Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients.
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BACKGROUND: Primary adenocarcinoma of the small bowel is a rare neoplasm, and to the authors' knowledge, few studies to date have addressed the topic. METHODS: In the current study, the records of 217 patients with small bowel adenocarcinoma were reviewed retrospectively for the presentation, prognostic factors, treatment modalities, and outcome. RESULTS: The median age of the patients was 55 years and there were 133 (61%) males. Tumors originated in the duodenum in 113 (52%) patients, the jejunum in 54 (25%) patients, the ileum in 28 (13%) patients, and in nonspecified sites in 22 (10%) patients. Patients with proximal tumors were diagnosed for the most part using endoscopy (i.e., 46 of 108 [43%]), whereas laparotomy enabled diagnosis in 16 of 28 (57%) patients with distal tumors. Based on TNM staging, 9 (4%) patients had Stage I disease, 43 (20%) patients had Stage II disease, 86 (39%) patients had Stage III disease, and 75 (35%) patients had Stage IV disease. The liver was the most common site of metastasis in 44 (59%) patients. Cancer-directed surgery was performed in 146 (67 %) patients, including the Whipple procedure in 36 patients (17%). The median overall survival time was 20 months. The 5-year overall survival rate was 26%. Cancer-directed surgery, early-stage disease, and lymph node involvement ratio were significantly associated with overall survival by univariate analysis. However, only cancer-directed surgery and lymph node involvement ratio were independent predictors of overall survival in a multivariate analysis (adjusted rate ratio = 0.14; 95% confidence interval [95% CI], 0.04-0.46; P = 0.001 and adjusted rate ratio = 0.25; 95% CI, 0.12-0.53; P < 0.001, respectively). CONCLUSIONS: Performing an oncologic surgery resulted in the best outcome in patients with nonmetastatic disease. Because cancer-directed surgery is associated with high morbidity and mortality in primary centers, these patients should be referred to a tertiary center for adequate treatment. (+info)
Synchronous ileal and colonic adenocarcinomas associated with Crohn's disease: report of a case with a focus on genetic alterations and carcinogenesis.
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Patients with Crohn's disease have an increased risk of developing intestinal tumours. However, the carcinogenic mechanisms remain poorly understood. To address this question, this report describes an unusual case of Crohn's disease complicated by synchronous small intestinal and colonic adenocarcinomas. Genetic events in both the tumours and their adjacent mucosae were evaluated and the tumorigenesis of these cancers is discussed. (+info)
Angiographic findings of gastrointestinal stromal tumor.
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AIM: To discuss the angiographic features of gastrointestinal stromal tumor (GIST) and to evaluate their diagnostic role. METHODS: Twelve patients with pathologically proved GIST underwent angiography (DSA)1 wk before operation, using Puck and digital subtraction DSA. The origin, size, morphology and angiographic appearance of the lesions were reviewed. RESULTS: Two tumors arose from stomach, 8 from jejunum, and 2 from ileum. Seven cases were benign and 5 were malignant. Obviously thickened supplying arteries were detected in 8 tumors, and early-developed veins were found in 3. Two types of angiographic changes of GIST were observed. Four cases had twisted irregular neoplastic vessels with partially coarse and indistinct margins, which were all malignant. Eight cases had ball-like neoplastic vessels with uniform tumor staining, of which 7 were benign and 1 was malignant. CONCLUSION: Angiography facilitates localization and diagnosis of GIST, helps define their size, range and location, and is especially valuable to patients suffering from melena with unknown reasons. (+info)
Comparison of genetic alterations in neuroendocrine tumors: frequent loss of chromosome 18 in ileal carcinoid tumors.
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Carcinoid tumors and pancreatic endocrine tumors are uncommon neuroendocrine neoplasms, and their genetic alterations are not well characterized. These tumors have site-specific differences in neuroendocrine characteristics, clinical course and genetic alterations. We compared clinicopathological features and loss of heterozygosity of chromosomes 11q, 16q and 18, and BRAF gene mutations in 47 patients with neuroendocrine tumors including 16 with pancreatic endocrine tumors, 15 with nonileal carcinoid tumors and 16 with ileal carcinoid tumors. Patients with carcinoid tumors had more frequent history of alcohol consumption compared to patients with pancreatic endocrine tumors (P=0.02), and patients with ileal carcinoid tumors more frequently had liver metastasis compared to patients with nonileal carcinoid tumors and pancreatic endocrine tumors (P=0.02). Allelic loss of chromosome 11q was present in 21% of tumors, chromosome 16q in 13%, and chromosome 18 in 30%. These alterations differed with the anatomical subsite of tumor: allelic loss of chromosome 18 was present in 69% of ileal carcinoid tumors, 13% of nonileal carcinoid tumors and 6% of pancreatic endocrine tumors (P=0.001). In contrast to pancreatic endocrine tumors and nonileal carcinoid tumors, all 11 ileal tumors with loss of chromosome 18 had complete loss of both chromosomal arms. No BRAF mutations were identified. Complete allelic loss of chromosome 18 was associated with smaller tumor size (P=0.02). Our study indicates that genetic alterations vary by tumor subsite and clinicopathologic features, and ileal carcinoid tumors have distinctive clinicopathologic and genetic profiles. (+info)
Granulocytic sarcoma of the small bowel causing intestinal obstruction.
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Granulocytic sarcomas of the small bowel are rare. They are discrete tumours of leukaemic myeloblasts and partially matured granulocytes that form in any part of the body. This disease is infrequently seen in patients with acute myeloid leukaemia, and rarely seen in patients without leukaemia. Here we report a case of small bowel obstruction due to granulocytic sarcoma of mid-ileum in a non-leukaemic patient. We also review the literature on treatment and prognosis of this condition. (+info)
Synchronous adenocarcinoma and carcinoid tumor of the terminal ileum in a Crohn's disease patient.
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BACKGROUND: Several malignancies have been described in association with inflammatory bowel diseases, the most common being adenocarcinoma. Carcinoid tumor and Crohn disease has also been previously reported, however the coexistence of both neoplasms is quite rare and the clinical diagnosis is very difficult. Here we report what we believe to be the fourth case of a mixed adenocarcinoid tumor coexisting with Crohn's disease. CASE REPORT: The patient presented with clinical and radiological features of intestinal obstruction. Laparotomy showed a stricturing lesion in the last 6 cm of the terminal ileum with proximal dilation. Only the histology of the resected surgical specimen proved the presence of a mixed adenocarcinoid tumor involving the terminal ileum. CONCLUSION: Carcinoid tumor should be suspected in elderly patients with Crohn's disease presenting with intestinal obstruction and laparotomy should be considered to exclude malignancy. (+info)
An increase of CA 19.9 as the first clinical sign of ileocecal valve metastasis from breast cancer.
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CASE REPORT: The case of a breast cancer patient with a progressive increase of CA 19.9 that indicated gastrointestinal metastasis is reported. After the observation of an increased CA 19.9 serum value (104.00; n.v. 0.0-37.00) a colonoscopy was performed. This examination showed the presence of an erythematous and granular zone near the ileocecal valve. Histological examination of biopsies taken during the colonoscopy revealed atypical monomorphic cells between the organoid pattern of the colon-type ducts. Immunohistochemical staining was positive for cytokeratin 7 and for estrogen receptors, consistent with metastatic epithelial malignancy. After eleven months, the patient presented with signs of intestinal obstruction, requiring an ileocolic bypass. At definitive histological examination, the tumor exhibited features of mammary metastases. CONCLUSION: This is the first report in the literature of an ileocecal valve metastasis from breast cancer diagnosed by an increase of CA 19.9, which is a marker of primary colorectal carcinoma. (+info)
Multiple and recurrent inflammatory fibroid polyps in a Devon family ('Devon polyposis syndrome'): an update.
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Inflammatory fibroid polyps are uncommon but well documented as solitary polyps occurring typically in the stomach or ileum. A Devon family has previously been reported in which a female in three successive generations has presented with multiple polyps requiring repeated surgery over a number of years. A further two female family members, both siblings from the 3rd generation, who required surgery for the same condition are now reported. (+info)