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286 Current Essentials of Surgery Small Intestine Tumors, Malignant s Essentials of Diagnosis Adenocarcinoma: 50 of cases; risk factors include Crohn dis- ease, polyposis syndromes, villous adenomas Lymphoma: 1520 of cases; most common is extranodal lym- phoma Stromal tumors: 1020 of cases; distinction between benign and malignant is difficult Metastatic tumors: affect small bowel by direct extension, carci- nomatosis, or hematogenous spread Symptoms and signs include abdominal pain, GI bleeding, mal- absorption (lymphoma), weight loss, abdominal distention, abdominal tenderness, palpable abdominal mass (stromal tumor) Imaging: adenocarcinoma: radiographic contrast study shows annular lesion with ulcerated mucosa, apple core appearance; CT scan detects metastases and allows staging; lymphoma: CT scan shows diffuse bowel wall thickening, mesenteric adenopa- thy, mass lesion; stromal tumors: CT scan shows extraluminal mass with vascularity and central necrosis s Differential Diagnosis Rule out benign tumors s Treatment All malignant tumors require wide segmental resection; even if not curative, resection may palliate obstruction and bleeding Prognosis: adenocarcinoma has 80 survival if localized, 1015 if positive nodes; lymphoma 5-year survival is 2040; stromal tumors have 20 5-year survival if high grade s Pearl Always evaluate entire small bowel for synchronous lesions.
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