SB TumorSB Tumor

Mazen M. HassanainMazen M. Hassanain

IntroductionIntroduction

1-3% of GI malignancy.1-3% of GI malignancy. Benign lesion in autopsy 0.2% , 15 Benign lesion in autopsy 0.2% , 15

times more than the OR incidence.times more than the OR incidence. Alkaline , dilute liquid.Alkaline , dilute liquid. Low Bacterial number.Low Bacterial number. Rapid transient time.Rapid transient time. Lymphoid tissue with IgA.Lymphoid tissue with IgA.

TypesTypes

Benign : Benign : GIST 45%GIST 45% Lipoma 15%Lipoma 15% Adenoma 15%Adenoma 15%

Malignant:Malignant: Adenoca 40%Adenoca 40% Carcinoid 30%Carcinoid 30% NHL 30%NHL 30%

Pre- malignant lesionsPre- malignant lesions

Chron`s disease : 100 fold , unusual Chron`s disease : 100 fold , unusual location.location.

FAB : leading cause of death.FAB : leading cause of death. Celiac sprueCeliac sprue ImmunosuppressionImmunosuppression 20-30% 220-30% 2ndnd primary malignancy. primary malignancy. Colorectal and breastColorectal and breast 30-50% in Carcinoid30-50% in Carcinoid

Clinical presentationClinical presentation

Benign Benign

Asymptomatic 50%Asymptomatic 50% Abd pain 30%Abd pain 30% GIB 25%GIB 25% Anemia 30%Anemia 30% SBO 15%SBO 15%

Malignant: Malignant: Asymptomatic 10%Asymptomatic 10% Abd pain 70%Abd pain 70% GIB 20%GIB 20% Anemia 25%Anemia 25% Wt loss 45%Wt loss 45% N / V 45%N / V 45% Mass 25%Mass 25%

DiagnosisDiagnosis

Accurate Dx 40%.Accurate Dx 40%. CT : SB wall thicker than 1.5cmCT : SB wall thicker than 1.5cm

AdenomaAdenoma

BrunnerBrunner `s gland.`s gland. Very min malignant transformation.Very min malignant transformation. ClassificationClassification Periampullary Periampullary >2 cm>2 cm

GISTGIST

The most common form of The most common form of mesenchymal tumor of the mesenchymal tumor of the gastrointestinal tract. gastrointestinal tract.

Commonly found in the stomach 60%, Commonly found in the stomach 60%, 30% from the small intestine.30% from the small intestine.

>5cm, Necrosis , 5 mitosis HPF & mets.>5cm, Necrosis , 5 mitosis HPF & mets. Surgery , Surgery , Imatinib mesylate , Imatinib mesylate ,

Radiotherapy.Radiotherapy.

LipomaLipoma

Polypoid, compressible intraluminal Polypoid, compressible intraluminal lesions.lesions.

2 cm2 cm

AdenocaAdenoca

80% in duodenum.80% in duodenum. Respectability 55%.Respectability 55%. Stage 1 , 5 year 70%Stage 1 , 5 year 70% Stage 4, 10% Stage 4, 10%

NHLNHL

GI most common extrtanodal 15%GI most common extrtanodal 15% Stomach , SB , Colon.Stomach , SB , Colon. Primary : No superficial , Mediastinal Primary : No superficial , Mediastinal

LN , Normal WBC, No splenic or LN , Normal WBC, No splenic or Hepatic involvement.Hepatic involvement.

Mostly B-cell type.Mostly B-cell type. MALT MALT

StagingStaging

1- Confined to GI single or multiple.1- Confined to GI single or multiple. 2- LN or direct invasion below 2- LN or direct invasion below

diaphragm.diaphragm. 3- Supra-diaphragmatic.3- Supra-diaphragmatic. 4- Disseminated.4- Disseminated.

TreatmentTreatment

Complete surgical resection 30%.Complete surgical resection 30%. Local control and control of Local control and control of

symptoms.symptoms. Adjuvant therapy for > stage 1Adjuvant therapy for > stage 1 DebulkingDebulking Post chemo perforation 15%.Post chemo perforation 15%.

CarcinoidCarcinoid

Neuroendocrine from Neuroendocrine from enterochromaffin cells at the base of enterochromaffin cells at the base of the crypts of Lieberkuhn. (APUD the crypts of Lieberkuhn. (APUD system )system )

80% GI (appendix, SB) , 10% lung.80% GI (appendix, SB) , 10% lung. Distal 2 feet of ileum.Distal 2 feet of ileum. 35% SB multicentric.35% SB multicentric. Carcinoid syndrome (5-HIAA).Carcinoid syndrome (5-HIAA).

MetastasisMetastasis

LungLung BreastBreast MelanomaMelanoma DirectDirect PeritonealPeritoneal