Asunto(s)
Adenoma , Resección Endoscópica de la Mucosa , Neoplasias del Íleon , Válvula Ileocecal , Humanos , Resección Endoscópica de la Mucosa/métodos , Adenoma/cirugía , Adenoma/patología , Válvula Ileocecal/cirugía , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Masculino , Femenino , Anciano , Persona de Mediana EdadAsunto(s)
Adenoma , Resección Endoscópica de la Mucosa , Neoplasias del Íleon , Válvula Ileocecal , Humanos , Resección Endoscópica de la Mucosa/métodos , Adenoma/cirugía , Adenoma/patología , Válvula Ileocecal/cirugía , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Colonoscopía/métodosAsunto(s)
Neoplasias del Íleon , Linfangioma Quístico , Humanos , Femenino , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/cirugía , Linfangioma Quístico/patología , Niño , Neoplasias del Íleon/diagnóstico , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Diagnóstico Diferencial , Inmunohistoquímica , Dolor Abdominal/etiología , Ultrasonografía , Íleon/patología , Íleon/cirugía , Íleon/diagnóstico por imagenAsunto(s)
Neoplasias del Íleon , Tumor Rabdoide , Proteína SMARCB1 , Humanos , Masculino , Carcinoma/patología , Carcinoma/genética , Carcinoma/cirugía , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Tumor Rabdoide/patología , Tumor Rabdoide/genética , Proteína SMARCB1/genética , Proteína SMARCB1/deficiencia , Persona de Mediana EdadAsunto(s)
Neoplasias del Íleon , Procedimientos Quirúrgicos Mínimamente Invasivos , Tumores Neuroendocrinos , Humanos , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/mortalidad , Tumores Neuroendocrinos/patología , Tasa de Supervivencia , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/mortalidad , Neoplasias del Íleon/patología , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , PronósticoRESUMEN
A 53-year-old man with an abnormal routine physical examination was referred to our hospital. Colonoscopy showed a 5-mm submucosal tumor that was 7cm proximal to the ileocecal valve. It was identified as a neuroendocrine tumor (NET) on biopsy. Preoperatively, we conducted a double balloon endoscopy to examine the entire small intestine. Another 7-mm submucosal tumor was found on the ileocecal valve, which was missed during the first colonoscopy. A final diagnosis of multiple ileal NETs (<10mm in diameter) was made, and the patient underwent ileocecal resection with lymphadenectomy. Histopathological evaluation of the surgical specimen verified the diagnosis of NET Grade 1 with submucosal invasion. Metastasis to lymph node #202 was also detected. He remained relapse-free for 5 years and 5 months after the operation. In conclusion, this was a case of multiple ileal NETs (<10mm in diameter) with lymph node metastasis that could not be detected preoperatively on contrast-enhanced computed tomography. This case highlights the significance of detailed endoscopic observation of the terminal ileum.
Asunto(s)
Neoplasias del Íleon , Metástasis Linfática , Tumores Neuroendocrinos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico por imagen , Colonoscopía , Escisión del Ganglio Linfático , Endoscopía GastrointestinalRESUMEN
BACKGROUND: Ileal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS. METHODS: One hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to <0.2. RESULTS: Overall, 129 (77%) patients underwent MIS and 39 (23%) underwent open surgery. Twenty-seven MIS patients were converted to an open procedure. The median follow-up time was 49 months (interquartile range 23-87 months). In the PSM cohorts, overall survival did not differ significantly between the MIS and open surgery cohorts {median 99 months (95% confidence interval [CI] 91-not applicable [NA]) vs. 103 months (95% CI 86-NA), p = 0.77; hazard ratio 0.87 (95% CI 0.33-2.2), p = 0.77}. CONCLUSIONS: MIS is an alternative to open surgery for i-NETs, achieving similar short- and long-term oncological outcomes. Bulky mesenteric mass and a plan for concurrent liver resection are potential criteria for open surgery.
Asunto(s)
Neoplasias del Íleon , Procedimientos Quirúrgicos Mínimamente Invasivos , Tumores Neuroendocrinos , Humanos , Masculino , Femenino , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Estudios de Seguimiento , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/mortalidad , Neoplasias del Íleon/patología , Procedimientos Quirúrgicos Mínimamente Invasivos/mortalidad , Anciano , Pronóstico , Hepatectomía/mortalidad , Hepatectomía/métodos , AdultoRESUMEN
ABSTRACT: 64 Cu-DOTATATE PET/CT of a 44-year-old man with an ileal neuroendocrine tumor demonstrated the primary tumor, local nodal metastases, and a pericaval nodal metastasis. Localization of the pericaval node during surgery may be difficult, thus 4.4 mCi of 111 In-pentetreotide was administered before surgery to assist with localization and resection. At surgery, the pericaval nodal metastasis was readily detected by gamma probe, which could then be resected and pathologically proven to be a metastasis. This demonstrates the use of somatostatin receptor-targeted imaging for intraoperative localization of an otherwise difficult to surgically localize metastasis. Without intraoperative somatostatin receptor-targeted radiosurgery, disease may have been incompletely resected.
Asunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Radiocirugia , Somatostatina , Humanos , Masculino , Adulto , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Somatostatina/análogos & derivados , Metástasis Linfática , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Neoplasias Retroperitoneales/patología , Periodo Intraoperatorio , Cirugía Asistida por Computador , Tomografía Computarizada por Tomografía de Emisión de PositronesAsunto(s)
Calcinosis , Mesenterio , Humanos , Masculino , Calcinosis/diagnóstico por imagen , Calcinosis/cirugía , Calcinosis/patología , Mesenterio/diagnóstico por imagen , Mesenterio/patología , Mesenterio/cirugía , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/cirugía , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/diagnóstico , AncianoRESUMEN
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
Asunto(s)
Adenocarcinoma , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias del Yeyuno , Humanos , Intestino Delgado/patología , Neoplasias del Yeyuno/tratamiento farmacológico , Neoplasias del Yeyuno/patología , Neoplasias del Íleon/tratamiento farmacológico , Neoplasias del Íleon/patología , Neoplasias Duodenales/patología , Neoplasias Duodenales/terapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , InmunoterapiaRESUMEN
AIM: Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD. METHODS: We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists. RESULTS: Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002). CONCLUSIONS: Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.
Asunto(s)
Adenocarcinoma , Enfermedad de Crohn , Neoplasias Duodenales , Neoplasias del Íleon , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Casos y Controles , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/etiología , Neoplasias del Íleon/patología , Neoplasias Duodenales/patología , Imagen por Resonancia Magnética , Adenocarcinoma/patologíaAsunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Humanos , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Íleon/cirugía , Íleon/patología , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/cirugía , Neoplasias del Íleon/patologíaRESUMEN
Testicular metastasis are rare findings and bilateral metastasis of testes are extremely rare. Here we are describing for the first time a case of bilateral testicular metastasis in a patient with a known ileocecal valve NET using an in-depth ultra-sound studying including microvascular flow imaging (MV-flow), ultra-sound new technique, able to detect small vessel slow-signal.
Asunto(s)
Neoplasias del Íleon , Tumores Neuroendocrinos , Neoplasias Testiculares , Humanos , Masculino , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/secundario , Tumores Neuroendocrinos/patología , Neoplasias del Íleon/patologíaRESUMEN
PURPOSE: Small intestinal cancers have a non-specific clinical presentation and hence a delayed diagnosis. The prevalence of small intestinal cancers is low, and there are no cost-effective methods of screening. This study aimed to identify clinical characteristics of duodenal and jejunal adenocarcinomas that can assist in the early detection and diagnosis of disease. METHODS: Duodenal adenocarcinoma and jejunal adenocarcinoma in Explorys database (1999-2019) were compared using odds ratio (OR) with 95% confidence intervals. Data on demographic characteristics, risk factors, clinical features, and treatment were collected. RESULTS: Out of a total of 8100 patients with a diagnosis of primary adenocarcinoma of the small intestine, 5110 are primary adenocarcinoma of duodenum (63%), and 600 are primary adenocarcinoma of jejunum (7.4%). Patients with jejunal adenocarcinoma when compared with patients with duodenal adenocarcinoma are more obese (OR, 1.36) and have a significantly higher prevalence of malignant neoplasm of colon (OR, 3.07), Crohn's disease (OR, 4.42), and celiac disease (OR, 2.48). Jejunal adenocarcinoma patients presented more frequently with intestinal obstruction (OR, 1.99), whereas duodenal adenocarcinoma patients more commonly presented with iron deficiency anemia (OR, 0.16). Patients with jejunal adenocarcinoma are less likely to undergo therapy with anti-neoplastic agents when compared with duodenal adenocarcinoma (OR, 0.81). There are no differences in patients undergoing surgical intervention or a combination of surgical intervention and antineoplastic therapy. CONCLUSIONS: Jejunal adenocarcinoma is more commonly associated with colorectal cancer, celiac disease, and Crohn's disease. They also had lower odds of requiring chemotherapeutic agents.
Asunto(s)
Adenocarcinoma , Enfermedad Celíaca , Enfermedad de Crohn , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias del Yeyuno , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad Celíaca/complicaciones , Intestino Delgado/cirugía , Intestino Delgado/patología , Neoplasias del Yeyuno/diagnóstico , Neoplasias del Yeyuno/epidemiología , Neoplasias del Yeyuno/terapia , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/epidemiología , Neoplasias Duodenales/terapia , Neoplasias del Íleon/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/terapiaRESUMEN
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
Asunto(s)
Adenocarcinoma , Neoplasias del Colon , Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias Intestinales , Neoplasias del Yeyuno , Humanos , Neoplasias Intestinales/epidemiología , Neoplasias Intestinales/terapia , Intestino Delgado/patología , Neoplasias del Íleon/patología , Neoplasias del Íleon/terapia , Neoplasias Duodenales/epidemiología , Neoplasias Duodenales/terapia , Neoplasias del Yeyuno/patología , Neoplasias del Yeyuno/terapia , Adenocarcinoma/epidemiología , Adenocarcinoma/terapia , Adenocarcinoma/diagnóstico , Neoplasias del Colon/patologíaRESUMEN
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.
Asunto(s)
Neoplasias Duodenales , Neoplasias del Íleon , Neoplasias Intestinales , Intususcepción , Leiomiosarcoma , Femenino , Humanos , Adulto , Intususcepción/etiología , Intususcepción/cirugía , Leiomiosarcoma/complicaciones , Leiomiosarcoma/cirugía , Neoplasias del Íleon/patología , Intestino Delgado/cirugía , Intestino Delgado/patología , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/cirugía , Neoplasias Intestinales/patología , Neoplasias Duodenales/patologíaRESUMEN
PURPOSE: The number of neuroendocrine tumors (NETs) is gradually increasing worldwide, and those located in the small intestine (siNETs) are the most common. As some biological and clinical characteristics of tumors of the jejunum and the ileum differ, there is a need to assess the prognosis of individuals with siNETs of the jejunum and ileum separately. We generated a predictive nomogram by assessing individuals with siNETs from the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: We used univariate Cox regression analysis to determine both the overall survival (OS) and the cancer-specific survival (CSS) of 2501 patients with a pathological confirmation of siNETs of the jejunum and ileum. To predict 3-, 5-, and 10-year OS of siNETs, a nomogram was generated based on a training cohort and validated with an external cohort. Accuracy and clinical practicability were evaluated separately by Harrell's C-indices, calibration plots, and decision curves. The correlation was examined between dissected lymph nodes and positive lymph nodes. RESULTS: Dissection of 7 or more lymph nodes significantly improved patient OS and was found to be a protective factor for patients with siNETs. In Cox regression analyses, age, primary site, tumor size, N stage, M stage, and regional lymph node examination were significant predictors in the nomogram. A significant positive correlation was found between dissected lymph nodes and positive lymph nodes. CONCLUSIONS: Patients with 7 or more dissected lymph nodes showed an accurate tumor stage and a better prognosis. Our nomogram accurately predicted the OS of patients with siNETs.