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Gimbel S, Wiese D. [63/m-Very strong diffuse abdominal pain after ongoing hematochezia : Preparation for the medical specialist examination: part 43]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:71-74. [PMID: 37266704 DOI: 10.1007/s00104-023-01882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Sarah Gimbel
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH Standort Marburg, Baldingerstr., 35033, Marburg, Deutschland
| | - Dominik Wiese
- Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH Standort Marburg, Baldingerstr., 35033, Marburg, Deutschland.
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2
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Teufel A, Meindl-Beinker NM, Hösel P, Gerken M, Roig A, Ebert MP, Herr W, Scheiter A, Pauer A, Schlitt HJ, Klinkhammer-Schalke M. Characteristics and outcome of patients with small bowel adenocarcinoma (SBA). J Cancer Res Clin Oncol 2023; 149:4579-4590. [PMID: 36163558 PMCID: PMC10349691 DOI: 10.1007/s00432-022-04344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
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Affiliation(s)
- Andreas Teufel
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Pauline Hösel
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Ana Roig
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias P Ebert
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Medical Center Regensburg, Regensburg, Germany
| | | | - Armin Pauer
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
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Alshamsan B, Aseafan M, Badran A, Shaheen A, Elshenawy MA, Bazarbashi S, Aljubran AH. Characteristics and outcomes of small bowel adenocarcinoma: 14 years of experience at a single tertiary hospital in Saudi Arabia. Mol Clin Oncol 2023; 18:17. [PMID: 36798464 PMCID: PMC9926043 DOI: 10.3892/mco.2023.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) is an extremely rare cancer type. In the present study, the patient characteristics and clinical outcomes of patients diagnosed and treated for SBA at a single tertiary hospital were reported. All patients diagnosed and managed between 2007 and 2020 were reviewed. Regression analysis was used to assess variables associated with the metastatic stage at diagnosis. The Kaplan-Meier method was used to estimate survival and the log-rank test was used to determine factors associated with survival outcomes. Out of 137 cases of small bowel primary tumor, 43 consecutive patients with SBA were diagnosed with a median age of 53 years and the majority (76.7%) were males. The common initial presenting symptoms were abdominal pain (58.8%) and bowel obstruction (30.2%). The most common primary site was the duodenum (60.5%) and the majority (65.1%) were diagnosed with stage III/IV disease. Patients with a high neutrophil-lymphocyte ratio (NLR) (≥0.85) were more likely to be in the metastatic stage at diagnosis (P=0.01). The 3-year overall survival (OS) rates based on stage were 100% (I), 85% (II), 53% (III) and 33.9% (IV) (P=0.001). In addition to the stage, the Eastern Cooperative Oncology Group Performance Status (P<0.001), NLR (P<0.001), hypoalbuminemia (P=0.02) and chemotherapy in a metastatic setting (P=0.02) were prognostic factors for OS. In conclusion, NLR is a potential prognostic biomarker for a metastatic stage at diagnosis. Advanced stage, lower performance status score, low albumin level and high NLR are associated with short OS.
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Affiliation(s)
- Bader Alshamsan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Department of Medicine, College of Medicine, Qassim University, Buraidah 51432, Saudi Arabia
| | - Mohamed Aseafan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Section of Medical Oncology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
| | - Ahmed Badran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt
| | - Amgad Shaheen
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mahmoud A. Elshenawy
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom 32511, Egypt
| | - Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ali H. Aljubran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia,Correspondence to: Dr Ali H. Aljubran, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, 7375 Alowantat Mountain Street, King Abdulaziz, Riyadh 11211, Saudi Arabia
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Small bowel neuroendocrine neoplasm: what surgeons want to know. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4005-4015. [PMID: 35312820 DOI: 10.1007/s00261-022-03485-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/18/2023]
Abstract
Neuroendocrine neoplasms of the small bowel are a diverse group of tumors with a broad spectrum of imaging findings and clinical implications. Most tumors originate in close proximity to the ileocecal valve and most commonly metastasize to the mesentery and liver. This review will highlight the imaging findings of primary and metastatic small bowel neuroendocrine neoplasm that are most relevant to the surgical team.
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Novel Multicentric Hepatic Lymphoma with Extrahepatic Biliary Obstruction Associated with Duodenal Perforation in a Cat. Case Rep Vet Med 2021; 2021:5808886. [PMID: 34925932 PMCID: PMC8677407 DOI: 10.1155/2021/5808886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/06/2021] [Indexed: 11/18/2022] Open
Abstract
An 11-year-old male castrated domestic shorthair cat was presented for evaluation due to clinical deterioration and potential extrahepatic biliary obstruction (EHBO). Further investigations confirmed EHBO and revealed severe and previously unreported comorbidities. On initial examination, the cat was markedly icteric with a poor body condition score and severe muscle wasting. Serum chemistry and complete blood count showed evidence of cholestasis and anemia. Primary diagnostics and therapeutics targeted these abnormalities. Abdominal ultrasound revealed peritoneal effusion, multifocal mixed echogenic hepatic and splenic foci, small intestinal thickening, cholelithiasis, choledocholithiasis, and common bile duct and pancreatic duct dilation with evidence of obstruction. Peritoneal effusion cytology confirmed septic peritonitis. Hepatic and splenic cytology was consistent with lymphoma. Based on these results, euthanasia was elected by the owners of the animal. Necropsy confirmed the ultrasound diagnoses, septic peritoneal effusion associated with a duodenal perforation, multiorgan lymphoma, and common bile duct carcinoma. Flow cytometry classified the lymphoma as a double-negative phenotype of T-cell lymphoma (CD3+ and CD5+, but CD4- and CD8-) present in the duodenum and liver and suspected in the spleen which has previously not been reported in cats. This case report documents a cat with EHBO caused by multiple disease processes including a novel T-cell lymphoma phenotype, biliary carcinoma, duodenal perforation and septic abdomen, and choleliths, as well as inflammatory hepatobiliary disease.
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Molina-Valencia JL, Delgado-López CA. Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El linfoma puede afectar el tracto gastrointestinal de manera primaria o secundaria, y representa hasta el 2 % de todas las neoplasias malignas del intestino delgado y colon. El tracto gastrointestinal es la ubicación extraganglionar primaria más común en el linfoma no Hodgkin.
Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos académicas, con revisión de textos publicados sobre el tema en los últimos 5 años.
Discusión. La presentación clínica del linfoma con compromiso gastrointestinal es inespecífica y, hasta en la mitad de los pacientes, se puede presentar de manera inicial con complicaciones que requieran manejo quirúrgico. Entre las principales se encuentran la perforación intestinal, el sangrado digestivo y la obstrucción intestinal.
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Dai ZH, Wang QW, Zhang QW, Yan XL, Aparicio T, Zhou YY, Wang H, Zhang CH, Zaanan A, Afchain P, Zhang Y, Chen HM, Gao YJ, Ge ZZ. Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study. EBioMedicine 2020; 60:102979. [PMID: 32980692 PMCID: PMC7519244 DOI: 10.1016/j.ebiom.2020.102979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Log odds of positive lymph nodes (LODDS) classification showed superiority over 8th edition N staging in predicting survival of small bowel adenocarcinoma (SBA) patients. The aim of this study was to develop and validate the Tumor, LODDS, and Metastasis (TLM) staging of SBA. METHODS Totally 1789 SBA patients from the Surveillance, Epidemiology, and End Results (SEER) database between 1988-2010, 437 patients from SEER database between 2011-2013 and 166 patients from multicenters were categorized into development, validation and test cohort, respectively. The TLM staging was developed in the development cohort using Ensemble Algorithm for Clustering Cancer Data (EACCD) method. C-index was used to assess the performance of the TLM staging in predicting cancer-specific survival (CSS) and was compared with the traditional 8th edition TNM staging. FINDINGS Four-category TLM staging designed for the development cohort showed higher discriminatory power than TNM staging in predicting CSS in the development cohort (0.682 vs. 0.650, P < 0.001), validation cohort (0.682 vs. 0.654, P = 0.022), and test cohort (0.659 vs. 0.611, P = 0.023), respectively. TLM staging continued to show its higher predictive efficacy than the 8th TNM in TNM stage II/III patients or in patients with lymph node yield less than 8. INTERPRETATION TLM staging showed a better prognostic performance than the 8th TNM staging especially TNM stage II/III or patients with lymph node yield less than 8 and therefore, could serve to complement the TNM staging in patients with SBA. FUNDING A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.
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Affiliation(s)
- Zi-Hao Dai
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China
| | - Qi-Wen Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Thomas Aparicio
- Gastroenterology department, Saint Louis Hospital, APHP, University Paris Diderot, Paris, France
| | - Yang-Yang Zhou
- Department of Rheumatology and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Huan Wang
- Department of Biostatistics, The George Washington University, Washington, DC, United States
| | - Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China
| | - Aziz Zaanan
- Gastroenterology and Digestive Oncology department, Georges Pompidou Hospital, APHP, Paris, France
| | - Pauline Afchain
- Oncology department, Saint Antoine Hospital, APHP, Paris, France
| | - Yan Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China
| | - Hui-Min Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China
| | - Yun-Jie Gao
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China.
| | - Zhi-Zheng Ge
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China.
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Detz DJ, Podrat JL, Muniz Castro JC, Lee YK, Zheng F, Purnell S, Pei KY. Small bowel obstruction. Curr Probl Surg 2020; 58:100893. [PMID: 34130796 DOI: 10.1016/j.cpsurg.2020.100893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Yoon K Lee
- Houston Methodist Hospital, Houston, Texas
| | - Feibi Zheng
- Weill Cornell Medicine, Houston Methodist Hospital, Houston, Texas
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9
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Are depression and anxiety disorders associated with adductor pollicis muscle thickness, sleep duration, and protein intake in cancer patients? Exp Gerontol 2020; 130:110803. [DOI: 10.1016/j.exger.2019.110803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
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10
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Vusqa UT, Patel S, Rashid MU, Sarvepalli D, Khan AH. Carcinoid Tumor: Advances in Treatment Options. Cureus 2020; 12:e6641. [PMID: 32064213 PMCID: PMC7011579 DOI: 10.7759/cureus.6641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Small bowel neoplasms are rare, accounting for only 3%-6% of all gastrointestinal neoplasms. Carcinoid tumors represent a large portion of these (20%-30%), making them the second most common small bowel malignancy after adenocarcinoma. Gastrointestinal carcinoids constitute 70% of all neuroendocrine tumors, and out of those, 42% originate in the small bowel. They are predominantly seen in older patients around the age of 65 years. From 1973 to 2004, there has been more than a fourfold increase in the incidence of carcinoid tumors. This can be probably due to increased diagnostic accuracy rather than an actual increase in the number of new cases. The workup of a suspicious case of gastrointestinal bleeding consists of esophagogastroduodenoscopy and/or colonoscopy, and other imaging tests including video capsule endoscopy and balloon-assisted endoscopy. Management of the tumors is dependent on the size and location of the lesion. Treatment options include surgery, endoscopic removal of tumors, and various immunotherapy and chemotherapeutic agents.
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Affiliation(s)
- Urwat T Vusqa
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Stuti Patel
- Internal Medicine, Gujarat Medical Education and Research Society Medical College, Vadodara, IND
| | | | | | - Abu H Khan
- Gastroenterology, AdventHealth, Orlando, USA
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11
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Singh H, Krishnamurthy G, Kumar H, Mandavdhare H, Sharma V, Yadav TD. Surgical Management of Jejunal Tumors: Experience from Tertiary Care Centre. J Gastrointest Cancer 2019; 51:901-907. [PMID: 31705396 DOI: 10.1007/s12029-019-00327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Small bowel is an uncommon site for primary neoplasm in the gastrointestinal tract. Traditionally, duodenum has been combined with jejunum and ileum in analysing the presentation and management of these tumors. Given the different presentation pattern, diagnostic difficulties and anatomical considerations, jejunal tumors may differ from duodenal tumors. METHODOLOGY Retrospective analysis of a prospectively maintained database of patients with histology proven jejunal tumors was done. Clinico-radiological characters, histological findings, surgical procedures and the outcomes in these patients were studied. RESULTS Sixteen patients were included in the study. Median age at presentation was 42 years (26-76 years) and majority were males (n = 11, 68.8%). Seven (43.7%) patients presented with emergencies. Endoscopic tissue diagnosis could be obtained in 5 (31.3%) patients. Histology of tumors were adenocarcinoma, gastrointestinal stromal tumor and lymphoma in 6 (37.5%), 5 (31.3%) and 3 (18.8%) respectively. Sarcoma (myxofibroma) and metastasis (urothelial origin) were present in one patient each. Two patients with adenocarcinoma had neoadjuvant chemotherapy. Curative resection was feasible in 14 patients. Resection of tumor-bearing segment with anastomosis was performed in 9 patients. Among these, 5 had duodenojejunostomy. One patient had resection and double-barrel jejunostomy. One patient with jejunal GIST had sleeve resection. Multi-visceral resection was performed in 3 patients. There were no mortality and median postoperative hospital stay was 11 days (range 7-33 days). CONCLUSION Histology spectrum of jejunal tumors are distinct. Difficulty in obtaining preoperative tissue diagnosis of these lesions need to be addressed by improved endoscopic and image-directed biopsy techniques.
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Affiliation(s)
- Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, 5th floor, F block, Chandigarh, India.
| | - Gautham Krishnamurthy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, 5th floor, F block, Chandigarh, India
| | - Hemanth Kumar
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, 5th floor, F block, Chandigarh, India
| | - Harshal Mandavdhare
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, 5th floor, F block, Chandigarh, India
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Gupta A, Lubner MG, Wertz RM, Foley E, Loeffler A, Pickhardt PJ. CT detection of primary and metastatic ileal carcinoid tumor: rates of missed findings and associated delay in clinical diagnosis. Abdom Radiol (NY) 2019; 44:2721-2728. [PMID: 31016344 DOI: 10.1007/s00261-019-01945-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the rate of missed CT findings of ileal carcinoid tumor prior to pathologic diagnosis and the resultant diagnostic delay. METHODS Initially, 74 patients with abdominal and pelvic CT prior to pathologically-proven diagnosis of ileal carcinoid were identified. Patients were excluded when the original CT study (n = 6) or report (n = 4) was not available, resulting in a final cohort of 64 patients (mean age, 58.3 years; 29 M/35F); 27 (42%) patients had more than one abdominal CT prior to diagnosis. All available CT studies prior to diagnosis were retrospectively reviewed for the presence of the primary ileal tumor and metastatic disease (mesenteric and hepatic). RESULTS Primary ileal tumors were prospectively missed on at least one CT scan in 64% (32/50) of patients with retrospectively identifiable disease. CT findings of mesenteric spread were missed at least once in 46% (25/54) of cases where present in retrospect. By the final pre-operative CT, hepatic metastases and bowel wall thickening were present in 55% (35/64) and 52% (33/64) of cases, respectively. In patients with missed ileal and/or mesenteric findings resulting in diagnostic delay, mean delay was 40 months (range 4-98 months). CONCLUSION Initial presentation of ileal carcinoid tumor, even with mesenteric involvement, is often missed prospectively at abdominal CT, leading to delay in diagnosis until bowel or mesenteric findings become more obvious, or hepatic metastatic disease manifests. Radiologists should make a concerted effort to evaluate the bowel and mesentery in patients with long-standing vague abdominal symptoms.
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Affiliation(s)
- Akshya Gupta
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Robert M Wertz
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Eugene Foley
- Department of Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Agnes Loeffler
- Department of Pathology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
- Department of Radiology, E3/311 Clinical Science Center, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Ansari D, Torén W, Lindberg S, Pyrhönen HS, Andersson R. Diagnosis and management of duodenal perforations: a narrative review. Scand J Gastroenterol 2019; 54:939-944. [PMID: 31353983 DOI: 10.1080/00365521.2019.1647456] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Duodenal perforation is a rare, but potentially life-threatening injury. Multiple etiologies are associated with duodenal perforations such as peptic ulcer disease, iatrogenic causes and trauma. Computed tomography with intravenous and oral contrast is the most valuable imaging technique to identify duodenal perforation. In some cases, surgical exploration may be necessary for diagnosis. Specific treatment depends upon the nature of the disease process that caused the perforation, the timing, location and extent of the injury and the clinical condition of the patient. Conservative management seems to be feasible in stable patients with sealed perforations. Immediate surgery is required for patients presenting with peritonitis and/or intra-abdominal sepsis. Minimally invasive techniques are safe and effective alternatives to conventional open surgery in selected patients with duodenal perforations. Here we review the current literature on duodenal perforations and discuss the outcomes of different treatment strategies.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - William Torén
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Sarah Lindberg
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Helmi-Sisko Pyrhönen
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
| | - Roland Andersson
- Department of Surgery, Division of Clinical Sciences, Lund University, Skane University Hospital , Lund , Sweden
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An Examination of Lymph Node Sampling as a Predictor of Survival in Resected Node-Negative Small Bowel Adenocarcinoma: a SEER Database Analysis. J Gastrointest Cancer 2019; 51:280-288. [PMID: 31111426 DOI: 10.1007/s12029-019-00250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare disease. Current recommendations are largely extrapolated from the colorectal literature. For node-negative (N -ve) cases, optimally stratifying cases into high or low risk, may help define optimal management. The objective of this analysis was to determine the importance of lymph node sampling for prognostication and to define what number of lymph nodes sampled is adequate. METHODS Cases of non-metastatic SBA with complete staging, pathologic, and demographic information were selected from the SEER database and SAS 9.4 software was used. Variables included age, gender, race, grade, TNM staging, and number of lymph nodes were examined. Comparisons were made between N -ve and N +ve cases. Survival analysis using N -ve cases was performed to characterize the impact of nodal sampling on survival and to determine which nodal cut-offs best predict survival. RESULTS A total of 523 cases from 2004 to 2014 were included in this analysis. Statistically significant differences identified included the median number of nodes sampled between the N -ve and N +ve groups, and the distribution of T stage and grade. Survival analysis in the N -ve cases demonstrated that the strongest predictor of survival was sampling of 16 or more lymph nodes. CONCLUSION In this analysis, lymph node sampling was shown to be the most important pathologic predictor of survival in cases of N -ve SBA. Replicating these findings in a secondary dataset and determining whether a clinical benefit of adjuvant chemotherapy exists for SBA patients with inadequate sampling are both important next steps.
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Abstract
OBJECTIVE. The purpose of this article is to provide a multimodality imaging review of ileal carcinoid tumor. CONCLUSION. Ileal carcinoid tumors display a variety of radiologic findings. Delay in diagnosis is common because of initial nonspecific symptoms and subtle imaging findings. Reviewing the multimodality imaging appearance of the primary tumor, metastatic disease, and associated ancillary findings can help improve patient care.
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Zhou YY, Du XJ, Zhang CH, Aparicio T, Zaanan A, Afchain P, Chen LP, Hu SK, Zhang PC, Wu M, Zhang QW, Wang H. Comparison of three lymph node staging schemes for predicting the outcome in patients with small bowel adenocarcinoma: A population-based cohort and international multicentre cohort study. EBioMedicine 2019; 41:276-285. [PMID: 30824384 PMCID: PMC6443578 DOI: 10.1016/j.ebiom.2019.02.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/06/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prognostic roles of three common lymph node staging schemes, number of positive lymph nodes (pN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS) in small bowel adenocarcinoma (SBA) are unclear. We assessed their prognostic ability in SBA. METHODS A total of 2128 patients diagnosed with SBA between 1988 and 2010 from the Surveillance, Epidemiology, and End Results (SEER) database and 186 patients from 15 hospitals in France and China were identified. We evaluated the prognostic ability of the schemes in both continuous and stratified patterns using R2, Harrell's C, and time-dependent receiver operating characteristic curve analyses. FINDINGS For continuous pattern, the LODDS had a better capacity of discrimination and higher accuracy of prognosis than pN and LNR. Similarly, the stratified LODDS classification had a better performance of discrimination and higher accuracy of prognosis than the pN and LNR classification. The multivariable model using the LODDS classification also showed superiorly predictive accuracy and discriminatory capacity to those of the 7th and, 8th TNM node and LNR classification. These results were fully validated in an independent international multicentre cohort. INTERPRETATION The LODDS scheme showed a better prognostic performance than the LNR or pN schemes in patients with SBA regardless of continuous or stratified pattern. The LODDS scheme could serve as an auxiliary to lymph node staging systems in future revisions of the American Joint Committee on Cancer (AJCC) manual. FUND: This work was funded by the Zhejiang Province Natural Science Fund of China.
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Affiliation(s)
- Yang-Yang Zhou
- Department of Rheumatology and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Xiao-Jing Du
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan 201999, Shanghai, China
| | - Thomas Aparicio
- Gastroenterology department, Saint Louis Hospital, APHP, University Paris Diderot, Paris, France
| | - Aziz Zaanan
- Gastroenterology and Digestive Oncology department, Georges Pompidou Hospital, APHP, Paris, France
| | - Pauline Afchain
- Oncology department, Saint Antoine Hospital, APHP, Paris, France
| | - Li-Ping Chen
- Chemical Biology Research Center, College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Sun-Kuan Hu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Pei-Chen Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Ming Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Qing-Wei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai 200001, China.
| | - Hong Wang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
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Forero Molina MA, Garcia E, Gonzalez-Devia D, García-Duperly R, Vera A. A 17-year-old male with a Small Bowel Neuroendocrine Tumor: flushing differential diagnosis. World Allergy Organ J 2017; 10:30. [PMID: 28904734 PMCID: PMC5582400 DOI: 10.1186/s40413-017-0161-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022] Open
Abstract
Background Neuroendocrine tumors (NETs) are heterogeneous neoplasms that originate from cells with a secretory function. Small bowel NETs (SB-NETs) are related to serotonin hypersecretion which causes: flushing, diarrhea, abdominal pain, bronchoconstriction and heart involvement, also known as carcinoid syndrome (CS). CS can be confused with an allergic reaction and thus should be considered as a differential diagnosis in the allergy consult. We present the case of a pediatric patient initially referred under the suspicion of food allergies. Case presentation We present the case of a 17-year-old male with evanescent non-pruriginous erythematous lesions- flushing that appeared with food consumption, associated with conjunctival injection, warmth and diaphoresis after the lesions disappeared. He denied abdominal pain, diarrhea, cough or wheezing. The 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion was elevated. The CT scan showed thickening of the distal ileum and multiple lesions on both hepatic lobules and the colonoscopy revealed a tumor in the ileocecal valve. Hepatic and intestinal biopsies reported a well-differentiated NET of the ileocecal valve with hepatic metastasis. He was started on octreotide and underwent a wide hepatectomy and right hemicolectomy with improvement of symptoms. Conclusions NETs can present as carcinoid syndrome (flushing, diarrhea, abdominal pain, wheezing), which constitutes vague symptomatology and represents a challenging diagnosis for physicians. They can be confused with an allergic reaction and the allergist should consider it as a differential diagnosis. Accurate diagnostic tests will help to diagnose NETs earlier and potentially prevent carcinoid heart disease, bowel obstruction, and improve quality of life and mortality in these patients.
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Affiliation(s)
- Maria Alejandra Forero Molina
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Hospital Universitario Fundación Santa Fe de Bogotá, Av 9 N° 116-20, oficina 213, Bogotá, D.C, Colombia
| | - Elizabeth Garcia
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Allergy Section, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Deyanira Gonzalez-Devia
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Department of Internal Medicine-Endocrinology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rafael García-Duperly
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Alonso Vera
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,Department of Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Ecker B, McMillan M, Datta J, Dempsey D, Karakousis G, Fraker D, Drebin J, Mamtani R, Giantonio B, Roses R. Lymph node evaluation and survival after curative-intent resection of duodenal adenocarcinoma: A matched cohort study. Eur J Cancer 2016; 69:135-141. [DOI: 10.1016/j.ejca.2016.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 08/17/2016] [Accepted: 09/25/2016] [Indexed: 02/06/2023]
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Goulart RDA, Barbalho SM, Gasparini RG, de Carvalho ADCA. Facing Terminal Ileitis: Going Beyond Crohn's Disease. Gastroenterology Res 2016; 9:1-9. [PMID: 27785317 PMCID: PMC5051106 DOI: 10.14740/gr698w] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 12/12/2022] Open
Abstract
Terminal ileitis (TI) is an inflammatory condition of the terminal portion of the ileum that may occur acutely with right lower quadrant pain followed or not by diarrhea, or exhibit chronic obstructive symptoms and bleeding and normally it is associated to Crohn's disease (CD) although it may be associated to other different conditions. This review intended to contribute to a better understanding of TI in order to help in the diagnosis, medical approach and patient care. This work was performed on a survey of articles collected in different databases and a retrospective search was carried out to identify relevant studies in the field. Pathological conditions such as ulcerative colitis, the intake of non-steroidal anti-inflammatory drugs, infectious diseases, eosinophilic enteritis, malignant diseases, spondyloarthropathies, vasculitides, ischemia, sarcoidosis, amyloidosis and others may be related to ileitis but it is commonly referred to CD. To a correct therapeutic approach, it is necessary to understand the causes of this inflammation process. The performance of a clinical, laboratory, endoscopic, and histopathological evaluation of the individuals is crucial to the correct diagnosis and treatment once the inflammation of the ileum may occur due to different pathological conditions besides CD, leading to difficulties in the diagnosis. Thus, an individual approach is necessary once the correct diagnosis is crucial for the immediate therapeutic approach and recovering of the patient.
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Affiliation(s)
- Ricardo de Alvares Goulart
- Department of Gastroenterology, University Hospital - UNIMAR, Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marilia and Food Technology School (FATEC), Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
| | - Rodrigo Galhardi Gasparini
- Department of Gastroenterology, University Hospital - UNIMAR, Higino Muzzi Filho Avenue, 1001, Marilia, SP, Brazil
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