Gastrointestinal stromal tumour (GIST) presenting as a strangulated inguinal hernia with small bowel obstruction.

Gastrointestinal stromal tumours (GISTs) can arise everywhere along the gastrointestinal (GI) tract. Their presentation in unusual locations should always be taken into account. A 74-year-old man referred to the emergency department for small bowel obstruction caused by an incarcerated inguinal hernia. A CT scan showed a mesenchymal tumour originating from the herniated bowel loop and a mass in the ascending colon. Laparoscopic resection of the mass and laparoscopic right hemicolectomy were performed. The histology showed a ruptured GIST arising from the herniated small bowel and a high-grade dysplasia villous adenoma of the right colon. GISTs can present with symptoms spanning from vague abdominal discomfort to surgical urgencies. Strangulated hernia is an extremely rare presentation, with only two cases described in the literature. A safe surgical approach was obtained with laparoscopy, maintaining surgical radicality. The ileal localisation and the pseudocapsule rupture were the main risk factors on prognostic stratification.

Grading of neuroendocrine tumors with Ki-67 requires high-quality assessment practices.

Gastrointestinal and pancreatic neuroendocrine tumors (NETs) arise from disseminated neuroendocrine cells, expressing general and specific neuroendocrine markers. The World Health Organization 2010 classification of NETs is based on grading them according to the proliferation index (PI), which is determined by immunohistochemical staining of the nuclear antigen Ki-67. The classification introduces Ki-67 as the most important criterion for tumor grading, influencing patients' prognoses and the choice of treatment. The aim of this study was to evaluate the assessment of PI value in NETs and its influence on tumor grading. The tumor material consisted of 51 NETs from the pancreas (n=31) and ileum (n=20). The slides were stained with the Ki-67 antibody and visualized using a polymer kit. PI was assessed visually by microscope oculars and using a public domain image analysis software, ImmunoRatio. The PI was measured from the most proliferative areas of the tumor. The PI values and tumor grade by ImmunoRatio were highly reproducible as compared with conventional assessment, which suffered from variation especially if ascertained by different observers. Computer-aided assessments had almost perfect correlation (r=0.985, r=0.987, and r=0.995) (P=0.000) and reproducibility (κ=0.886, κ=0.886, and κ=1.000) (P=0.000) in PI values and tumor grades, respectively. The PI values and tumor grade between conventional and ImmunoRatio assessments by a qualified observer were in good agreement. ImmunoRatio is a qualified diagnostic aid to more objectively analyze Ki-67 PI-based tumor grade in NETs.

[Enteroscopy in the diagnostics of the jejunum and ileum tumors].

Small bowel tumors are very uncommon and account for 3% to 6% of all gastrointestinal neoplasms. Practical application of videocapsule endoscopy and balloon-assisted enteroscopy have allowed to investigate and reveal neoplasmatic leasions in deep parts of gastrointestinal tract which earlier were hard to access. The modern techniques allow to evaluate the macroscopic picture of tumors more clearly, to determine its nature and location, take biopsy sample, to prescribe reasonable chemotherapy, to remove a tumor endoscopically or define indications for a planned surgical intervention. This article presents a widely overview over epidemiology, classification, clinical aspects, methods and diagnostic possibilities of different diagnostic techniques of revealing small bowel tumors, and own results of diagnosis and treatment of patients (n = 48) with small bowel tumors (2003-2010).

[Small bowel lymphomas: a case report]. / Considerazioni diagnostiche e chirurgiche su un caso di linfoma del tenue.

The Authors, reporting a recent case of small bowel lymphoma, review progress in diagnosis, methodology and therapeutical approach. They also stress the crucial role of surgery as diagnostic and therapeutic tool, sometimes curative in early stages, and however necessary for a proper staging and definition of these rare neoplasms of intestinal tube.

Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification.

BACKGROUND: The aims of this study were to classify primary ileocolonic lymphomas according to colonoscopic findings and to determine the clinicopathologic relationship according to classes. METHODS: Thirty-two patients (22 men, 10 women; age range 29 to 75 years) with primary malignant lymphoma of the terminal ileum and/or colorectum were studied. The clinicopathologic features were evaluated according to colonoscopic findings. RESULTS: Thirty-six lesions in 32 patients were endoscopically classified as follows: fungating (14, 39%), ulcerofungating (11, 31%), infiltrative (5, 14%), ulceroinfiltrative (4, 11%), and ulcerative (2, 6%). Location of the lesions was as follows: terminal ileum, 15 (42%); colorectum, 14 (39%); both regions, 7 (19%). The most common histopathologic types were diffuse large cell (22, 69%) and large cell immunoblastic (5, 16%). There was no relationship between the endoscopic findings and histologic types. In 9 patients (28%), the clinical manifestation was intussusception, and all were found endoscopically to have the fungating type lesion. CONCLUSIONS: Primary ileocolonic lymphomas can be classified endoscopically into fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative types. Among these, fungating and ulcerofungating are the most frequent. Intussusception is a common clinical finding in ileocolonic lymphomas, occurring mainly in patients with the fungating type of lesion.

[Mediterranean lymphoma mimicking Crohn's disease]. / Lymphome méditerranéen simulant une maladie de Crohn.

We report an uncommon localization of mediterranean lymphoma of the terminal ileum in a 28 year-old male patient. Ultrasound and Computed Tomography showed moderate regular and symmetrical intestinal wall thickening simulating Crohn's disease. We highlight the role of computed tomography in the diagnosis, staging and detection of complications.

Prognostic value of the TNM-classification for small bowel cancer.

BACKGROUND/AIMS: To examine the relationship between the pathological stage and survival for adenocarcinoma of the small bowel. MATERIALS AND METHODS: The medical records of 99 patients with small bowel cancer, diagnosed between January 1984 and December 1993, were reviewed retrospectively. Lymphomas and carcinomas of the ampulla of Vater were excluded from this study. All operated patients with adenocarcinomas were staged by the TNM-classification using pathological and surgical reports. RESULTS: Sixty-four adenocarcinomas, 24 carcinoid tumours and 11 sarcomas were analysed. The cancer-specific 5-year survival rate for patients with adenocarcinoma, carcinoid tumours and sarcomas was 22%, 39% and 55%, respectively. Twenty-eight patients with adenocarcinoma underwent radical tumor resection: segmental resection in 20, pancreaticoduodenectomy in 7 and ileocoecal resection in one patient. In the remaining 34 patients "curative" resection was not feasible and none of them survived for more than 3 years. The 5-year survival rate of the curatively resected patients was 46%. Actuarial 3-year survival rate for stage I was 38%, 70% for stage II and 0% for stage III. CONCLUSION: Our results demonstrate that survival is poor for patients with lymph node metastasis, despite apparently curative surgery.

Acute abdomen due to granulocytic sarcoma of the terminal ileum.

A 57-year-old patient with chronic granulocytic leukemia in blast crisis and severe neutropenia is presented. This patient developed right sided peritonitis due to an isolated transmural granulocytic sarcoma of the terminal ileum. The affected segment was resected and the patient survived 4 more months. Thus, despite neutropenia, an aggressive surgical approach should be considered in a leukemic patient presenting with unexplained acute abdomen, since, as demonstrated here, a localized lesion which could not have otherwise been detected, was ultimately found and promptly resected.

[Focal lymphoid hyperplasia (pseudolymphoma) of the terminal ileum in adults]. / Hyperplasie lymphoïde focale (pseudo-lymphome) de l'iléon terminal chez l'adulte.

We report two cases of focal lymphoid hyperplasia (FLH) of terminal ileum in adult patients. Both cases showed identical morphological findings. The first was discovered during cholecystectomy in a 75-year-old woman who complained mild non-specific abdominal discomfort. The second was manifested by right lower quadrant abdominal pain in a 32-year-old man. The surgical specimens revealed a thickened wall, a narrowed lumen and multiple ulcerations. The histologic features were small cell, well differentiated lymphocyte infiltration, with several follicles showing large germinal centers; regional lymph nodes revealed a conspicuous reactive size enlargement. Further clinical investigations revealed no other abnormalities. Clinical course showed benign evolution after 6 and 3 years of respective follow-up. FLH should be differentiated from terminal ileum inflammatory and infectious diseases. It can be differentiated from Crohn's disease by the absence of characteristic histological features; from Yersinia infection by the absence of significant rates of specific serum antibodies. Moreover, FLH can be differentiated from malignant lymphoma by the presence of follicles and enlarged germinal centers and by the long-term benign evolution. The nature of FLH in terminal ileum, as well as those of the stomach and colo-rectum is still to be determined. Several hypothesis are proposed: reactive, benign neoplastic, or prelymphomatous lesion?