小肠肿瘤(中英文)

Back ground
• The most common small bowel malignancies: ALymphoma[lɪmˈfoʊmə] Carcinoid['kɑ:səˌnɔɪd] GIST (Gastrointestinal stromal tumors) [ˌgæstroʊɪnˈtestɪnl]
Lymphoma
• Here a typical presentation • There is irregular wall thickening of the terminal ileum with aneurysmatic dilatation
Lymphoma
• Reversed fold pattern indicating celiac disease • Ileal-ileal intussusception (yellow arrow), in a patient with multifocal small bowel lymphoma (not all lesions shown here). • Mesenteric lymphadenopathy (red arrows).
Adenocarcinoma
• Here an adenocarcinoma in the proximal jejunum • The mass is better depicted with MRI than with CT
Adenocarcinoma
• Here a patient with active Crohn's disease, who has a stenotic segment in the terminal ileum • This patient does not have an adenocarcinoma • Diffuse wall thickening in the distal ileum • Comb sign: hypervascularity in the adjacent mesentery
（HNPCC）Hereditary nonpolyposis colorectal cancer遗传性非息肉病性 大肠癌 [həˈredɪteri]遗传的 [nɒn] [ˌpɒlə'poʊsɪs] 非息肉病的[ˌkoʊlə'rektəl] 结肠直肠的 Familial adenomatous polyposis 家族性腺瘤性息肉病 [ædɪ'nɒmətəs]腺瘤（状）的 [ˌpɒlə'poʊsɪs] Peutz-Jeghers syndrome (PJS) 黑斑息肉病 （Diff.Diagn.）differential diagnosis[ˌdɪfəˈrɛnʃəl ˌdaɪəɡˈnosɪs] 鉴别诊断 aneurysmal dilatation [æn'jʊərɪzməl] [ˌdɪləˈteɪʃən, ˌdaɪlə-]动脉瘤样扩张 sclerosing mesenteritis [sklɪə'rəʊsɪŋ] [mesənˈteraɪtɪs] 硬化性肠系膜炎
Adenocarcinoma
• Features that favour adenocarcinoma are fat stranding due to mesenteric fat infiltration and lymph node metastases • In lymphoma fat stranding is uncommon, but lymph node metastases do occur and are usually more bulky • The images show a short obstructing circular mass in the jejunum (yellow arrow) with enlarged lymph node (red arrow)
Lymphoma
• Here another patient with celiac disease • There is an irregular mass in the jejunum with luminal dilatation • There is infiltration of the mesentery • Pathology showed a T-cell lymphoma in celiac disease • This is called enteropathy associated T-cell lymphoma (EATL)
Carcinoid tumor
• Carcinoid tumors are rare neuroendocrine tumors • Neuroendocrine tumors of the small can be divided in welldifferentiated - also known as carcinoid and poorly differentiated small or large cell neuroendocrine carcinoma • Carcinoid tumors constitute 2% of all gastrointestinal tumors • The incidence of carcinoid tumors increased over the last decades, exceeding that of adenocarcinoma, making it the most common small bowel malignancy
Adenocarcinoma
• Stenotic lesion in the duodenum as a result of an adenocarcinoma (yellow arrow) • Not possible to separate from the pancreas (red arrow) • Pre-stenotic dilatation of the duodenum
Adenocarcinoma
• There is pre-stenotic dilatation • Post-contrast T1Wimage with fatsat (left) and T2W-image (right) show an obstructing mass in the jejunum with shouldering (arrow)
Adenocarcinoma
[ˌædnəʊˌkɑ:sə'nəʊmə]
• Adenocarcinoma represents 25-40% of all small bowel neoplasms['ni:oʊplæzəm] • However colon carcinoma [ˈkolən ˌkɑrsəˈnomə] is 50 times more common • 50% of small bowel adenocarcinomas occur in the duodenum [ˌdu:əˈdi:nəm] and most of these are found with endoscopy [enˈdɑ:skəpi] • The jejunum [dʒɪ'dʒu:nəm] is the second most prevalent site
Adenocarcinoma
• A duodenal carcinoma presenting as irregular wall thickening in the distal duodenum (arrows)
Adenocarcinoma
• Adenocarcinomas often show moderate enhancement • Metastases to the liver and peritoneum occur frequently • Show a circumferential mass with shouldering borders
Lymphoma
• Lymphomas make up about 20 % of all small bowel tumors • The distal ileum is the most common site, owing to the large amount of lymphoid tissue that is present in the distal ileum • The typical presentation of a small bowel lymphoma is a thick walled infiltrating mass with aneurysmal dilatation without obstruction • Aneurysmal dilatation is based upon destruction of the bowel wall and the myenteric nerve plexus
Adenocarcinoma
• Large adenocarcinomas can mimic a lymphoma • The images show an irregular mass in the proximal jejunum • Although it is a large mass, the lumen is not obstructed • This proved to be an adenocarcinoma, but these findings could very well represent a lymphoma
Adenocarcinoma
• The typical imaging representation of a small bowel adenocarcinoma is a focal unilocular, circumferential mass with shouldering of the margins and obstruction • Less frequently adenocarcinomas present as an intraluminal polypoid mass, which can lead to intussusception • Ulceration is a quite common feature • Extraluminal infiltration can present as fat stranding
Adenocarcinoma
• Here a patient with extensive wall thickening of the proximal jejunum with aneurysmatic dilatation • On top of our differential diagnostic list would be a lymphoma, but this proved to be an adenocarcinoma
Adenocarcinoma
• The adenocarcinoma located in the jejunum • There are multiple lymph nodes (red arrow) and there is fat stranding (yellow arrows) • It should not be mistaken for mesenteric panniculitis as these large necrotic lymph nodes are pathologic
Small Bowel Tumors
Back ground
• Small bowel tumours are rare, accounting for 3-6% of gastrointestinal [ˌgæstroʊɪnˈtestɪnl] tumors • The clinical presentation is non-specific • Symptoms ['sɪmptəmz] include anemia (贫血), gastrointestinal bleeding (胃肠道出血), abdominal pain (腹 痛) or small bowel obstruction (小肠梗阻)