Uncommon tumors (~5% of all GI neoplasms); usually present with bleeding, abdominal pain, weight loss, fever, or intestinal obstruction (intermittent or fixed); increased incidence of lymphomas in pts with gluten-sensitive enteropathy, Crohn's disease involving small bowel, AIDS, prior organ transplantation, autoimmune disorders.
Usually benign; most common are adenomas (usually duodenal), leiomyomas (intramural), and lipomas (usually ileal); 50% of malignant tumors are adenocarcinoma, usually in duodenum (at or near ampulla of Vater) or proximal jejunum, commonly coexisting with benign adenomas; primary intestinal lymphomas (non-Hodgkin's) account for 25% and occur as focal mass (Western type), which is usually a T cell lymphoma associated with prior celiac disease, or diffuse infiltration (Mediterranean type), which is usually immunoproliferative small-intestinal disease (IPSID; α-heavy chain disease), a B cell MALT lymphoma associated with Campylobacter jejuni infection, which can present as intestinal malabsorption; carcinoid tumors (usually asymptomatic) occasionally produce bleeding or intussusception (see below).
Endoscopy and biopsy most useful for tumors of duodenum and proximal jejunum; otherwise barium x-ray examination best diagnostic test; direct small-bowel instillation of contrast (enteroclysis) occasionally reveals tumors not seen with routine small-bowel radiography; angiography (to detect plexus of tumor vessels) or laparotomy often required for diagnosis; CT useful to evaluate extent of tumor (esp. lymphomas).
Treatment: Small-Bowel Tumors Surgical excision; adjuvant chemotherapy appears helpful for focal lymphoma; IPSID appears to be curable with combination chemotherapy used in aggressive lymphoma plus oral antibiotics (e.g., tetracycline); no proven role for chemotherapy or radiation therapy for other small-bowel tumors. |
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