Small bowel cancer diagnosis: role of nuclear magnetic resonance

Abstract

Small intestine tumors are rare, with an incidence of less than 1 case per 100,000/year and accounting for less than 0.5% of all cancers.1 However, in almost 80% of the cases small bowel tumors are malignant.2,3 Adenocarcinomas comprise 35-50% of all tumors, carcinoid tumors 20-40%, lymphomas 15% and the remaining is characterized by sarcomas. 4 Generally, adenocarcinomas are located in the duodenum, while lymphomas and carcinoid tumors are frequently in the ileum. Benign tumors are generally stromal tumor and adenomas. Finally, cancers from other organs may infiltrate peritoneum and small bowel in metastatic diseases. Small bowel tumors did not have a recurrent clinical presentation and could be associated with abdominal pain, unspecific gastrointestinal symptoms or can exhibit symptoms/signs due to the secretion of different hormones. 3 The diagnosis of small bowel tumor is really challenging even in the modern medicine when novel approaches such as video capsule endoscopy and nuclear magnetic resonance (NMR) are available.5-12 Here, we report the diagnosis of small bowel cancer with NMR in a patient presenting with intestine sub-occlusion. Case ReportA male patient was admitted to our division of Internal Medicine because of abdominal pain, weight loss and intestinal sub-occlusion. Both abdomen echography and computed tomography-scan (data not shown) did not reveal any significant pathological signs. Due to the persistence of the symptoms, an abdomen NMR was performed. As shown in Figure 1A and B, NMR revealed that a portion of the small bowel was characterized by the swelling of the bowel wall. A laparoscopic surgical evaluation was performed confirming the presence of small bowel stenosis. This small intestine segment was therefore surgical removed. At the pathological examination, this portion of the bowel revealed an infiltration of the wall by an adenocarcinoma ( Figure 1C). Moreover, infiltration of the peritoneum was also observed ( Figure 1D). Small bowel cancer diagnosis: role of nuclear magnetic resonance ABSTRACTThe diagnosis of small intestine tumors is challenging. Even in the era of modern medicine, standard approaches including echography, computed tomography-scan and conventional endoscopy are unable to reveal small bowel lesions. Video-capsule has substantially improved the evaluation of small bowel; however this procedure cannot be proposed to all patients and in particular to those experiencing intestine sub-occlusion. Nuclear magnetic resonance (NMR) of the abdomen is an additional diagnostic approach that offers high sensitivity in the identification of small bowel lesions. Here, we describe a case of small bowel neoplasia identified with NMR of the abdomen.

Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

“…7 Worthy of note in the present case study was the incidental diagnosis of the typical ST manifested by a hiatus hernia, gallbladder disorder, and colonic diverticula. [12][13][14] According to the literature, this report involves the unsuspected, underreported, or very infrequent association of the intramucosal duodenal adenocarcinoma with the ST. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Personal (duodenal polypoid lesion) and family (uncle with intestinal cancer) antecedents may have a role in the origin of the duodenal malignancy herein described. Nevertheless, there were no consistent findings to confirm the diagnostic hypothesis either of hereditary nonpolyposis colorectal cancer or familial adenomatous polyposis.…”

“…Duodenal adenocarcinomas are rare, represent 0.3% of gastrointestinal and 33-45% of the small bowel tumors, and with nonspecific symptoms, the diagnosis is incidental. [1][2][3][4][5][6][7][8][9][10] They are prevalent in the second duodenal portion of people between 40 and 60 years. 10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.…”

“…2,7,8 Duodenal adenocarcinoma is strongly associated with the rare tubulovillous and villous adenomas, a phenomenon favoring misdiagnosis or late cancer diagnosis. 1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options.…”

“…1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options. 10,11 Adjuvant or neoadjuvant chemotherapy are tools for patients considered inoperable.…”