small bowel adenocarcinoma
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Author(s):  
Abdul Mohammed ◽  
Sophie Trujillo ◽  
Sara Ghoneim ◽  
Neethi Paranji ◽  
Nisheet Waghray

Author(s):  
M. Harish ◽  
N. Hariprasad ◽  
R. Kannan

Small bowel malignancies are rare entity, with adenocarcinoma being one of common type along with neuroendocrine tumours. Associated with Crohns, celiac disease, FAP and HNPCC. Jejunal adenocarcinoma produce vague symptoms, accounting for late presentation leading to difficult and delayed diagnosis in favour of poor prognosis. Diagnosis is established by CECT abdomen and CEA levels. Ro resection with regional lymphadenectomy and jejunojejunal anastomosis is preferred followed by adjuvant FOLFOX chemotherapy. Here we presenting a 68 years old male, anaemic with vague abdominal pain for 3 months, CECT showed malignant wall thickening involving 10 cm of proximal jejunal loop with no enlarged lymph nodes and CEA was elevated. Proceeded with laparotomy, an irregular hard mass of 10×10 cm involving 20 cm of jejunum with transverse colon infiltration with multiple mesenteric nodes found, composite resection with jejunojejunostomy and colocolic anastomosis done. Histopathology showed poorly differentiated jejunal adenocarcinoma with colonic infiltration with reactive nodes and post operatively on day 7, patient developed seizures and weakness of left upper and lower limbs, MRI brain showed solitary metastasis 2×2 cm in right frontal region and PET CT showed brain metastasis and multiple intraabdominal lymph node, lung and prostate metastasis, planned SBRT for brain metastasis and palliative chemotherapy. Lymph node, liver and peritoneum are common site of metastasis for small bowel adenocarcinoma, very rarely brain metastasis can occur in short time and to be considered if neurological symptoms occur pre and postoperatively.


Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6378
Author(s):  
Ariadna Sánchez ◽  
Luis Bujanda ◽  
Miriam Cuatrecasas ◽  
Alex Bofill ◽  
Cristina Alvarez-Urturi ◽  
...  

Background: Small bowel adenocarcinoma (SBA) is a rare disease which can be associated with Lynch syndrome (LS). LS tumors are characterized by the presence of microsatellite instability (MSI) and/or the loss of mismatch repair (MMR) protein expression. In SBA, the frequency of MMR deficient (MMRd) tumors varies from 5% to 35%. This study aims to describe the prevalence of LS carriers among patients with MMRd small bowel adenocarcinomas. Methods: A multicenter retrospective study with identification and MMR testing of all consecutive SBA between 2004 and 2020 in a multicenter Spanish study. Demographical data, tumor characteristics, follow-up and survival information were collected. Germline testing was driven by identification of MMRd tumors. Results: A total of 94 individuals diagnosed with SBA were recruited. We observed 20 (21.3%) MMRd tumors. In 9/15 (60%) patients with MMRd tumors, a pathogenic variant was identified (three MLH1, four MSH2, one MSH6 and one PMS2). Accordingly, the prevalence of LS among all SBA cases was 10.1%. Conclusions: More than one-fifth of SBA display MMRd and in more than a half is due to LS. Our data supports the implementation of universal MMR tumor testing among SBA for the identification of LS families.


Cureus ◽  
2021 ◽  
Author(s):  
Orlando Fleites ◽  
Stephanie S Pelenyi ◽  
Charles K Lee ◽  
Christopher A Wisnik ◽  
Ammarah Tariq ◽  
...  

2021 ◽  
Vol 8 ◽  
Author(s):  
Yanmei Gu ◽  
Haixiao Deng ◽  
Daijun Wang ◽  
Yumin Li

Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA.Methods: From 2010 to 2015, patients diagnosed with SBA were identified based on the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier survival analysis was applied to compare survival differences between metastasis patterns. Then, univariate and multivariate cox analyses were applied to screened out independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS), and identify the risk factors for metastasis of SBA. To assess the discrimination and calibration of nomograms, the concordance index (C-index), calibration curves, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were calculated.Results: Kaplan–Meier curves revealed that metastasis patterns were significantly correlated with CSS (p < 0.001) and OS (p < 0.001). Then, the metastasis pattern was showed to be an independent prognostic factor of OS and CSS in patients with SBA, as well as age, grade, T stage, N stage, surgery, retrieval of regional lymph nodes, and chemotherapy. Combining these factors, we constructed prognostic nomograms, which suggested that the metastasis pattern made the greatest contribution to the survival of patients with SBA. Nomograms for OS and CSS had a C-index of 0.787 and 0.793, respectively. Calibration curves showed an excellent agreement between probability and actual observation in the training and validation cohort. Decision curve analysis also exhibited its clinical value with an improved net benefit. In addition, the models we constructed had better prognostic accuracy and clinical utility than traditional TNM staging based on C-index and ROC. Further, Cox regression analysis showed that old age, poor differentiation, N2, and not receiving chemotherapy were the risk factors for prognosis in patients with metastatic SBA.Conclusion: As an independent prognostic factor, the metastasis pattern exhibited the greatest predictive effect on OS and CSS for patients with SBA. Adjuvant chemotherapy had a positive effect on the survival of patients with SBA. Nomograms for predicting 3-and 5-year OS and CSS of patients with SBA were constructed, which could identify patients with higher risk and might be superior in predicting the survival of patients with SBA than TNM staging.


2021 ◽  
Vol 9 (11) ◽  
pp. 1194-1198
Author(s):  
Umesh O. Paprunia ◽  
◽  
Girija A. Patil ◽  
Bhushan H. Mahamulkar ◽  
◽  
...  

Small bowel adenocarcinoma(SBA)is a rare neoplasm presenting usually in elderly patients as a single tumour. Multiple synchronous SBA is unique and difficult to diagnose due to non-specific presentations.Faecalomas have been described in association with Hirschsprungs disease, psychiatric patients, Chagas disease, both inflammatory and neoplastic conditions, and in patients suffering with chronic constipation.We herein report a case of multiple faecalomas secondary to multiple small bowel strictures leading to small bowel obstruction in a patient with previous history of pulmonary tuberculosis.Thepatient was successfully treated surgically. The strictures on histopathology turned out to be low grade adenocarcinoma. Multiple synchronous SBA as well as multiple fecalomas are individually rare entities, and their combined occurrence is even rarer.


Author(s):  
Richard J. Straker ◽  
Adrienne B. Shannon ◽  
Robert R. Roses ◽  
Douglas L. Fraker ◽  
Najjia N. Mahmoud ◽  
...  

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongyi Dong ◽  
Xiang Xia ◽  
Zizhen Zhang

Background: Small bowel adenocarcinoma are relatively rare tumors of the digestive system. Due to the lack of specific screening methods, patients are often diagnosed at an advanced stage. At present, there is no specific surgical guidance and chemotherapy regimen for small bowel adenocarcinoma. Here, we report a rare small bowel adenocarcinoma case with mesenteric vascular embolization and microsatellite instability, in which palliative surgery combined with chemotherapy and anti-Programmed cell death protein 1(PD-1) therapy resulted in complete remission.Case Presentation: The patient was a 55-year-old man who was admitted for suspected small bowel adenocarcinoma combined with incomplete ileus, mesenteric vascular occlusion and distant metastasis. We performed palliative surgery to remove adenocarcinoma as well as relieve obstruction. Then according to the pathological and immunohistochemical results (Stage IV and microsatellite instability), we used XELOX regimen combined with anti-PD-1 therapy. In last 2 years follow up, this patient achieved complete remission.Conclusions: The possibility of small intestinal tumor should be considered in patients with mesenteric vascular obstruction. PD-1 blockade is an effective therapy for small bowel adenocarcinoma with microsatellite instability.


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