a long history of alveolar soft part sarcoma, metastatic to the lung and brain, who developed an intussuseption from metastases to the small bowel.     

Small Carcinoid Tumor of Papilla of the Vater with Lymph Node Metastases

Introduction

Carcinoid of papilla of the Vater is a rare entity. Detailed prognostic factors of this tumor have not yet been elucidated, and treatment choices include local resection and pancreatoduodenectomy with excision of lymph nodes.

Case Report

A 59-year-old woman, who was diagnosed with liver dysfunction and underwent a cholecystectomy, was referred to our institution with a suspected ampullary tumor. Computed tomography showed 1 cm of enhancement at the duodenal ampulla, but no visible lymph adenopathy. In the duodenoscopic view, her papilla was slightly enlarged without orifice, so that forceps biopsy was performed from the common ampullary channel after needle-knife incision. Tissue obtained by biopsy revealed a possible carcinoid tumor, with 1.1% of Ki-67 labeling index. Pancreatoduodenectomy was performed, and the resected specimen showed a carcinoid tumor of the ampulla, 1.2 cm in diameter, with metastases to regional lymph nodes and a 4% Ki-67 labeling index. It is suggested that despite the small size and low proliferation index, an ampullary carcinoid may not be cured by local resection. Clinicians must pay careful attention to the choice of treatment and monitoring after the resection.     

Primary Duodenal Adenocarcinoma without Stenosis: A Case Report with a Brief Literature Review

This article focuses on the symptomatic and diagnostic problems of primary duodenal adenocarcinoma (PDA) by way of two case reports and a literature review. An 85-year-old woman with an adenocarcinoma in the 1st duodenal portion was offered palliative care. A 90-year-old woman with an adenocarcinoma in the 3rd duodenal portion was also offered palliative care. A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen. As no reports of PDA without stenosis have been published so far, these cases may add to our knowledge of PDA. The diagnosis of PDA is often delayed because its symptoms may be absent until the tumor has progressed, thus leading to a delay of several months. Patients typically present with a long history of variable and vague symptoms, and many are diagnosed with advanced disease. As regards clinical manifestations, abdominal pain is the most frequent symptom. The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion. Esophagogastroduodenoscopy and gastrointestinal barium radiography are the main diagnostic tests for PDA, detecting 88.6 and 83.3% of tumors, respectively. In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.Key words: Primary duodenal adenocarcinoma, without stenosis; Primary duodenal adenocarcinoma, first portion; Primary duodenal adenocarcinoma, third portion; Best supportive care; Symptoms; Clinical manifestations     

Carcinoid tumors of the ampulla of Vater: a comparison with duodenal carcinoid tumors

BACKGROUND: Although ampullary carcinoid tumors (ACs) are often categorized clinically as duodenal carcinoid tumors (DCs), there are distinct clinical and pathologic differences. METHODS: Clinical, histopathologic, and immunohistochemical features of 12 ACs were compared with those of 53 DCs that did not involve the ampulla. RESULTS: Patients with AC were ages 28-74 years (mean, 54.9 years); 8 were males and 4 were females. Five were white and three were black; the race of four patients was not known. The size of ACs ranged from 0.2 to 5.0 cm in greatest dimension. There were no significant differences between AC patients and DC patients with respect to male predominance, race, tumor size, and mitotic rate. The insular growth pattern was more common in AC; the cribriform type was more common in DC. Four of 12 ACs contained psammoma bodies, versus none of 53 DCs (P = 0.001). The rate of metastasis was similar in patients with AC (4 of 12, 33%) compared with DC patients (14 of 53, 26%). In DC patients, involvement of the muscularis propria, a size greater than 2 cm, and mitotic activity were significantly correlated with metastatic risk. In AC patients, tumor size and mitotic activity had no correlation with metastatic potential. One AC had features of an atypical carcinoid tumor; there were none in the duodenal group. One-half of patients with AC presented with jaundice versus 7% of patients with DC (P = 0.005). Three patients (25%) with AC had von Recklinghausen disease versus 0 of 53 patients with DC (P = 0.003). Immunohistochemically, tumor cells expressed somatostatin in 67%, serotonin and cholecystokinin in 17%, insulin in 25%, and glucagon and gastrin in 0% of ACs. In contrast, 56% of DCs expressed gastrin (P < 0.001). CONCLUSIONS: Carcinoid tumors of the ampulla differ clinically, histologically, and immunohistochemically from carcinoid tumors elsewhere in the duodenum.     

A case report of primary adenocarcinoma of small intestine

This is an account of a case of primary adenocarcinoma of the small intestine with peritoneal dissemination successfully treated with chemotherapy. A 64-year-old woman was admitted with a complaint of severe abdominal distension. Abdominal computerized tomography revealed a bowel obstruction with tumor and the remarkable small bowel dilation of oral side of tumor. The tumor was found at surgery to be at the ileum 15 cm proximal from the ileocecal region. Peritoneal dissemination was recognized around the ileocecal region, so ileum partial resection was performed for the primary cancer lesion and dissemination region. Pathological diagnosis of the resected specimen was adenocarcinoma with lymph nodes metastasis. The peritoneal dissemination consisted of metastatic adenocarcinoma from small intestine. After an operation, internal use of S-1 was performed as adjuvant chemotherapy. But a recurrent lesion at the ovarium was detected 6 months after surgery. The patient was subsequently treated with resection of the ovarium. For lung metastasis, the combination chemotherapy with mFOLFOX6 + bevacizumab was administered. Primary small intestinal adenocarcinoma is a rare disease, and it is often diagnosed as advanced cancer because of few characteristic symptoms. So carcinoma of the small intestine usually has a poor prognosis.     

Primary carcinoid tumor of the ovary: report of an unusual case

Carcinoid tumors are endocrine malignancies that are often associated with a characteristic syndrome, the malignant carcinoid syndrome, which is most common in patients with small bowel tumors and liver metastases. In the rare instances when the syndrome is present without liver metastases the primary tumor is usually localized to the bronchus or ovary and secretes hormones directly into the systemic circulation. About two thirds of patients with carcinoid syndrome have evidence of carcinoid heart disease. We report on a case of a primary ovarian carcinoid tumor with an unusual clinical presentation.     

Cervical metastases from small bowel carcinoid tumors

Small bowel carcinoid tumors usually metastasize to regional lymph nodes and the liver but metastases to the neck are extremely rare. Over a ten-year period 48 cases of small bowel carcinoid were diagnosed at our institution and of these, three cases (6%) were associated with neck metastases--one to the thyroid gland and two to cervical lymph nodes. The former patient and one of the latter patients had symptoms of the carcinoid syndrome. The other patient was asymptomatic and presented with a solitary neck mass. Urine levels of 5-hydroxyindolacetic acid (5-HIAA) were elevated in the two symptomatic patients but were undetectable in the asymptomatic patient. Extirpation of the involved cervical nodes and the primary small bowel lesion was performed in two patients. In addition, both patients have received chemotherapy with 5-fluorouracil. One patient remains asymptomatic four years after diagnosis but the other patient continues to have five to six bowel movements per day nine months after operation. Small bowel resection was performed in the patient with a metastasis to the thyroid. This patient died of sepsis after a second operation for an intraabdominal abscess. The histological patterns of the primary tumor and the metastatic lesions were similar and the cells of the metastases contained argentaffin-positive granules. We conclude that 1) an intraabdominal carcinoid tumor should be considered as the location of the primary tumor in patients who present with a neck mass containing metastatic carcinoid and 2) the prognosis for patients with extraabdominal metastases is similar to that for patients with intraabdominal disease only.