Barbara H. Jung1 and Maria Rosario Ferreira2 1 University of Washington, Seattle, WA, USA 2 Northwestern University Feinberg School of Medicine, Chicago, IL, USA, Tumors of the small intestine originate from epithelial, neuroendocrine, or mesenchymal cells. Overall, they are rare and account for only about 2% of all primary gastrointestinal tumors. Adenocarcinoma used to be the most common type of primary small intestinal cancer, but it is now being surpassed by small intestinal carcinoids. The mesenchymal gastrointestinal stromal tumors (GISTs), as well as primary small bowel lymphomas, are less common. Given their anatomical location in a part of the bowel that is difficult to reach, small intestinal tumors pose a significant challenge in regard to diagnosis and management; malignant tumors have often spread by the time of diagnosis. Both benign and malignant small bowel tumors are associated with significant morbidity and mortality, and more mechanistic insight is needed to advance therapeutic measures. This chapter summarizes our current knowledge on the various types of small intestinal tumors. A 51‐year‐old man underwent an upper endoscopy for evaluation of dyspeptic symptoms. The exam was otherwise unremarkable except for a submucosal lesion identified in the duodenal bulb (Figure 27.1a). An endoscopic ultrasound was performed which revealed features consistent with hamartoma (Figure 1b). This was subsequently removed with endoscopic mucosal resection and the specimen is seen in Figure 27.1c. A 61‐year‐old woman presented with iron deficiency anemia and had an initial negative evaluation with an esophagogastroduodenoscopy and colonoscopy. She then had a video capsule endoscopy revealing a jejunal lesion, in addition to several jejunal arteriovenous malformations (AVMs). An enteroscopy was performed and showed a jejunal tubulovillous adenoma (Figure 27.2), which was removed with endoscopic mucosal resection. The anemia improved after iron therapy but eventually recurred, requiring repeat evaluation with enteroscopy. No further adenomas were identified but there were several AVMs that were cauterized, after which the anemia resolved. A 73‐year‐old man presented with abdominal discomfort, gradually worsening over 3 months, associated with anorexia, early satiety, and weight loss of 20 pounds. Physical exam was unremarkable. An esophagogastroduodenoscopy revealed a mass in the third portion of the duodenum with biopsies consistent with adenocarcinoma. The patient underwent surgical resection (Figure 27.3a). Pathology confirmed adenocarcinoma (Figure 27.3b,c); the margins of resection were clear but three of seven lymph nodes examined were positive for adenocarcinoma. The patient did well initially after resection, and received adjuvant chemotherapy with 5‐fluorouracil. However, several months later there was evidence of metastatic disease in the liver and peritoneum and the patient died 18 months after the initial diagnosis. A 44‐year‐old woman underwent an esophagogastroduodenoscopy for evaluation of abdominal pain. A nodular lesion was identified in the third portion of the duodenum (Figure 27.4
CHAPTER 27
Tumors of the small intestine
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