Primary Small Intestinal Tumors Tsuneyoshi Yao Stomach and Intestine(Tokyo) ISSN 0536-2180 （Print） ISSN 1882-1219 （Online） Vol.36 No.7 （2001.06）P.871-881（ISID:1403103243）.
Keigo Mitsui, Shu Tanaka, Hironori Yamamoto, Tsuyoshi Kobayashi, Akihito Ehara, Tomonori Yano, Hidemi Goto, Hiroshi Nakase, Shinji Tanaka, Toshiyuki Matsui, Mitsuo Iida, Kentaro Sugano, Choitsu Sakamoto
Role of double-balloon endoscopy in the diagnosis of small-bowel tumors: the first Japanese multicenter study.
Gastrointest Endosc. 2009 Sep;70(3):498-504. doi: 10.1016/j.gie.2008.12.242. Epub 2009 Jun 24.
Abstract/Text
BACKGROUND: The early diagnosis of small-bowel tumors (SBT) was a difficult task until the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE) allowed access to the disease site. However, although CE and DBE have greatly simplified the task, DBE studies have yet to provide sufficient data on the diagnosis and outcome of patients with SBTs.
OBJECTIVE: To determine the efficacy of DBE examination in the detection and diagnosis of SBT.
DESIGN: A retrospective analysis of cross-sectional case series.
SETTING: Seven major medical centers in Japan.
PATIENTS: The first 1035 consecutive DBE cases at these major Japanese centers since the introduction of DBE.
MAIN OUTCOME MEASUREMENTS: The percentage of subjects with SBT and a diagnosis of SBT, their indications for DBE, and diagnostic and therapeutic DBE procedures carried out for SBT.
RESULTS: SBTs were identified in 144 of 1035 subjects (13.9%) who underwent DBE between September 2000 and December 2005. For subjects with SBT, the most common indication for DBE was the suspected presence of a SBT (61/144 [42.4%]). For subjects without SBT, the most common indication was obscure GI bleeding (OGIB) (419/891 [47.0%]). Malignant lymphoma and GI stromal tumor (GIST) were the most frequent (31/144 [21.5%]) and the second-most frequent SBTs (27/144 [18.8%]), respectively, in this database. We also performed 85 biopsies and 45 therapeutic procedures for the evaluation and treatment of SBTs in 144 patients. Although complications were encountered in 5.3% of cases (14/266 sessions), none of these were life threatening in the present study.
CONCLUSION: DBE proved a valuable tool for the detection and diagnosis of SBTs, especially when tumors were suspected. Biopsies and therapeutic procedures were also possible in most of these patients, which directed our management of the disease.
Karl Y Bilimoria, David J Bentrem, Jeffrey D Wayne, Clifford Y Ko, Charles L Bennett, Mark S Talamonti
Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years.
Ann Surg. 2009 Jan;249(1):63-71. doi: 10.1097/SLA.0b013e31818e4641.
Abstract/Text
BACKGROUND: Previous studies have shown an increasing incidence of small bowel tumors in the United States. Our objective was to assess this increase by examining changes in histology-specific incidence, treatment, and survival.
METHODS: Patients with small bowel malignancies were identified from the National Cancer Data Base (NCDB, 1985-2005) and the Surveillance Epidemiology and End Results (SEER, 1973-2004) database. Age-adjusted incidence rates were calculated using SEER. Treatment and survival trends over time were examined using the National Cancer Data Base. Regression models were developed to assess survival over time.
RESULTS: Sixty-seven thousand eight hundred forty-three patients were identified with small bowel malignancies: 37.4% carcinoid, 36.9% adenocarcinomas, 8.4% stromal tumors, and 17.3% lymphomas. From 1973 to 2004, the incidence of carcinoid tumors increased more than 4-fold (2.1 to 9.3 per million), whereas changes in adenocarcinomas, stromal tumors, and lymphomas were less pronounced. From 1985 to 2005, utilization of surgery increased significantly for carcinoid tumors from 78.8% to 87.4% (P < 0.0001). Adjuvant chemotherapy utilization for adenocarcinoma increased from 8.1% in 1985 to 23.8% in 2005 (P < 0.0001). Treatment over time was generally unchanged for lymphoma and stromal tumors. Five-year survival after resection remained unchanged over time for all histologic subtypes even after adjusting for changes in patient demographics, tumor characteristics, and treatment approaches.
CONCLUSIONS: The overall incidence of small intestine malignancies has increased considerably, primarily because of carcinoid tumors which are now the most common small bowel cancer. With current treatments, survival has remained relatively unchanged over the last 20 years. Novel therapeutic options need to be investigated.
三澤俊一，堀江久永，熊野秀俊，他1当院での原発性小腸癌10例の臨床病理学的検討と最近5年間の本邦報告例116例の文献的考察.日本消化器 病学会雑誌 108;429-435:2011.
INTESTINE vol.15 No.2 p157-166 2011年.
Janice L Pasieka
Carcinoid tumors.
Surg Clin North Am. 2009 Oct;89(5):1123-37. doi: 10.1016/j.suc.2009.06.008.
Abstract/Text
Carcinoid tumors, which arise from the enterochromaffin cells of the gastrointestinal tract, encompass a diverse group of neoplasms. Once thought to be "carcinoma-like," these neoplasms exhibit a biologic behavior that varies from an indolent, benign course to an aggressive, rapidly progressive, and deadly disease. Today the term carcinoid is reserved for neuroendocrine tumors arising from the small bowel or neuroendocrine tumors that can cause carcinoid syndrome. This newer terminology has yet to be universally adopted, adding to the confusion in the literature. For the general surgeon there are several "carcinoid" tumors that he or she must be familiar with because many of these lesions are encountered during emergency laparotomies or incidentally discovered during investigation for vague abdominal pain. This review focuses on the gastrointestinal neuroendocrine tumors that general surgeons are likely to encounter during their career.
胃と腸 vol.43. No.4 p547-552 2008年.
B Stinner, O Kisker, A Zielke, M Rothmund
Surgical management for carcinoid tumors of small bowel, appendix, colon, and rectum.
World J Surg. 1996 Feb;20(2):183-8.
Abstract/Text
Carcinoid tumors occur most frequently in the gastrointestinal tract. Despite their ability to produce hormones, most of the midgut and hindgut carcinoids covered in this study are clinically silent, and the diagnosis is often not made before emergency surgery or evaluation for liver metastases. Because the rate of lymph node involvement and the prognosis of carcinoid tumors depend on their site and size, surgery refers to these two factors too. Lymph node metastases are most commonly found with small bowel carcinoids (20-45%), providing the rationale for an extended resection including the adjacent lymph node drainage area. Carcinoid tumors of the appendix < 1 cm in diameter rarely metastasize, simply requiring appendectomy for treatment. Lesions > 2 cm should be treated by right hemicolectomy because of their approximately 30% risk of lymph node metastases. Resection should always be done for carcinoid tumors of the colon resection as for adenocarcinomas. Rectal carcinoids < 2 cm rarely metastasize, directing the conclusion that for these smaller lesions local excision is sufficient; for lesions >2 cm a standard cancer resection should be performed provided distant metastases are absent. In general, the younger the patient or the larger the primary tumor, the more aggressive the treatment should be.
S A C van Tuyl, E J Kuipers, R Timmer, M F J Stolk
Video capsule endoscopy: procedure, indications and diagnostic yield.
Neth J Med. 2004 Jul-Aug;62(7):225-8.
Abstract/Text
Video capsule endoscopy (VCE) is a new noninvasive imaging technique for the complete small bowel. It provides good to excellent visualisation of the mucosa of the small bowel and has a high diagnostic yield in selected patients with gastrointestinal blood loss of suspected small bowel origin and in patients with Crohn's disease. In comparison with small bowel X-ray and push enteroscopy, diagnostic yield appears to be superior. Although VCE is becoming increasingly popular, good studies on its clinical implications and application are only just emerging. In this paper we review the possibilities and limitations of clinical application of VCE.
Tetsuya Nakamura, Akira Terano
Capsule endoscopy: past, present, and future.
J Gastroenterol. 2008;43(2):93-9. doi: 10.1007/s00535-007-2153-6. Epub 2008 Feb 29.
Abstract/Text
A capsule endoscope is a swallowable wireless miniature camera for getting images of the gastrointestinal (GI) mucosa. The initial capsule endoscope model was developed by Given Imaging and approved in Western countries in 2001. Before the introduction of capsule endoscopy (CE) and double-balloon endoscopy (DBE), there was no effective modality for the evaluation and management of patients with obscure GI bleeding. Obscure GI bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial or primary endoscopy (colonoscopy or upper endoscopy) result. The first capsule endoscope model, which is now regarded as a first-line tool for the detection of abnormalities of the small bowel, was the PillCam SB. It was approved in Japan in April 2007. The main indication for use of the PillCam SB is obscure GI bleeding. Almost the only complication of CE is capsule retention, which is the capsule remaining in the digestive tract for a minimum of 2 weeks. A retained capsule can be retrieved by DBE. There are some limitations of CE in that it cannot be used to obtain a biopsy specimen or for endoscopic treatment. However, the combination of a PillCam SB and DBE seems to be the best strategy for management of obscure GI bleeding. Recently, several new types of capsule endoscope have been developed, such as Olympus CE for the small bowel, PillCam ESO for investigation of esophageal diseases, and PillCam COLON for detection of colonic neoplasias. In the near future, CE is expected to have a positive impact on many aspects of GI disease evaluation and management.
Small intestine. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 127-32.
Mark S Talamonti, Laura H Goetz, Sambasiva Rao, Raymond J Joehl
Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management.
Arch Surg. 2002 May;137(5):564-70; discussion 570-1.
Abstract/Text
HYPOTHESIS: This study was done to review the clinical presentation, surgical management, pathologic features, and prognostic factors for primary small-bowel cancers.
DESIGN: Retrospective case series.
SETTING: Tertiary care, university hospital.
PATIENTS: One hundred twenty-nine patients were surgically treated between January 1, 1977, and December 31, 2000. There were 73 men and 56 women, with a median age of 55 years (age range, 19-82 years). Median follow-up was 36 months.
MAIN OUTCOME MEASURES: Presenting symptoms and signs, operations performed, and surgical pathologic features were analyzed and survival curves were generated.
RESULTS: Clinical findings included abdominal pain (63%), vomiting (48%), weight loss (44%), and gastrointestinal tract bleeding (23%). The distribution of tumors by histological features was as follows: adenocarcinoma (33%), carcinoid tumor (29%), lymphoma (19%), and sarcoma (19%). Cumulative 5-year survival rate was 37% in the adenocarcinoma group, 64% in the carcinoid tumor group, 29% in the lymphoma group, and 22% in the sarcoma group. Significant prognostic predictors of overall survival for the entire cohort and for each tumor subtype included complete resection and American Joint Committee on Cancer tumor stage (P<.05). Patient age, tumor location, histological grade, and use of chemotherapy and radiation therapy did not significantly influence survival. Curative resections were accomplished in 83 patients (64%) with a median survival of 37 months compared with 46 patients undergoing incomplete or palliative resections with a median survival of 10 months (P<.05). Adjacent organ resection was required in 18 (22%) of the 83 patients undergoing potentially curative resections. The median time to recurrence was 16 months. Twenty-one patients (16%) developed associated primary cancers.
CONCLUSIONS: Aggressive surgical resection in an attempt to achieve complete tumor removal seems warranted. Despite complete resections, patients with high-stage tumors remain at risk for recurrence.
Yutaka Ogata, Keizo Yamaguchi, Teruo Sasatomi, Shinji Uchida, Yoshito Akagi, Kazuo Shirouzu
[Treatment and outcome in small bowel cancer].
Gan To Kagaku Ryoho. 2010 Aug;37(8):1454-7.
Abstract/Text
In adenocarcinoma of the small intestine, delays in diagnosis are frequent, and the majority of patients present with advanced- stage disease and either lymph node involvement or distant metastatic disease. Surgical resection is a mainstay in treatment of this disease, but the role of adjuvant therapy is unclear. Recent retrospective and prospective studies have helped to clarify the optimal chemotherapy approach for advanced small bowel adenocarcinoma. The combination of capecitabine and oxaliplatin is reportedly highly effective. Further clinical studies on this rare type of tumor are needed. This article reviews the focuses on recent advances in management. The 72nd Japanese Society for Cancer of the Colon and Rectum have conducted a retrospective review of Japanese patients with adenocarcinoma of the jejunum or ileum. The data indicated that although not statistically significant, there was a trend in median overall survival favoring the chemotherapy for advanced jejunal or ileal adenocarcinoma (17 months vs. 8 months, p=0.114).
Ping Lu
Staging and classification of lymphoma.
Semin Nucl Med. 2005 Jul;35(3):160-4. doi: 10.1053/j.semnuclmed.2005.02.002.
Abstract/Text
In 2004, new cases of non-Hodgkin's lymphoma in the United States were estimated at 54,370, representing 4% of all cancers and resulting 4% of all cancer deaths, and new cases of Hodgkin's lymphoma were estimated at 7,880. The appropriate staging and management of lymphomas greatly depend on an accurate pathological diagnosis and classification. The recently established Revised European-American Classification of Lymphoid Neoplasms (REAL) and the subsequently adopted and updated World Health Organization (WHO) classification include modern cytogenetic, molecular, and immunologic techniques and knowledge and reach an international consensus on the classification of lymphomas. This classification scheme represents an advance in our understanding of lymphomas and serves as an operative guideline for studying and diagnosing lymphomas. Imaging techniques always have served as staging and monitoring tools for the clinical management of lymphomas. The understanding and adoption of the current classification system is important in refining the role of imaging modalities in the management of specific lymphoma. To help one understand the current classification, this current review gives a brief history of lymphoma classifications and summaries the recent classification schemes, including new entities, clinical staging methods, and clinical prognostic criteria.
A Rohatiner, F d'Amore, B Coiffier, D Crowther, M Gospodarowicz, P Isaacson, T A Lister, A Norton, P Salem, M Shipp
Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma.
Ann Oncol. 1994 May;5(5):397-400.
Abstract/Text
It was considered timely to review the pathological and staging classifications of GI tract lymphoma. This meeting specifically did not address the question of treatment; the management of GI tract lymphoma could perhaps form the basis for a further workshop. The following recommendations were made: to adopt the Isaacson histological classification, that all patients with GI tract lymphoma be investigated uniformly, to record the prognostic factors described above, to use the staging classification shown above. It is hoped that these recommendations will be taken into account in the design of future clinical trials of therapy for GI tract lymphoma.
Iris D Nagtegaal, Robert D Odze, David Klimstra, Valerie Paradis, Massimo Rugge, Peter Schirmacher, Kay M Washington, Fatima Carneiro, Ian A Cree, WHO Classification of Tumours Editorial Board
The 2019 WHO classification of tumours of the digestive system.
Histopathology. 2020 Jan;76(2):182-188. doi: 10.1111/his.13975. Epub 2019 Nov 13.
Abstract/Text
Tina Binderup, Ulrich Knigge, Annika Loft, Jann Mortensen, Andreas Pfeifer, Birgitte Federspiel, Carsten Palnaes Hansen, Liselotte Højgaard, Andreas Kjaer
Functional imaging of neuroendocrine tumors: a head-to-head comparison of somatostatin receptor scintigraphy, 123I-MIBG scintigraphy, and 18F-FDG PET.
J Nucl Med. 2010 May;51(5):704-12. doi: 10.2967/jnumed.109.069765. Epub 2010 Apr 15.
Abstract/Text
UNLABELLED: Functional techniques are playing a pivotal role in the imaging of cancer today. Our aim was to compare, on a head-to-head basis, 3 functional imaging techniques in patients with histologically verified neuroendocrine tumors: somatostatin receptor scintigraphy (SRS) with (111)In-diethylenetriaminepentaacetic acid-octreotide, scintigraphy with (123)I-metaiodobenzylguanidine (MIBG), and (18)F-FDG PET.
METHODS: Ninety-six prospectively enrolled patients with neuroendocrine tumors underwent SRS, (123)I-MIBG scintigraphy, and (18)F-FDG PET on average within 40 d. The functional images were fused with low-dose CT scans for anatomic localization, and the imaging results were compared with the proliferation index as determined by Ki67.
RESULTS: The overall sensitivity of SRS, (123)I-MIBG scintigraphy, and (18)F-FDG PET was 89%, 52%, and 58%, respectively. Of the 11 SRS-negative patients, 7 were (18)F-FDG PET-positive, of which 3 were also (123)I-MIBG scintigraphy-positive, giving a combined overall sensitivity of 96%. SRS also exceeded (123)I-MIBG scintigraphy and (18)F-FDG PET based on the number of lesions detected (393, 185, and 225, respectively) and tumor subtypes. (123)I-MIBG scintigraphy was superior to (18)F-FDG PET for ileal neuroendocrine tumors, and (18)F-FDG PET was superior to (123)I-MIBG scintigraphy for pancreaticoduodenal neuroendocrine tumors. The sensitivity of (18)F-FDG PET (92%) exceeded that of both SRS (69%) and (123)I-MIBG scintigraphy (46%) for tumors with a proliferation index above 15%.
CONCLUSION: The overall sensitivity of (123)I-MIBG scintigraphy and (18)F-FDG PET was low compared with SRS. However, for tumors with a high proliferation rate, (18)F-FDG PET had the highest sensitivity. The results indicate that, although SRS should still be the routine method, (18)F-FDG PET provides complementary diagnostic information and is of value for neuroendocrine tumor patients with negative SRS findings or a high proliferation index.
Kazuo Kubota, Momoko Okasaki, Ryogo Minamimoto, Yoko Miyata, Miyako Morooka, Kazuhiko Nakajima, Takashi Sato
Lesion-based analysis of (18)F-FDG uptake and (111)In-Pentetreotide uptake by neuroendocrine tumors.
Ann Nucl Med. 2014 Dec;28(10):1004-10. doi: 10.1007/s12149-014-0900-3. Epub 2014 Sep 2.
Abstract/Text
PURPOSE: To characterize the heterogeneity of metastatic neuroendocrine tumor (NET) lesions, we compared the [(18)F]-fluorodeoxyglucose (FDG) uptake and the (111)In-pentetreotide (SRS) uptake for somatostatin receptor scintigraphy using the CT-based fusion imaging techniques of PET/CT and SPECT/CT.
METHODS: Fifteen consecutive patients with NET lesions were examined using both FDG-PET/CT and SRS SPECT/CT prospectively. A total of 45 metastatic NET lesions were evaluated for FDG uptake according to the standardized uptake value (SUV) and for SRS uptake according to the tumor-to-muscle count ratio (T/M ratio); these values were then compared according to the grade of NET (G), also compared to the tumor volume.
RESULTS: Both the SRS uptake and FDG uptake showed no significant correlation to the tumor volume, and suggested no significant artifacts in these data. The T/M ratio for the SRS uptake ranged from 192.7 to 1.9 and exhibited very wide range of distribution. The SUV for the FDG uptake ranged from 13.8 to 0.77 and exhibited narrow range of distribution. The uptake of the two tracers in individual lesions showed an inverse correlation. The G1 + 2 lesions had a higher SRS uptake than the G3 lesions, but the difference was not significant because of the large variation (40.65 ± 48.03, n = 39 vs. 8.66 ± 13.13, n = 6). However, the G1 + 2 lesions had a significantly lower FDG uptake than the G3 lesions (3.52 ± 1.84, n = 39 vs. 10.82 ± 4.50, n = 6). The tracer uptakes varied largely not only in an inter-subject manner, but also in an intra-subject manner.
CONCLUSION: An inverse correlation between SRS uptake and FDG uptake in the metastatic NET lesions observed in this study may be consistent with the opposing ideas of differentiation and proliferation in oncology. The large variations in SRS and FDG uptake by metastatic NET lesions suggest the biological heterogeneity of advanced NET. These results support the idea that combination therapy targeting both receptor-positive cells and proliferating cells may be beneficial from a functional imaging perspective.
日本神経内分泌腫瘍研究会（JNETS）膵・消化管神経内分泌腫瘍診療ガイドライン第2版作成委員会編：膵・消化管神経内分泌腫瘍（NEN）診療ガイドライン2019年【第2版】．金原出版、2019.
Stefano Partelli, Detlef K Bartsch, Jaume Capdevila, Jie Chen, Ulrich Knigge, Bruno Niederle, Els J M Nieveen van Dijkum, Ulrich-Frank Pape, Andreas Pascher, John Ramage, Nick Reed, Philippe Ruszniewski, Jean-Yves Scoazec, Christos Toumpanakis, Reza Kianmanesh, Massimo Falconi, Antibes Consensus Conference participants
ENETS Consensus Guidelines for Standard of Care in Neuroendocrine Tumours: Surgery for Small Intestinal and Pancreatic Neuroendocrine Tumours.
Neuroendocrinology. 2017;105(3):255-265. doi: 10.1159/000464292. Epub 2017 Feb 25.
Abstract/Text
