1
|
Wang L, Zhang H, Wang D, Shen Q, Huang L, Liu T. Clinical features of intussusception in children secondary to small bowel tumours: a retrospective study of 31 cases. BMC Pediatr 2024; 24:227. [PMID: 38561715 PMCID: PMC10983748 DOI: 10.1186/s12887-024-04717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Summarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease. METHODS Retrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis. RESULTS Thirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types. CONCLUSIONS Lymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients.
Collapse
Affiliation(s)
- Li Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hanwen Zhang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Dayong Wang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Qiulong Shen
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Liuming Huang
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Beijing, 100045, PR China.
| | - Tingting Liu
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56, Nanlishi Road, Beijing, 100045, PR China.
| |
Collapse
|
2
|
Hallet J, Clarke CN. ASO Practice Guidelines Series: Surgical Management of Gastrointestinal (Midgut) Neuroendocrine Neoplasms. Ann Surg Oncol 2024; 31:1704-1713. [PMID: 38167813 DOI: 10.1245/s10434-023-14802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
Gastrointestinal midgut neuroendocrine neoplasms (NENs) are a heterogeneous group of uncommon malignancies. For well-differentiated NENs, known as neuroendocrine tumors (NETs), surgery is a cornerstone of management in localized and metastatic disease. Because of heterogeneous tumor behaviour, association with endocrine syndrome, and prognosis, the management of NETs must be individualized to all these factors in addition to the primary site. With the fast pace of advancement in the field, both for therapies and understanding of tumoral etiology and behaviour, it is important for surgical oncologists to remain updated on guidelines recommendations and suggested treatment pathways. Those guidelines provide important guidance for management of NETs but are largely based on expert opinions and interpretation of retrospective evidence. This article reviews highlights of most recent practice guidelines for midgut (gastric, duodenal, small intestinal, and appendiceal) NETs.
Collapse
Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Susan Leslie Clinic for Neuroendocrine Tumors, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Callisia N Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
3
|
Butterworth JW, Brooker-Thompson C, Qureshi YA, Mohammadi B, Dawas K. Emergency laparotomy for abdominal catastrophes secondary to lymphoma: A systematic review. Eur J Surg Oncol 2024; 50:107268. [PMID: 38043361 DOI: 10.1016/j.ejso.2023.107268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Abstract
Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess the presentation, diagnosis, optimal surgical approach and associated post-operative outcomes. A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract data. 95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28 %) and Diffuse Large B-cell lymphoma (29 %)) were identified with a median age of 52 years, 40 % were female. Of the small bowel resections 25% (n = 18) suffered post-operative complications with a 13.8 % (n = 10) 30-day mortality. Ileocolonic resections had a 27 % complication rate with 18 % mortality and primary repair had a 25 % complications rate and 25 % mortality. Median follow-up was 8 days (range 1-96). Notable points of differences in the presentations between these different lymphomas included the majority of Burkitt's lymphoma were younger, had a known diagnosis, were on chemotherapy and presented with perforation in contrast to those with B cell lymphoma who were predominately older, had new diagnoses and presented with a balanced proportion of obstruction and perforation. Abdominal catastrophes secondary to intestinal lymphomas most commonly present with perforation. Aggressive surgical management, including small bowel resection, may offer similar remission rates for lymphoma patients presenting with abdominal catastrophes as those without such emergency complications.
Collapse
Affiliation(s)
| | | | | | | | - Khaled Dawas
- Department of Upper GI Surgery, University College Hospital London, UK
| |
Collapse
|
4
|
Alliet B, Severi C, Veekmans T, Cuypers J, Topal H, Deroose CM, Roskams T, Bex M, Dekervel J. Fulminant ectopic Cushing's syndrome caused by metastatic small intestine neuroendocrine tumour - a case report and review of the literature. Acta Gastroenterol Belg 2024; 87:48-51. [PMID: 38431792 DOI: 10.51821/87.1.11872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Cushing's syndrome (CS) secondary to adrenocorticotropic hormone (ACTH) producing tumours is a severe condition with a challenging diagnosis. Ectopic ACTH-secretion often involves neuroendocrine tumours (NET) in the respiratory tract. ACTH-secreting small intestine neuro-endocrine tumours (siNET) are extremely rare entities barely reported in literature. This review is illustrated by the case of a 75-year old woman with fulminant ectopic CS caused by a ACTH-secreting metastatic siNET. Severe hypokalemia, fluid retention and refractory hypertension were the presenting symptoms. Basal and dynamic laboratory studies were diagnostic for ACTH-dependent CS. Extensive imaging studies of the pituitary and thorax-abdomen areas were normal, while [68Ga]Ga-DOTATATE PET-CT revealed increased small intestine uptake in the left iliac fossa. The hypercortisolism was well controlled with somatostatin analogues, after which a debulking resection of the tumour was performed. Pathological investigation confirmed a well-differentiated NET with sporadic ACTH immunostaining and post-operative treatment with somatostatin analogues was continued with favourable disease control.
Collapse
Affiliation(s)
- B Alliet
- Department of Gastroenterology, UZ Leuven, Leuven, Belgium
| | - C Severi
- Department of Gastroenterology, ZOL, Genk, Belgium
| | - T Veekmans
- Department of Pathology, UZ Leuven, Leuven, Belgium
| | - J Cuypers
- Department of Endocrinology, AZ Turnhout, Turnhout, Belgium
| | - H Topal
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - C M Deroose
- Department of Nuclear Medicine, UZ Leuven, Leuven, Belgium
| | - T Roskams
- Department of Pathology, UZ Leuven, Leuven, Belgium
| | - M Bex
- Department of Endocrinology, UZ Leuven, Leuven, Belgium
| | - J Dekervel
- Department of Gastroenterology - Digestive Oncology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Kawakita H, Ono Y, Watanabe T, Sugiyama Y, Kato F, Katsumata K, Nagakawa Y. [A Patient with Small Intestinal Leiomyosarcoma and Intussusception Who Underwent Single Port Surgery]. Gan To Kagaku Ryoho 2023; 50:1638-1640. [PMID: 38303367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The patient was a 33-year-old female. She was referred to our hospital from a previous clinic with abdominal pain and vomiting. Contrast-enhanced abdominal CT revealed intussusception, leading to a diagnosis of intussusception with a small intestinal tumor as an advanced part. Intestinal obstruction symptoms were observed, and emergency surgery was performed on the same day. As a technique, single port surgery was selected, and laparoscopic reduction was attempted. However, it was ineffective. The site of intussusception was induced outside the body through a small laparotomy wound, and reduction was performed using Hutchinson's procedure. As an adjacent lymph node was markedly swollen, the mesentery involving this lymph node was dissected in a fan shape, and the tumor was extirpated. The tumor measured 40 mm in long diameter, being a hemicircular, protruding lesion. Histologically, disarray of short spindle tumor cells was observed. Immunostaining showed Kit- and DOG1-negtive reactions and partially α-SMA and desmin-positive reactions, suggesting leiomyosarcoma. With the establishment of an immunostaining-test-based classification, leiomyosarcoma is currently rare. In this study, we report a patient in whom single port surgery for intussusception related to small intestinal leiomyosarcoma was successful.
Collapse
Affiliation(s)
- Hideaki Kawakita
- Dept. of Gastrointestinal and General Surgery, Kohsei Chuo General Hospital
| | | | | | | | | | | | | |
Collapse
|
6
|
Ersoy Guller Z, Harewood RN, Weiderpass E, Huybrechts I, Jenab M, Huerta JM, Sánchez MJ, Jakszyn P, Amiano P, Ardanaz E, Agnoli C, Tumino R, Palli D, Skeie G, Manjer J, Papier K, Tjønneland A, Eriksen AK, Schulze MB, Kaaks R, Katzke V, Bergmann MM, Riboli E, Gunter MJ, Cross AJ. Diet and lifestyle in relation to small intestinal cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 2023; 34:927-937. [PMID: 37330982 PMCID: PMC10460357 DOI: 10.1007/s10552-023-01731-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE The incidence of small intestinal cancer (SIC) is increasing, however, its aetiology remains unclear due to a lack of data from large-scale prospective cohorts. We examined modifiable risk factors in relation to SIC overall and by histological subtype. METHODS We analysed 450,107 participants enrolled in the European Prospective Investigation into Cancer and Nutrition cohort. Cox proportional hazards models were used to estimate univariable and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS During an average of 14.1 years of follow-up, 160 incident SICs (62 carcinoids, 51 adenocarcinomas) were identified. Whilst univariable models revealed a positive association for current versus never smokers and SIC (HR, 95% CI: 1.77, 1.21-2.60), this association attenuated in multivariable models. In energy-adjusted models, there was an inverse association across vegetable intake tertiles for SIC overall (HRT3vsT1, 95% CI: 0.48, 0.32-0.71, p-trend: < 0.001) and for carcinoids (HRT3vsT1, 95% CI: 0.44, 0.24-0.82, p-trend: 0.01); however, these attenuated in multivariable models. Total fat was also inversely associated with total SIC and both subtypes but only in the second tertile (SIC univariable HRT2vsT1, 95% CI: 0.57, 0.38-0.84; SIC multivariable HRT2vsT1, 95% CI: 0.55, 0.37-0.81). Physical activity, intake of alcohol, red or processed meat, dairy products, or fibre were not associated with SIC. CONCLUSION These exploratory analyses found limited evidence for a role of modifiable risk factors in SIC aetiology. However, sample size was limited, particularly for histologic subtypes; therefore, larger studies are needed to delineate these associations and robustly identify risk factors for SIC.
Collapse
Affiliation(s)
- Zeynep Ersoy Guller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Rhea N Harewood
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer World Health Organization, Lyon, France
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Mazda Jenab
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - José María Huerta
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, 18012, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Ardanaz
- Navarra Public Health Institute, 31003, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008, Pamplona, Spain
- CIBER Epidemiology and Public Health CIBERESP, 28029, Madrid, Spain
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research AIRE ONLUS, Ragusa, Italy
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Guri Skeie
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jonas Manjer
- Department of Surgery, Lund University, Skåne University Hospital, SE 205 02, Malmö, Sweden
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| |
Collapse
|
7
|
Chetcuti Zammit S, Sidhu R. Small bowel neuroendocrine tumours - casting the net wide. Curr Opin Gastroenterol 2023; 39:200-210. [PMID: 37144538 DOI: 10.1097/mog.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Our aim is to provide an overview of small bowel neuroendocrine tumours (NETs), clinical presentation, diagnosis algorithm and management options. We also highlight the latest evidence on management and suggest areas for future research. RECENT FINDINGS Dodecanetetraacetic acid (DOTATATE) scan can detect NETs with an improved sensitivity than when compared with an Octreotide scan. It is complimentary to small bowel endoscopy that provides mucosal views and allows the delineation of small lesions undetectable on imaging. Surgical resection is the best management modality even in metastatic disease. Prognosis can be improved with the administration of somatostatin analogues and Evarolimus as second-line therapies. SUMMARY NETs are heterogenous tumours affecting most commonly the distal small bowel as single or multiple lesions. Their secretary behaviour can lead to symptoms, most commonly diarrhoea and weight loss. Metastases to the liver are associated with carcinoid syndrome.
Collapse
Affiliation(s)
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
| |
Collapse
|
8
|
Delhomme C, Walter T, Arangalage D, Suc G, Hentic O, Cachier A, Alkhoder S, François L, Lombard-Bohas C, Iung B, Ruszniewski P, de Mestier L. Carcinoid heart disease in patients with midgut neuroendocrine tumours. J Neuroendocrinol 2023; 35:e13262. [PMID: 37005217 DOI: 10.1111/jne.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/29/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Carcinoid heart disease (CHD) is the main complication of carcinoid syndrome (CS) associated with metastatic small intestine neuroendocrine tumours (NETs). The pathophysiology of CHD is partly understood but vasoactive hormones secreted by NETs, especially serotonin, play a major role, leading to the formation of fibrous plaques. These plaque-like deposits involve the right side of the heart in >90% of cases, particularly the tricuspid and pulmonary valves, which become thickened, retracted and immobile, resulting in regurgitation or stenosis. CHD represents a major diagnostic and therapeutic challenge for patients with NET and CS and is associated with increased risk of morbidity and mortality. CHD often occurs 2-5 years after the diagnosis of metastatic NET, but diagnosis of CHD can be delayed as patients are often asymptomatic for a long time despite severe heart valve involvement. Circulating biomarkers (5HIAA, NT-proBNP) are relevant tools but transthoracic echocardiography is the key examination for diagnosis and follow-up of CHD. However, there is no consensus on the optimal indications and frequency of TTE and biomarker dosing regarding screening and diagnosis. Treatment of CHD is complex and requires a multidisciplinary approach. It relies on antitumour treatment, control of CS and surgical valve replacement in cases of severe CHD. However, cardiac surgery is associated with a high risk of mortality, notably due to perioperative carcinoid crisis and right ventricular dysfunction. Timing of surgery is the most crucial point of CHD management and relies on the case-by-case determination of the optimal compromise between tumour progression, cardiac symptoms and CS control.
Collapse
Affiliation(s)
- Clémence Delhomme
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Thomas Walter
- Hospices Civils de Lyon, Department of Medical Oncology, ENETS Centre of Excellence, Lyon, France
| | - Dimitri Arangalage
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Gaspard Suc
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Olivia Hentic
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Agnès Cachier
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Soleiman Alkhoder
- Université Paris-Cité, Department of Cardiac Surgery, Bichat Hospital (APHP.Nord), ENETS Centre of Excellence, Paris, France
| | - Laurent François
- Hospices Civils de Lyon, Department of Cardiology, ENETS Centre of Excellence, Lyon, France
| | - Catherine Lombard-Bohas
- Hospices Civils de Lyon, Department of Medical Oncology, ENETS Centre of Excellence, Lyon, France
| | - Bernard Iung
- Université Paris-Cité, Department of Cardiology, Bichat/Beaujon Hospital (APHP.Nord), ENETS Centre of Excellence, Paris/Clichy, France
| | - Philippe Ruszniewski
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
| | - Louis de Mestier
- Université Paris-Cité, Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP.Nord), Clichy, France
| |
Collapse
|
9
|
Kostiainen I, Karppinen N, Simonen P, Rosengård-Bärlund M, Lindén R, Tarkkanen M, Gordin D, Rapola J, Schalin-Jäntti C, Matikainen N. Arterial function, biomarkers, carcinoid syndrome and carcinoid heart disease in patients with small intestinal neuroendocrine tumours. Endocrine 2022; 77:177-187. [PMID: 35536452 PMCID: PMC9242958 DOI: 10.1007/s12020-022-03065-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Carcinoid heart disease (CHD) is a life-threatening complication of carcinoid syndrome (CS) characterised by tricuspid regurgitation (TR). However, there is an unmet need for earlier diagnosis of CHD. We cross-sectionally assessed the prevalence and potential predictive or diagnostic markers for CS and CHD in a contemporary cohort of patients with small intestinal neuroendocrine tumours (SI-NETs). METHODS Biochemical characteristics, hepatic tumour load, measures of arterial and endothelial function, atherosclerosis, and transthoracic echocardiography were analysed in a prospective cross-sectional setting. RESULTS Among the 65 patients studied, 29 (45%) had CS (CS+ ), and 3 (5%) CHD. CS+ was characterised by significantly higher hepatic tumour load, S-5-HIAA and fP-CgA, higher frequency of diarrhoea and flushing, and more frequent PRRT compared to CS- (for all, P < 0.05). Central systolic, central mean, and central end-systolic blood pressures were significantly higher in CS+ than in CS- (for all, P < 0.05). Subjects with grades 2-4 TR had higher hepatic tumour burden, fP-CgA, and S-5-HIAA compared to those with grades 0-1 TR, but measures of vascular function did not differ. fP-CgA (P = 0.017) and S-5-HIAA (P = 0.019) but not proBNP increased significantly according to the severity of TR. CONCLUSION Although CS is common, the prevalence of CHD was found to be lower in a contemporary cohort of SI-NET patients than previously anticipated. Measures of arterial or endothelial function or carotid atherosclerosis do not identify subjects with mild TR. Echocardiography remains the most sensitive means to diagnose CHD in CS patients with high tumour burden and elevated CgA and 5-HIAA.
Collapse
Affiliation(s)
- Iiro Kostiainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Noora Karppinen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Piia Simonen
- Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Milla Rosengård-Bärlund
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riikka Lindén
- Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maija Tarkkanen
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Finnish Medicines Agency FIMEA, Helsinki, Finland
| | - Daniel Gordin
- Department of Nephrology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Minerva Institute for Medical Research, Helsinki, Finland
| | - Janne Rapola
- Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Niina Matikainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| |
Collapse
|
10
|
de Jong MA, van Leerdam ME, Offerhaus GJAJ, Keller JJ. [100 years Peutz-Jeghers syndrome]. Ned Tijdschr Geneeskd 2022; 166:D6507. [PMID: 35736377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In 2021 it was 100 years since drPeutz published his case report titled: 'a very remarkable case of familial polyposis of mucous membranes of intestinal tract and nasopharynx accompanied by peculiar pigmentations of skin and mucous membrane'. This is the first description of the Peutz-Jeghers syndrome, which is named after him. Like Peutz already suggested a century ago, we know now that this is a genetic disorder (autosomal dominant) caused by mutations in the STK11 gene. The clinical symptoms are typical pigmentations of the mucous membranes and hamartomatous polyps which already at a young age can result in polyp related complications like intussusception. Thereby patients with the Peutz-Jeghers syndrome have a high risk of developing an intestinal or extra-intestinal malignancy. For this reason there are strict surveillance guidelines for these patients. Even after a hundred years there is still a high mortality risk for patients with this syndrome.
Collapse
Affiliation(s)
- Myrthe A de Jong
- LUMC, afd. Maag-, Darm- en Leverziekten, Leiden
- Contact: Myrthe A. de Jong
| | | | | | | |
Collapse
|
11
|
Takemura M, Shimada Y, Takii M, Gyobu K, Oshima T, Yamada M, Tanaka Y, Mayumi K, Fujio N. [A Case of Multiple Small Bowel GIST Complicated with von Recklinghausen's Disease]. Gan To Kagaku Ryoho 2021; 48:1667-1669. [PMID: 35046291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The case was a 55-year-old woman. She have been pointed out von Recklinghausen's disease for several years. She was referred to our hospital due to multiple abdominal tumor and severe anemia. Enhanced CT examination revealed multiple intraabdominal tumors with central necrosis. The tumors diagnosed mesenchymal tumors associated with von Recklinghausen's disease, and tumor resection was indicated under laparotomy. Tumors were resected together with small and large bowel. The tumor in the pelvic space was resected together with the uterus and right ureter. She was discharged without any postoperative complications at 15 days after the operation. Because immunostaining was positive for CD34, c-kit and DOG1 and Ki-67-positive cells were 18%, the tumors were diagnosed with high-risk GIST for small bowel.
Collapse
Affiliation(s)
- Masashi Takemura
- Dept. of Gastrointestinal Surgery, Social Medical Corporation, Minamiosaka Hospital
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND Monomorphic epitheliotropic intestinal T-cell lymphomas (MEITL) is a rare and aggressive subtype of lymphoma. The most common site of origin is small intestine. Patients are often presented with diagnosis of intestinal perforation with abdominal pain as the main consulting symptoms. Because of the deficiency of specific diagnostic measures and effective management, diagnosis is often confirmed in advanced stage with poor prognosis. CASE PRESENTATION Here, we introduce a patient who has suffered from abdominal pain and diarrhea, and eventually been diagnosed as Monomorphic epitheliotropic intestinal T-cell lymphomas. CONCLUSION MEITL is rare in clinical practice with deficiency of early diagnostic measures and poor prognosis. Therefore, any patient with ambiguous gastrointestinal symptoms or perforation of the digestive tract where the primary lesion is difficult to identify should be alert to the possibility of this disease.
Collapse
Affiliation(s)
- Haibin Zhong
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yang Zheng
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Feiran Zhang
- Department of General Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
| |
Collapse
|
13
|
Symeonidis NG, Stavrati KE, Pavlidis ET, Psarras KK, Martzivanou EC, Nikolaidou CC, Meitanidou MC, Tsiftsi SN, Pavlidis TE. Undiagnosed Endoscopy Capsule Retention Causing Delayed Intestinal Obstruction in a Patient with a Small Bowel Neuroendocrine Tumor. Am J Case Rep 2021; 22:e932419. [PMID: 34301913 PMCID: PMC8317584 DOI: 10.12659/ajcr.932419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Capsule endoscopy has played a significant role in small bowel investigation, providing the opportunity of detecting neoplastic lesions to a greater degree and at an earlier stage than other diagnostic procedures. Failure to excrete the capsule with the feces within 48 h can lead to capsule retention with increased risk of further complications such as bowel obstruction and perforation. Capsule retention can remain undetected in case of incomplete follow-up and poor patient compliance. Acute small bowel obstruction as late as many months following capsule endoscopy investigation is very rare, with only a few cases reported in the published literature. We herein report a rare case of prolonged capsule retention which remained undiagnosed, resulting in small bowel obstruction 6 months after the initial investigation. CASE REPORT An 82-year-old woman presented with abdominal pain and symptoms suggestive of intestinal obstruction. The patient history included a capsule endoscopy investigation because of episodes of abdominal pain 6 months prior to admission. Both the outcome of the investigation and the excretion of the capsule remained undetermined due to her history of dementia and follow-up failure. Radiologic investigations identified the capsule causing small bowel obstruction. Upon surgery, the capsule was found to be impacted in a stenotic small bowel lesion, and a segmental small bowel resection was performed. Histologic examination revealed the presence of a stenotic small bowel neuroendocrine tumor. CONCLUSIONS Appropriate follow-up is necessary to diagnose the complication of capsule retention which, if it remains unrecognized, can cause life-threatening complications as late as many months after capsule endoscopy.
Collapse
|
14
|
Hoitsy M, Hoitsy G, Jakab C, Molnár T, Gál J, Baska F. Intussusception caused by intestinal neoplasia in mature rainbow trout (Oncorhynchus mykiss, Walbaum 1792). J Fish Dis 2021; 44:893-898. [PMID: 33690895 DOI: 10.1111/jfd.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
The aquaculture industry is growing and includes the farming and breeding of more than 580 aquatic species worldwide. The rainbow trout (Oncorhynchus mykiss, Walbaum 1792) is the most commonly bred trout species in Hungary. As broodfish form the basis of most fish farms, investigation into tumours occurring in trout, although under-researched, has proven to be a valuable and necessary field of study. During our investigation, we examined a broodstock of 3- to 6-year-old rainbow trouts (800) affected with idiopathic intestinal tumours (3%) which had consequentially led to ileus (40%). While performing necropsy, initial pathological observations showed intussusceptions. Tumours were discovered upon opening the body cavity, as well as metastasis forming in the livers and in the vessels of the gills. Histopathological and immunohistochemical tests allowed us to identify the neoplasms. The primary adenocarcinoma was found to have been developed within the intestines of the fish. The tumour tissue broke through the basal membrane and infiltrated the propria, protruding asymmetrically into the lumen of the mid-intestines, causing it to narrow significantly. This subsequently led to passage disorders, invagination of the intestinal segment and finally the emaciation of the fish. Histopathological and immunohistochemical inspection of the tumour cells displayed a high mitotic index, confirming malignancy.
Collapse
Affiliation(s)
- Márton Hoitsy
- Kaposvár Campus, Institute of Environmental Sciences and Nature Conservation, Szent István University, Kaposvár, Hungary
| | | | | | - Tamás Molnár
- Kaposvár Campus, Institute of Environmental Sciences and Nature Conservation, Szent István University, Kaposvár, Hungary
| | - János Gál
- Department of Exotic Animal and Wildlife Medicine and Clinic, University of Veterinary Medicine, Budapest, Hungary
| | - Ferenc Baska
- Department of Exotic Animal and Wildlife Medicine and Clinic, University of Veterinary Medicine, Budapest, Hungary
| |
Collapse
|
15
|
de Vries FE, Godthelp A, Spruit JR, Ruissen AM, Tesselaar MET, Boekhout AH. Coping with social consequences of disease-related symptoms in patients with a metastatic small intestinal neuroendocrine tumour: A qualitative study. J Neuroendocrinol 2021; 33:e12956. [PMID: 33733525 DOI: 10.1111/jne.12956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/20/2022]
Abstract
Patients with small intestine neuroendocrine tumours (SINETs) face various disease-related symptoms that can affect their social functioning and quality of life. The present study aimed to explore the social consequences of disease-related symptoms in patients with a metastatic SINET and to develop a theory on how these patients experience their disease. Patients were eligible when they were diagnosed with a metastatic SINET between 2009 and 2016 and were younger than 60 years of age during diagnosis, and had a good functional performance status. Semi-structured interviews were conducted between January and June 2018. Data were transcribed and analysed independently by two researchers using grounded theory. Data saturation was reached at 10 interviews and, in total, 12 patients participated. A core component that arose from the interviews was resilience in the face of social consequences of having a metastatic SINET. Prominent physical symptoms were fatigue, diarrhoea and flushes. All of these symptoms were associated with limitations to function in work-related and social activities, as well as feelings of embarrassment and shame. Adaptive strategies, such as careful planning, or focusing on the perspective to live well with a neuroendocrine tumour, helped patients to experience the consequences as less burdensome. Other helpful factors that were identified constituted social support, engaging in meaningful activities and financial stability. Patients with a metastatic SINET experienced social consequences of disease-related symptoms in daily life, although they were able to attenuate the burden of these consequences by using adaptive problem-based, emotion-based and meaning-based coping strategies. Clinicians could explore the perceived consequences and educate patients about adaptive strategies.
Collapse
Affiliation(s)
- Froukje E de Vries
- Department of Psychiatry and Centre for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Albertien Godthelp
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jocelyn R Spruit
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrea M Ruissen
- Department of Psychiatry, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | - Margot E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelies H Boekhout
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Zhang G, Lin L, Dong D, Qiu H, Liu T, Lian L, Shen G. Nivolumab plus regorafenib in patients with small bowel adenocarcinoma: A case report. Medicine (Baltimore) 2021; 100:e24295. [PMID: 33530218 PMCID: PMC7850762 DOI: 10.1097/md.0000000000024295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Small bowel adenocarcinomas (SBAs) are rare cancers that have a distinct clinical characteristic and genetic profile. The only potentially curative treatment for localized SBAs is surgery, and treatment options are limited for patients in the advanced stage of disease. PATIENT CONCERNS A 39-year-old woman presented in October 2015 with a complaint of persistent vomiting for 8 months. DIAGNOSIS The patient had obstruction caused by a 3 × 2 cm mass at the ascending part of the duodenum and suspected metastasis in the right adnexal region. Postoperative pathology showed a moderately differentiated adenocarcinoma with serosal invasion. The diagnosis was stage IV duodenum adenocarcinoma with right adnexal metastasis. INTERVENTIONS After the failure of multi-line treatment with chemotherapy and targeted therapy, she was treated with the immune checkpoint inhibitor nivolumab plus regorafenib. OUTCOMES Disease control lasted for 15 months with markedly improved symptoms. CONCLUSION To the best of our knowledge, this is the first case of small bowel adenocarcinoma that has been treated with nivolumab combined with regorafenib. This case highlights the potential efficacy of combining nivolumab and regorafenib in the treatment of SBAs.
Collapse
Affiliation(s)
- Gairong Zhang
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
| | - Li Lin
- Department of Oncology, Peking University International Hospital, the 8th Clinical Medical College
| | - Dapeng Dong
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
| | - Hui Qiu
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
| | - Tao Liu
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
| | - Li Lian
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
| | - Ge Shen
- Department of Oncology, Beijing Huian Hospital of Integrated TCM and Western Medicine
- Department of Oncology, Beijing Fengtai You’anmen Hospital, Beijing, China
| |
Collapse
|
17
|
Ju M, Aoyama T, Endo K, Sugiyama A, Mori K, Sato T, Tamagawa H, Oshima T, Yukawa N, Masuda M, Rino Y. [A Case of Metastatic Small Intestinal Tumor Diagnosed with Intestinal Obstruction]. Gan To Kagaku Ryoho 2020; 47:2373-2375. [PMID: 33468965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 76-year-old man with a past history of liver transplantation because of liver cirrhosis visited a hospital in October 2018 because of vomiting and abdominal pain. Although the patient underwent conservative medical treatment, no improvement of the symptoms was observed, and he received consultation at our hospital. After thorough examination, and because of the policy of inpatient treatment after the diagnosis of adhesion ileus obstruction post liver transplantation surgery, intestinal decompression was performed using an ileus tube. However, there was no improvement in the symptoms even after inserting the ileus tube, and intestinal obstruction was diagnosed in November 2018. During the preoperative examination, a tumorous shadow was found in the right lung, although it became a policy of scrutiny after improvement of the bowel obstruction. During the laparotomy, a macroscopic tumor exposed on the serosal surface was observed on the anal side at 120 cm from the Treitz ligament, and this site was considered to be the blocking origin. Partial resection of the small intestine including the blockage site was performed. The pathological result revealed the diagnosis of adenosquamous carcinoma. Furthermore, immunostaining was CK7 positive, CK20 negative, TTF-1 negative, and Napsin negative, suggesting the possibility of a metastatic tumor derived from lung cancer. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. On day 30 after surgery, the left pleural effusion increased and pleural effusion cytology revealed a diagnosis of primary lung adenocarcinoma Stage Ⅳ. Considering the patient's PS, it became a best supportive care(BSC)policy after consultation with the family, and it ended on postoperative day 70. Here, we report about a case diagnosed with metastatic small bowel cancer and intestinal obstruction and conduct a literature review.
Collapse
Affiliation(s)
- Mihwa Ju
- Dept. of Surgery, Yokohama City University Hospital
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kidnie R, Momah T. Invasive Adenocarcinoma of the Ileum Presenting as a Small Bowel Obstruction. West Afr J Med 2020; 37:832-835. [PMID: 33296496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Invasive adenocarcinoma of the ileum is a rare tumor with an incidence of 0.59 per 1 million. Given its location in the distal portion of the small bowel, it is difficult to diagnose early and is often only discovered during surgery. This challenge leads to late diagnoses and poor prognosis. Surgical resection is the gold standard for treatment, with adjuvant therapy occasionally playing a supporting role. We present the case of a 62-year-old male with a complex past medical history, including non-small cell lung cancer with metastases to brain and treated with irradiation and left parietal craniotomy 13 years prior to presentation. Our patient presented to a community hospital complaining of abdominal pain. Findings on abdominal computerized tomography (CT) with intravenous (IV) contrast was consistent with a mechanical obstruction of the small bowel. The patient was admitted to the general medical floor for non-operative management. However, after three days of unsuccessful non-operative management, he was taken to the operating room for diagnostic laparoscopy. Surgery revealed an obstructing mass in the distal third of the ileum, which was excised and found to be invasive adenocarcinoma on histology. Adenocarcinoma of the ileum is very difficult to diagnose preoperatively. As a result, it often leads to delays in treatment and a poor prognosis in many patients, including ours. Because of its very low prevalence, a high index of suspicion is required to make an early diagnosis and obtain definitive treatment.
Collapse
Affiliation(s)
- R Kidnie
- University of Mississippi Medical Center, Jackson, MS,USA
| | - T Momah
- University of Mississippi Medical Center, Jackson, MS,USA
| |
Collapse
|
19
|
Dos Santos Pereira E, Magalhães Albuquerque L, de Queiroz Balbino V, da Silva Junior WJ, Rodriguez Burbano RM, Pordeus Gomes JP, Barem Rabenhorst SH. Helicobacter pylori cagE, cagG, and cagM can be a prognostic marker for intestinal and diffuse gastric cancer. Infect Genet Evol 2020; 84:104477. [PMID: 32736040 DOI: 10.1016/j.meegid.2020.104477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/15/2023]
Abstract
It is known that Helicobacter pylori is the main cause of peptic ulceration and gastric cancer. However, there is a lack of information on whether H. pylori strains may differ in gastric cancer histological subtypes. This study aimed to investigate different H. pylori strains considering six cag Pathogenicity Island - cagPAI genes (cagA, cagE, cagG, cagM, cagT, and virb11), and vacuolating cytotoxin - vacA alleles, and their relation to gastric cancer histologic subtypes. For this purpose, tumor samples from 285 patients with gastric carcinoma were used. H. pylori infection and genotypes were determined by polymerase chain reaction (PCR). H. pylori was detected in 93.9% of gastric tumors. For comparative analyzes between histopathological subtypes considering H. pylori cagPAI genes the strains were grouped according to the vacA s1/s2 alleles. In the vacAs1 group, the strains cagA(-)cagE(+), cagA(+)cagE(+)cagG(+), cagA(+)cagM(+), or only cagE(+) strains were more frequent in the intestinal subtype (P = .009; P = .024; P = .046, respectively). In contrast, cagM(+)cagG(+)cagA(-) and cagE(-) were associated with diffuse tumors (P = .036), highlighting the presence of cagE in the development of intestinal tumors, and the presence of cagG and absence of cagE in diffuse tumors. Furthermore, WEKA software and Decision Tree (CART) analyses confirmed these findings, in which cagE presence was associated with intestinal tumors, and cagE absence and cagG(+) with diffuse tumors. In conclusion our results showed that vacAs1 (cagG + cagM) strains, mainly cagG positive with cagE absence, were relevant in the studied population for the diffuse outcome, while the presence of cagE was relevant for the intestinal outcome. These findings suggest the relevance of these H. pylori genes as potential markers for gastric cancer histological outcomes.
Collapse
Affiliation(s)
- Eliane Dos Santos Pereira
- Department of Pathology and Forensic Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Valdir de Queiroz Balbino
- Department of Genetics, Biomedical Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | | | | |
Collapse
|
20
|
Portelli Tremont JN, Barnes E, Woodham C, Udekwu PO. A Perforated Small Bowel GI Stromal Tumor: An Unsuspecting Diagnosis in a Patient with Focal Peritonitis. Am Surg 2020; 86:e208-e209. [PMID: 32391782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
21
|
Jia N, Tang Y, Li Y. Rare malignant ulcer related to primary intestinal diffuse large B-cell lymphoma: A case report. Medicine (Baltimore) 2020; 99:e18590. [PMID: 32028388 PMCID: PMC7015566 DOI: 10.1097/md.0000000000018590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The specific pathogenesis of the diffuse large B-cell lymphoma(DLBCL)is still indefinite and argumentative. It is known that DLBCL is the most common type of non-Hodgkin's lymphomas (NHL). A lot of cases of DLBCL such as primary gastric diffuse large B-cell lymphoma(PG-DLBCL) are reported. However, primary intestinal diffuse large B-cell lymphoma(PI-DLBCL) is unusual. PATIENT CONCERNS We present a case of a 57-year-old male diagnosed in the Gastroenterology Department, which presented a bleeding duodenal ulcer with irregular borders. DIAGNOSES The immunohistochemical staining showed: CD20(+++), CD10(+) and Ki-67>40%. INTERVENTIONS The patient was successfully treated by Poly-chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vindesine and prednisolone). OUTCOMES After 6 courses of chemotherapy treatment, the duodenal ulcer was completely healed by reviewing the UGIE. LESSONS Our report might give further strength to avoiding the erroneous and missed diagnosis for PI-DLBCL which is different from common duodenal ulcer.
Collapse
Affiliation(s)
- Ning Jia
- Department of Gastroenterology, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine
| | - Yanping Tang
- Department of Gastroenterology, Tianjin Hospital of Integrated Traditional Chinese and Western Medicine
| | - Yang Li
- Department of Diabetes, Tianjin Nankai District Hospital of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
22
|
Franssen GJH, van Ginhoven TM, Hofland J, Feelders RA, Geilvoet W, van Lanschot JB. [Small bowel neuroendocrine tumours: to be considered in the differential diagnosis of unexplained abdominal pain and diarrhoea]. Ned Tijdschr Geneeskd 2020; 164:D4235. [PMID: 32186828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Small bowel neuroendocrine tumours (NET) are relatively rare malignancies. Due to the lack of specificity, the symptoms are usually initially attributed to irritable bowel syndrome. Frequently there is a delay of years after the onset of symptoms, before the diagnosis is made. We describe two patient cases with a small bowel NET that illustrate the typical course of the symptoms, as well as the complications of carcinoid syndrome, carcinoid heart disease, mesenteric venous congestion and arterial ischemia. On coloscopy the primary tumour can often not be reached. CT scan is the best diagnostic modality and should be considered in a patient with abdominal pain, diarrhoea, weight loss and a negative coloscopy, especially in the presence of flushing. In a non-curative situation, first-line treatment consists of a somatostatin analogue, in order to prolong progression-free survival and reduce hormonal hypersecretion. Palliative surgery can also play an important role in the management of small bowel NET.
Collapse
Affiliation(s)
- Gaston J H Franssen
- Erasmus MC, Rotterdam. Afd. Chirurgie
- Contact: Gaston J.H. Franssen (G. Franssen )
| | | | | | | | | | | |
Collapse
|
23
|
Seike T, Yamato M, Suda T, Soga S, Kobayashi M, Hirose K, Oishi N. A case of small bowel adenocarcinoma that caused intestinal obstruction after administration of patency capsule. Clin J Gastroenterol 2020; 13:522-526. [PMID: 31893340 DOI: 10.1007/s12328-019-01084-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/11/2019] [Indexed: 11/27/2022]
Abstract
An 80-year-old man was admitted to our hospital with iron deficiency anemia and exertional chest pain. Coronary artery angiography showed 90% stenosis in the middle left anterior descending branch; abdominal computed tomography (CT) showed enlarged mesenteric lymph nodes. Although his past medical history and results of imaging studies did not suggest intestinal stenosis, assessment of intestinal patency with the PillCam® patency capsule (tag-less PC) was performed. Thirty-three hours after administration, excretion of tag-less PC was not confirmed; an abdominal contrast-enhanced CT showed arrest of tag-less PC in the small bowel and thickening of the bowel wall, suggesting a small bowel tumor. Four days after administration of tag-less PC, he developed abdominal pain and vomiting. Intestinal obstruction was diagnosed by abdominal radiograph. A diagnosis of small bowel tumor with intestinal obstruction was made, and surgical resection was performed. The tumor was histologically an adenocarcinoma. It is necessary to carefully evaluate gastrointestinal patency before small intestine endoscopy especially in elderly people with reduced cardiopulmonary function and many underlying diseases.
Collapse
Affiliation(s)
- Takuya Seike
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Japan.
- System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Masatoshi Yamato
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Japan
- System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tsuyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Japan
- System Biology, Graduate School of Advanced Preventive Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shingo Soga
- Department of Surgery, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Masako Kobayashi
- Department of Clinical Laboratory, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Koichi Hirose
- Department of Surgery, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Naoki Oishi
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Japan
| |
Collapse
|
24
|
Shulutko AM, Agadzhanov VG, Moiseev AY, Mishchenko NP. [Metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy]. Khirurgiia (Mosk) 2020:118-120. [PMID: 32573543 DOI: 10.17116/hirurgia2020061118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Small bowel tumor causes gastrointestinal bleeding in 1-4% of cases. Gastrointestinal bleeding from metastases of renal cell carcinoma is a rare and little-known manifestation of this disease. We report a rare clinical case of a solitary metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy. The first symptom was intestinal bleeding. This example emphasizes the need for more thorough examination of patients with symptoms of latent and anamnestic blood loss.
Collapse
Affiliation(s)
- A M Shulutko
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - V G Agadzhanov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A Yu Moiseev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - N P Mishchenko
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| |
Collapse
|
25
|
Adachi Y, Katsuki T, Akiyama Y, Torigoe T, Hirata K. [A Case Report of Multiple Intussusceptions by Intestinal Metastases of Pleomorphic Carcinoma of the Lung]. J UOEH 2020; 42:83-88. [PMID: 32213746 DOI: 10.7888/juoeh.42.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 68-year-old male with abdominal pain and vomiting was brought to our hospital by ambulance. Computed tomography showed multiple intussusceptions with pseudokidney signs in the jejunum and ileocecum, and a tumor of 5 cm in diameter in the left lower lobe of the lung. We performed an emergent operation, as a release of multiple intussusceptions was difficult by conservative treatment. There were two intussusceptions, in the jejunum and the ileocecum. We performed a partial resection of the jejunum and a resection of the ileocecum. Histopathological examination of the resected specimens and a biopsy specimen collected by bronchoscopy allowed us to diagnose multiple intussusceptions due to small intestine metastases from a pleomorphic carcinoma of the lung. This case is presented here, with a review of the literature.
Collapse
Affiliation(s)
- Yasuhiro Adachi
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Takefumi Katsuki
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Akiyama
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Takayuki Torigoe
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Keiji Hirata
- Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Japan
| |
Collapse
|
26
|
Laing E, Kiss N, Michael M, Krishnasamy M. Nutritional Complications and the Management of Patients with Gastroenteropancreatic Neuroendocrine Tumors. Neuroendocrinology 2020; 110:430-442. [PMID: 31550712 DOI: 10.1159/000503634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022]
Abstract
Neuroendocrine tumors (NETs) have increased in incidence and prevalence over the past 2 decades and affect approximately 170,000 people in the United States alone. Gastroenteropancreatic (GEP) NETs (GEP NET) are a heterogeneous group of rare tumors that have distinct effects on the body due to their tumor location and potential to secrete hormones and peptides. Clinical practice guidelines and consensus guidelines for GEP NETs with regard to best practice for diagnosis, treatment, and medical management are available, but the supportive care needs and optimal nutritional management of patients affected by these unique tumors remain under-researched: evidence to guide clinical practice is lacking. The pathophysiology of the disease and its treatment can cause various symptoms that can have significant effects on vitamin synthesis and absorption, dietary habits, weight change, and appetite. Deficiency of fat-soluble vitamins and niacin exists amongst patients with GEP NET, particularly those on treatment with somatostatin analogs and with serotonin-secreting tumors, respectively. Malnutrition and dietary modification amongst patients with GEP NET is more prevalent than initially thought: up to 25% of inpatients with GEP NET are malnourished. Food intolerance is also reported in up to 40-90% of these patients, though its misdiagnosis is common. This review summarizes the evidence regarding the impact of GEP NET and its treatment on nutritional factors in these patients with emphasis on malnutrition, vitamin deficiencies, dietary intake, and quality of life. Recommendations for clinical practice and research approaches to address these nutritional issues are discussed.
Collapse
Affiliation(s)
- Erin Laing
- Department of Nutrition and Speech Pathology, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia,
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Nicole Kiss
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Michael
- Department of Medical Oncology and Neuroendocrine Unit, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Meinir Krishnasamy
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
27
|
Hasegawa H, Hu Q, Takada K, Kitagawa D, Kishihara F, Funahashi S, Kitamura M. [A Case Report of Gastrointestinal Bleeding with Difficulty in Diagnosis]. Gan To Kagaku Ryoho 2019; 46:2134-2136. [PMID: 32156856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The authors report a case involving a 55-year-old female patient who presented with melena and anemia 8 years ago. Esophagogastroduodenoscopy, colonoscopy, and CT did not reveal any sign of lesions except multiple uterine myoma. On reevaluation after the onset of melena, we did not find any lesions. However, the patient had a recurrent episode of melena with progressive anemia(Hb level 12.8 g/dL→9.8 g/dL). CT revealed a 29mm mass in the right side of the pelvis, which was retrospectively observed in the past CT scan, although its position had changed. We suspected gastrointestinal stromal tumor (GIST). Small intestine fluoroscopy revealed the tumor with effusion of barium inside the translucent areas of the ileum. For diagnostic treatment, laparoscopic partial jejunum resection was performed. Pathological diagnostic examination revealed that the tumor consisted of spindle cell disarray with moderate density, fewer heterocysts, and rare mitosis. The tumor cells were c-kit positive and CD34 negative in immunohistochemistry. All the results were consistent with GIST. Eight years had passed before diagnosis and surgical treatment were performed. This case report emphasizes the difficulty of diagnose of GIST because of its low malignancy and slow progression.
Collapse
|
28
|
Hara K, Aoyama T, Nukada S, Koumori K, Tanaka A, Amano S, Katayama Y, Numata M, Tamagawa H, Sato T, Oshima T, Jin Y, Yukawa N, Rino Y, Masuda M. [A Case of Perforated Intestinal Malignant Lymphoma Induced to Remission by Multidisciplinary Therapy]. Gan To Kagaku Ryoho 2019; 46:1972-1974. [PMID: 32157030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 61-year-old man had a sudden severe abdominal pain and visited our hospital. He was diagnosed with intestinal perforation, given the peritoneal irritation symptoms, the thickening of the intestinal wall and free air as shown on enhanced abdominal computed tomography. He then underwent emergent surgery. A tumor with small perforation was found on the intestine about 15 cm distant from the terminal ileum. Partial resection of the ileum was performed. Microscopically, a type 2 tumor of 70×50mm in diameter, was observed in the resected intestine. The tumor was diagnosed as diffuse large B-cell lymphoma via immunochemical staining. He received 6courses of R-CHOP therapy after surgery without recurrence. A primary intestinal malignant lymphoma is easily perforated, which lead to poor prognosis of the patient. We report a case of perforated intestinal malignant lymphoma, which was induced to remission by multidisciplinary therapy.
Collapse
Affiliation(s)
- Kentaro Hara
- Dept. of Surgery, Japanese Red Cross Hadano Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Neuroendocrine tumors (NETs) arise from enterochromaffin cells found in neuroendocrine tissues, with most occurring in the gastrointestinal tract. The global incidence of NETs has increased in the past 15 years, likely due to better diagnostic methods. Small-bowel NETs are frequently associated with carcinoid syndrome (CS). Carcinoid syndrome diarrhea occurs in 80% of CS patients and poses a substantial symptomatic and economic burden. Patients with CS diarrhea frequently suffer from diarrhea and flushing and report corresponding impairment in quality of life, requiring substantial changes in daily activities and lifestyle. Treatment paradigms range from surgical debulking to liver-directed therapies to treatment with somatostatin analogs, nonspecific anti-diarrheal agents, and a tryptophan hydroxylase inhibitor. Other causes of diarrhea, including steatorrhea, short bowel syndrome, and bile acid malabsorption, should be considered in NET patients with refractory diarrhea. More therapeutic options are needed for symptomatic management of patients with NETs, and better understanding of the pathophysiology can empower clinicians with improved patient care.
Collapse
Affiliation(s)
| | - Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Daniel M. Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy J. Purvis
- University of Arizona Cancer Center (UACC), Phoenix, AZ
| | - Thomas M. O'Dorisio
- Neuroendocrine Cancer Program, University of Iowa Health Care, Iowa City, IA
| | | |
Collapse
|
30
|
Sotiriou S, Papavramidis T, Hytiroglou P. Calcifying Fibrous Tumor of Small Bowel Causing Intussusception. Clin Gastroenterol Hepatol 2019; 17:e95. [PMID: 29981435 DOI: 10.1016/j.cgh.2018.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/28/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Sotiris Sotiriou
- Department of Pathology, Faculty of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Prodromos Hytiroglou
- Department of Pathology, Faculty of Medicine, Aristotle University, Thessaloniki, Greece
| |
Collapse
|
31
|
Tominaga K, Kamimura K, Yokoyama J, Terai S. Usefulness of Capsule Endoscopy and Double-balloon Enteroscopy for the Diagnosis of Multiple Carcinoid Tumors in the Small Intestine: Case Reports and a Literature Review. Intern Med 2019; 58:655-659. [PMID: 30333421 PMCID: PMC6443552 DOI: 10.2169/internalmedicine.1700-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The incidence of carcinoid tumor in the small intestine is increasing; however, its preoperative diagnosis is difficult. We recently experienced three cases of multiple carcinoid tumors in the small intestine successfully detected using capsule endoscopy (CE), followed by a pathological diagnosis using double-balloon enteroscopy (DBE). To diagnose multiple carcinoid in the small intestine appropriately, we reviewed the information of five cases reported to date along with our three recent cases. The literature review demonstrated that CE and DBE are useful for detecting and diagnosing small intestinal carcinoids and tumor multiplicity, which aids in determining the appropriate resection range.
Collapse
Affiliation(s)
- Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| |
Collapse
|
32
|
Miglio A, Morelli C, Gialletti R, Lauteri E, Sforna M, Marenzoni ML, Antognoni MT. Clinical and immunophenotypic findings in 4 forms of equine lymphoma. Can Vet J 2019; 60:33-40. [PMID: 30651648 PMCID: PMC6294024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The clinical, histological, and immunophenotypic findings are presented for 4 horses affected by different types of lymphoma. Diagnoses of a monomorphic epitheliotropic intestinal T-cell lymphoma, a diffuse splenic large B-cell lymphoma, a peripheral T-cell lymphoma, and a T-cell rich large B-cell lymphoma of the third eyelid were made.
Collapse
Affiliation(s)
- Arianna Miglio
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Chiara Morelli
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Rodolfo Gialletti
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Eleonora Lauteri
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Monica Sforna
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Maria Luisa Marenzoni
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| | - Maria Teresa Antognoni
- Department of Veterinary Medicine, University of Perugia, via S. Costanzo 4, 06126 Perugia, Italy
| |
Collapse
|
33
|
Cedrón Cheng HG, Chirinos Vega JA. [Single balloon enteroscopy in the management of small bowel pathology. Experience of the Small Bowel Unit - British American Hospital from December 2012 to December 2018]. Rev Gastroenterol Peru 2019; 39:27-37. [PMID: 31042234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. MATERIAL AND METHODS Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. RESULTS We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. CONCLUSION Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure.
Collapse
|
34
|
Hu R, Gong JP, Cao Z. Minimally Invasive Treatment of Small Intestinal Bleeding. Am Surg 2018; 84:e524-e526. [PMID: 30606364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
35
|
Capuano F, Grami O, Pugliese L, Paulli M, Pietrabissa A, Solcia E, Vanoli A. Grade 3 Neuroendocrine Tumor (G3 NET) in a Background of Multiple Serotonin Cell Neoplasms of the Ileum Associated with Carcinoid Syndrome and Aggressive Behavior. Endocr Pathol 2018; 29:369-373. [PMID: 30076568 DOI: 10.1007/s12022-018-9541-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Grade 3 well-differentiated neuroendocrine tumors (G3 NETs) have been characterized in the pancreas and stomach and distinguished from low-to-intermediate grade (G1-G2) NETs, as well as from highly malignant, poorly differentiated neuroendocrine carcinomas (NECs). Up to now, no G3 NET has been thoroughly described in the distal small intestine. We herein report a case of a 61-year-old man presenting with carcinoid syndrome. The surgical specimen showed, in a background of small G1 ileal NETs, a larger, grade 3 NET, which retained the nesting pattern and the expression of serotonin, chromogranin-A, and type 2A somatostatin receptors, typical of well-differentiated jejuno-ileal NETs. The patient had G3 NET metastasis to the liver and he died 14 months after surgery, due to deterioration in his clinical conditions.
Collapse
Affiliation(s)
- Francesca Capuano
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, 27100, Pavia, Italia
| | - Oneda Grami
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, 27100, Pavia, Italia
| | - Luigi Pugliese
- Unit of General Surgery 2, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Paulli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, 27100, Pavia, Italia
| | - Andrea Pietrabissa
- Unit of General Surgery 2, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Solcia
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, 27100, Pavia, Italia
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, 27100, Pavia, Italia.
| |
Collapse
|
36
|
Iwaya Y, Streutker CJ, Coneys JG, Marcon N. Hemangiolymphangioma of the small bowel: A rare cause of chronic anemia. Dig Liver Dis 2018; 50:1248. [PMID: 29886080 DOI: 10.1016/j.dld.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/04/2018] [Accepted: 05/06/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Yugo Iwaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Catherine J Streutker
- Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Gerard Coneys
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Norman Marcon
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Matsuo K, Inoue M, Shirai Y, Kataoka T, Kagota S, Taniguchi K, Lee SW, Uchiyama K. Primary small bowel mesentery de-differentiated liposarcoma causing torsion with no recurrence for 5 years: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e13446. [PMID: 30508962 PMCID: PMC6283127 DOI: 10.1097/md.0000000000013446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Liposarcoma (LPS) is a rare malignant soft-tissue tumor. Management of LPS is relatively difficult, because there are no characteristic symptoms, or biomarkers, nor any established effective treatment. Hence, the report of the accumulation of each LPS case is necessary. We experienced an extremely rare case of torsion caused by a primary small bowel mesentery LPS. PATIENT'S CONCERN A 70-year-old male consulted our hospital with the complaints of abdominal pain and sudden vomiting. DIAGNOSIS No lump could be palpated, and tumor markers tested were within normal limits. However, computed tomography revealed an intestinal obstruction caused by torsion of the small bowel due to an LPS tumor. INTERVENTIONS After decompression of the intestinal obstruction by use of an ileus tube, surgical treatment was performed with rapidity. OUTCOME The torsion was found to be caused by the tumor that originated from the small bowel mesentery. The tumor was resected along with a portion of the small bowel. The growth of adipose tissues of various sizes and containing atypical cells was detected by histopathological examination. Also, immunohistochemical examination resulted in positive immuno-reactions for MDM2, CDK4, and p16INK4, which indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 14 without any complications, and no recurrence of the tumor was observed at 5 years after the operation. LESSONS LPS should be considered in differential diagnosis of bowel torsion, and careful management is required because of the high possibility of recurrence. Patients should be followed carefully for at least 5 years, and further accumulation of data will be required in order to establish the appropriate management of LPS.
Collapse
Affiliation(s)
- Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Masaya Inoue
- Department of Gastroenterological Surgery, Katsuragi Hospital, Kishiwada, Osaka
| | - Yasutsugu Shirai
- Department of Gastroenterological Surgery, Katsuragi Hospital, Kishiwada, Osaka
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medical Science, Shogoin Kawahara-cho, Sakyo-ku Kyoto
| | - Shuji Kagota
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
- Translational Research Program, Osaka Medical College, Daigaku-machi, Takatsuki, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| |
Collapse
|
38
|
Wang CSE, Li WB, Wang HY, Ma YM, Zhao XH, Yang H, Qian JM, Li JN. VSL#3 can prevent ulcerative colitis-associated carcinogenesis in mice. World J Gastroenterol 2018; 24:4254-4262. [PMID: 30310258 PMCID: PMC6175759 DOI: 10.3748/wjg.v24.i37.4254] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/07/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effects of VSL#3 on tumor formation, and fecal and intestinal mucosal microbiota in azoxymethane/dextran sulfate sodium (AOM/DSS) induced mice model.
METHODS C57BL/6 mice were administered AOM/DSS to develop the ulcerative colitis (UC) carcinogenesis model. Mice were treated with 5-ASA (75 mg/kg/d), VSL#3 (1.5 × 109 CFU/d), or 5-ASA combined with VSL#3 by gavage from the day of AOM injection for three months (five days/week). The tumor load was compared in each group, and tumor necrosis factor (TNF-α) and interleukin (IL)-6 levels were evaluated in colon tissue. The stool and intestinal mucosa samples were collected to analyze the differences in the intestinal microbiota by 16s rDNA sequencing method.
RESULTS VSL#3 significantly reduced the tumor load in AOM/DSS-induced mice model and decreased the level of TNF-α and IL-6 in colon tissue. The model group had a lower level of Lactobacillus and higher level of Oscillibacter and Lachnoclostridium in fecal microbiota than the control group. After the intervention with 5-ASA and VSL#3, Bacillus and Lactococcus were increased, while Lachnoclostridium and Oscillibacter were reduced. 5-ASA combined with VSL#3 increased the Lactobacillus and decreased the Oscillibacter. The intestinal mucosal microbiota analysis showed a lower level of Bifidobacterium and Ruminococcaceae_UCG-014 and higher level of Alloprevotella in the model group as compared to the control group. After supplementation with VSL#3, Bifidobacterium was increased. 5-ASA combined with VSL#3 increased the level of both Lachnoclostridium and Bifidobacterium.
CONCLUSION VSL#3 can prevent UC-associated carcinogenesis in mice, reduce the colonic mucosal inflammation levels, and rebalance the fecal and mucosal intestinal microbiota.
Collapse
Affiliation(s)
- Chun-Sai-Er Wang
- Department of Gastroenterology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| | - Wen-Bin Li
- Department of Gastroenterology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| | - Hong-Ying Wang
- National Cancer Center/Cancer Hospital, CAMS and PUMC, Beijing 100021, China
| | - Yi-Ming Ma
- National Cancer Center/Cancer Hospital, CAMS and PUMC, Beijing 100021, China
| | - Xin-Hua Zhao
- National Cancer Center/Cancer Hospital, CAMS and PUMC, Beijing 100021, China
| | - Hong Yang
- Department of Gastroenterology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| | - Jia-Ming Qian
- Department of Gastroenterology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| | - Jing-Nan Li
- Department of Gastroenterology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| |
Collapse
|
39
|
Daskalakis K, Tsolakis AV. Upfront surgery of small intestinal neuroendocrine tumors. Time to reconsider? World J Gastroenterol 2018; 24:3201-3203. [PMID: 30090001 PMCID: PMC6079287 DOI: 10.3748/wjg.v24.i29.3201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
Small intestinal neuroendocrine tumors (SI-NETs) may demonstrate a widely variable clinical behavior but usually it is indolent. In cases with localized disease, locoregional resective surgery (LRS) is generally indicated with a curative intent. LRS of SI-NETs is also the recommended treatment when symptoms are present, regardless of the disease stage. Concerning asymptomatic patients with distant metastases, prophylactic LRS has been traditionally suggested to avoid possible future complications. Even the current European Neuroendocrine Tumor Society guidelines emphasize a possible effect of LRS in Stage IV SI-NETs with unresectable liver metastases. On the contrary, the 2017 National Comprehensive Cancer Network Guidelines on carcinoid tumors do not support the resection of a small, asymptomatic, relatively stable primary tumor in the presence of unresectable metastatic disease. Furthermore, a recent study revealed no survival advantage for asymptomatic patients with distant-stage disease who underwent upfront LRS. At the aforementioned paper, it was suggested that delayed surgery as needed was comparable with the upfront surgical approach in terms of postoperative morbidity and mortality, the length of the hospital stay and the rate of incisional hernia repairs but was associated with fewer reoperations for bowel obstruction. On the other hand, it is also important to note that some patients might benefit from a prophylactic surgical approach and our attention should focus on identifying this patient population.
Collapse
Affiliation(s)
- Kosmas Daskalakis
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
| | - Apostolos V Tsolakis
- Department of Oncology and Pathology, Karolinska Institute, Stockholm SE-171 76, Sweden
- Cancer Center Karolinska, Karolinska University Hospital Solna R8:04, Stockholm SE-171 76, Sweden
- Department of Gastrointestinal Endoscopy, Karolinska University Hospital Huddinge, Stockholm SE-141 86, Sweden
| |
Collapse
|
40
|
Li Z, Sun M, Song B, Shu Z. Gastrointestinal hemorrhage caused by adult intussusception secondary to small intestinal tumors: Two case reports. Medicine (Baltimore) 2018; 97:e12053. [PMID: 30142859 PMCID: PMC6112951 DOI: 10.1097/md.0000000000012053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/02/2018] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Adult intussusception is rarely observed, and the clinical manifestations are very atypical. The most common symptom is abdominal pain, while the incidence of hematochezia is relatively low. We report two cases of adult intussusception secondary to small intestinal tumors with gastrointestinal hemorrhage as the main symptom. PATIENT CONCERNS Two men aged 19 and 54 years were successively referred to our department due to intermittent hematochezia. The hemoglobin levels of the two patients declined progressively, and conservative treatment was ineffective. DIAGNOSES The first patient underwent an abdominal computed tomography angiography examination, which showed that the intestine and its mesentery were tortuous, suggesting an intra-abdominal hernia or intussusception. The second patient underwent an abdominal computed tomography examination, which suggested a high possibility of an intussusception. The two patients were diagnosed as adult intussusception caused by small intestinal tumors. INTERVENTIONS Emergency laparoscopic explorations were performed. Enteroenteric intussusceptions caused by ileal tumors were found during surgery. Reduction of the intussusceptions and resection of the ileal tumors were performed. OUTCOMES The patients recovered well after surgery, and postoperative pathology showed that the tumors were a vascular hamartoma polyp and a lipoma. LESSONS Adult intussusception is very rare, particularly with gastrointestinal hemorrhage as the main symptom. Isolated hamartoma polyp is a rare cause of intussusception in adults. The clinical manifestations of adult intussusception are very atypical, and thus, making a preoperative diagnosis is difficult. Abdominal CT or CTA is an effective diagnostic method for adult intussusception. For adult patients with gastrointestinal hemorrhage caused by intussusceptions, active surgery should be performed when conservative treatment is not effective. Laparoscopic surgery is a safe and effective treatment for adult intussusceptions caused by benign diseases.
Collapse
|
41
|
Al-Radaideh AM, Omari HZ, Bani-Hani KE. Adult intussusception : A 14-year retrospective study of clinical assessment and computed tomography diagnosis. Acta Gastroenterol Belg 2018; 81:367-372. [PMID: 30350523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Intussusception in adults often remains unrecognized. Our aim was to report our experience with this entity to determine the usefulness of CT scan in its preoperative diagnosis. PATIENTS AND METHODS The medical records and imaging studies of all patients ≥16 years of age with intussusception, who were managed at our hospitals, were retrospectively reviewed. RESULTS 17 cases of adult intussusception (7 males, 10 females; mean age 35.9 years; age range of 16-78) were identified. The diagnosis was possible in all patients using CT scan. The underlying etiologies were colon cancer (n=2), lymphoma (n=2), small bowel polyps (n=2), jejunal lipoma (n=1), metastatic melanoma (n=1), Meckel's diverticulum (MD) (n=1) and idiopathic (n=1). In the remaining 7 patients, the intussusceptions were of the transitory form and were treated conservatively and no significant sequela occurred after a follow-up of 2-60 months. CT scan findings in transient cases characteristically showed that the intussusception was localized to the proximal intestine and all of them had a short segment (2-4 cm) of intussusception. CONCLUSIONS The important role of the CT in the preoperative diagnosis of intussusception and characterizing its causes cannot be overemphasized. All transient cases had a short segment of intussusception.
Collapse
Affiliation(s)
- A M Al-Radaideh
- Department of Medical Imaging, Faculty of Allied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - H Z Omari
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - K E Bani-Hani
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| |
Collapse
|
42
|
Zhuang N, Zhu Q, Li W, Wang M, Yang Q, Liu W, Li J, Yang H, Zhou W. Rare intestinal fistula caused by primary lymphoma of the gastrointestinal tract: Two case reports and literature review. Medicine (Baltimore) 2018; 97:e11407. [PMID: 29979438 PMCID: PMC6076109 DOI: 10.1097/md.0000000000011407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Primary lymphoma that arises from the intestine is an uncommon malignant tumour, while intestinal fistula caused by primary lymphoma is even rarer. Non-specific clinical performance makes early diagnosis difficult, although imaging modalities might play an essential role in the detection of intestinal fistula. PATIENT CONCERNS Patient 1: A 60-year-old male hospitalized with diarrhoea and abdominal pain for seven months underwent computed tomography enterography (CTE) that demonstrated ileum internal fistula and ileac-sigmoid colon fistula. Ultrasound (US) showed small intestinal wall thickened and development of a fistula of the sigmoid colon due to malignance. Patient 2: A 43-year-old male presented with abdominal pain and diarrhoea lasting one year. US revealed a fistula between the sigmoid colon and the ileum, and CTE showed that the wall of the partial sigmoid colon was abnormally thickened and enhanced with an ileal-sigmoid fistula that strongly suggested the diagnosis of lymphoma. DIAGNOSES Both the two patients were diagnosed as intestinal fistula caused by primary non-Hodgkin's intestinal lymphoma. INTERVENTIONS The patient 1 underwent surgery followed by chemotherapy. The patient 2 accepted chemotherapy. OUTCOMES Two patients' general conditions remained stable and the imaging revealed no recurrence after follow-up of about 12 months. LESSIONS Cross-sectional imaging, such as US and CT, plays an essential role in intestinal lymphoma fistula diagnosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ji Li
- Department of Gastroenterology
| | | | - Weixun Zhou
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
43
|
Lee H, Sade I, Gilani S, Zhong M, Lombardo G. A Giant Fibroepithelial Polyp of the Small Bowel Associated with High-Grade Obstruction. Am Surg 2018; 84:e210-e211. [PMID: 30401014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
44
|
Matsuo K, Inoue M, Shirai Y, Kataoka T, Kagota S, Taniguchi K, Lee SW, Uchiyama K. A rare case of primary small bowel de-differentiated liposarcoma causing intussusception: A case report. Medicine (Baltimore) 2018; 97:e11069. [PMID: 29901613 PMCID: PMC6023844 DOI: 10.1097/md.0000000000011069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Liposarcoma (LPS) is a relatively rare malignant soft tissue tumor. Management of LPS including diagnosis is difficult, because it has no characteristic symptoms and no established effective treatment. Herein we reported an extremely rare case of intussusception induced by primary small bowel LPS. PATIENT'S CONCERN A-84-year-old male was a consult to our Emergency Department with symptoms of a terrible general fatigue, abdominal pain, and vomiting. DIAGNOSIS Abdominal ultrasonography and computed tomography (CT) revealed probable intussusception. INTERVENTIONS After decompression by insertion of an ileus tube, surgery was performed. OUTCOMES The ileum and mesentery of the small intestine had invaginated into the colon. There was no evidence of metastases in the intraabdominal space. The Hutchinson maneuver could not release the invagination, and so ileocecal resection with lymph node dissection was performed. Histopathological examination showed evidence of the growth of spindle-shaped cells. Also, immunohistochemical examination indicated the tumor to be a de-differentiated LPS. The patient was discharged on postoperative day 19 without any complications; and no recurrence of the tumor was observed at 16 months post operation. LESSONS LPS should be considered in the differential diagnosis of adult intussusception, and careful management should be required, including observation, after surgery.
Collapse
Affiliation(s)
- Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Masaya Inoue
- Department of Gastroenterological Surgery, Katsuragi Hospital, Habu cho, Kishiwada, Osaka
| | - Yasutsugu Shirai
- Department of Gastroenterological Surgery, Katsuragi Hospital, Habu cho, Kishiwada, Osaka
| | - Tatsuki Kataoka
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medical Science, Shogoin Kawahara-cho, Sakyo-ku Kyoto
| | - Shuji Kagota
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kohei Taniguchi
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
- Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Daigaku-machi, Takatsuki
| |
Collapse
|
45
|
Abstract
Malignant bowel obstruction is a common complication in patients with advanced abdominal or pelvic cancer. Whereas surgery should be considered in all cases of malignant bowel obstruction, many advanced and terminal cancer patients are considered unfit for surgery. In such patients with a short life expectancy, gastrointestinal symptoms such as nausea, vomiting, continuous and/or colicky pain, can be controlled by using a pharmacologic approach made up of analgesics, antiemetics and antisecretory drugs, without the use of a venting nasogastric tube. Among the antisecretory drugs, octreotide has been shown to reduce nausea and vomiting in bowel-obstructed patients owing to a reduction of gastrointestinal secretions, thus allowing in most patients removal of the nasogastric tube and the associated distress. Preclinical and clinical studies that demonstrated the role of somatostatin and octreotide in bowel obstruction are reviewed.
Collapse
Affiliation(s)
- C Ripamonti
- Rehabilitation and Palliative Care Division, National Cancer Institute, Milan, Italy.
| | | | | | | | | |
Collapse
|
46
|
Caruso ML, Cavalcanti E, De Michele F, Ignazzi A, Carullo R, Mastronardi M. Small bowel capsule endoscopy revealing neuromuscular and vascular hamartoma of the jejunum: A case report. Medicine (Baltimore) 2018; 97:e0196. [PMID: 29642143 PMCID: PMC5908559 DOI: 10.1097/md.0000000000010196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Digestive hemorrhage is a life-threatening and represents for both clinicians and patient a challenger problematic condition with the urgencies to discover the origin for correct the cause and safe the life of patient. PATIENT CONCERNS We report the case of a 58 -year-old man with extremely rare hamartomatous neurovascular lesion. Following recurrent episode of intestinal hemorrhage the patient underwent small bowel capsule endoscopy. DIAGNOSES Diagnosed with small intestine neoplasia. INTERVENTIONS The patient underwent curative small bowel resection. Histologic diagnosis was neuromuscular and vascular hamartoma (NMVH). In the small intestine, neoplastic lesions are very rare (2%) and mostly malformative while the more frequent cause of cryptic digestive hemorrhage remains angiodysplasia (50%) . The preexisting NMVH was exacerbated by the use of non-steroidal anti-inflammatory drugs, causing hemorrhage due to diffuse ulceration. OUTCOMES The patient stay healthy after treatment. LESSONS This is an hemorrhagic lesion with macroscopic "neoplastic" patterns due to abnormal mixing of normal indigenous tissue components. It poses a diagnostic challenge for clinicians and pathologists, but diagnosis is facilitated by capsule endoscopy and surgical treatment should provide definitive resolution.
Collapse
Affiliation(s)
| | | | | | | | | | - Mauro Mastronardi
- Department of Gastroenterology, National Institute of Gastroenterology “S. de Bellis”, Research Hospital, Castellana Grotte, Bari, Italy
| |
Collapse
|
47
|
Isenberg-Grzeda E, MacGregor M, Bergel A, Eagle S, Espi Forcen F, Mehta R, Matsoukas K, Wills J, Reidy-Lagunes D, Alici Y. Antidepressants appear safe in patients with carcinoid tumor: Results of a retrospective review. Eur J Surg Oncol 2018; 44:744-749. [PMID: 29622373 DOI: 10.1016/j.ejso.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/03/2018] [Accepted: 03/07/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Patients living with neuroendocrine tumors have high rates of depression, often necessitating antidepressants, including selective serotonin reuptake inhibitors (SSRI). Neuroendocrine tumors (NETs) secrete vasoactive substances, including serotonin, which contribute to the cluster of symptoms known as carcinoid syndrome (flushing and diarrhea). Controversy exists over whether or not antidepressants are safe in NET. We aimed to study the safety of antidepressant use in NET patients. METHODS We conducted a retrospective chart review of patients with well differentiated NET who were also prescribed antidepressants from January 2008 through April 2015. The study took place at Memorial Sloan Kettering Cancer Center and was approved by the hospital's institutional review board. RESULTS Ninety-two patients were included. There were 16 (17.4%) patients with carcinoid syndrome (10 ileum, 1 duodenum, 1 jejunum and 4 unknown primary); and 76 (82.6%) patients without (41 lung, 9 pancreas, 8 ileal, 5 duodenum, 5 appendix, 2 unknown primary, 1 jejunum and 5 other). Median duration of antidepressant prescription was 11.6 months (range, 0-121) among those with carcinoid syndrome (N = 16) and 14.3 months (range, 0-172) among those without carcinoid syndrome (n = 76). Antidepressants were stopped in 31 cases (33.7%), though the reason was not specified in the majority of cases (n = 18; 58%). None of the patients developed carcinoid syndrome while being prescribed antidepressants. No patients developed carcinoid crisis. CONCLUSION Our findings do not support previous authors' recommendations that SSRIs must be avoided in NET patients. Several classes of antidepressants appeared safe in NET patients with and without carcinoid syndrome.
Collapse
Affiliation(s)
- Elie Isenberg-Grzeda
- Department of Psychiatry, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, M4N3M5, Ontario, Canada.
| | - Meredith MacGregor
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA.
| | - Afton Bergel
- Long Island Jewish Medical Center, Department of Emergency Psychiatry, 270-05 76th Ave, Glen Oaks, 11004, NY, USA.
| | - Stacy Eagle
- Department of Psychiatry, Stony Brook University Medical Center, HSC, T10-020, Stony Brook, 11794-8101, NY, USA.
| | - Fernando Espi Forcen
- Department of Psychiatry, Rush University Medical Centerm, 1653 W Harrison, Chicago, 60612, IL, USA.
| | - Reema Mehta
- Department of Psychiatry, Jacobi Medical Center, 1400 Pelham Parkway, South Bronx, 10461, NY, USA.
| | - Konstantina Matsoukas
- Medical Library, Information Systems, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA.
| | - Jonathan Wills
- Information Systems, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA.
| | - Diane Reidy-Lagunes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA.
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA.
| |
Collapse
|
48
|
|
49
|
Affiliation(s)
- A Parfitt
- Department of General Surgery, St Mary's Hospital, London, England
| | | | | |
Collapse
|
50
|
Yang JH, Lee J, Kim SB, Kim SH, Lee GJ. Synchronous diffuse large B-cell lymphoma of the small intestine and adenocarcinoma of the colon. Korean J Intern Med 2018; 33:438-441. [PMID: 29117672 PMCID: PMC5840585 DOI: 10.3904/kjim.2015.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ji Hyun Yang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Jain Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Shin Bum Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Seon Hoo Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Guk Jin Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
- Correspondence to Guk Jin Lee, M.D. Division of Hematology and Medical Oncology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary’s Hospital, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea Tel: +82-32-340-7098 Fax: +82-32-340-2028 E-mail:
| |
Collapse
|