Introduction
Malignant small bowel neoplasms (MSBN) are rare entities, whose knowledge is even more limited due to their histological diversity and difficulty in their investigation. Studies show that the incidence of MSBN has been growing in recent decades; thus, interest in these neoplasms has increased in parallel with their rising incidence.
Aims & Methods
The aim of this study was to describe the demographic and clinical characteristics of patients with malignant neoplasms of duodenum, jejunum, and ileum, but also the evolution in the diagnosis of these neoplasms over 20 years.
Retrospective study of patients with MSBN diagnosed between 2001 and 2020 in a tertiary hospital was performed. Demographic and clinical data were collected. Statistical analysis was performed with SPSS vs 29.0 (significance level of 5%).
Results
A total of 135 patients were evaluated. Fifty-seven percent of patients (n=77) were male; the mean age at diagnosis was 64.2 years [diagnosis between 27-91 years]. The mean age at diagnosis showed no statistically significant relationship with the histological subtype (p=0.644).
Most neoplasms were found in the jejunum/ileum (65.9%, n=89). The most frequently diagnosed neoplasms were adenocarcinomas (31.1%, n=42), followed by neuroendocrine tumors (28.10%, n=38), gastrointestinal stromal tumors (GIST) (17.8%, n=24) and metastases from other carcinomas (12.6%, n=17); lymphomas accounted for 5.9% of cases (n=8) and other primary malignancies accounted for 4.4% of cases (n=6).
The majority of patients (80,7%, n= 109) were symptomatic at time of diagnosis - 29.6% (n=40) had abdominal occlusion at diagnosis; 19.3% (n=26) of patients had hemorrhage as the initial clinical presentation, and 7.4% (n=10) of patients had intestinal perforation. It’s also worth mentioning that almost half of the patients (43.7%, n=59) had anemia at diagnosis.
A regular CT was the exam that documented the neoplasm in 40.7% of cases (n=55); an upper digestive endoscopy identified the neoplasm in 22.2% of patients (n=30) and a video capsule endoscopy was necessary for diagnosis in 8.1% of cases (n=11); however, 22.2% of patients (n=30) still required surgery for making the diagnosis; the remaining patients (6.7%, n=9) were diagnosed using other complementary diagnostic methods (CDM).
It should be noted that most diagnoses were made between 2011 and 2020 (65.9%, n=89). Between 2011 and 2020, the most frequently diagnosed MSBN were neuroendocrine tumors (37.1%, n=33), whereas between 2001 and 2010, the most common diagnosed tumors were adenocarcinomas (37.0%, n=17). The diagnosis of each histological neoplasm type differed significantly statistically over the years (p=0.016).
More than half of the patients with adenocarcinoma of the small intestine died from this cause (54.8%, n=23), but only 7.9% (n=3) of the neuroendocrine tumors of the small intestine were the cause of death.
Conclusion
Although these are rare tumors, the sample of MSBN from this tertiary center over these 20 years has still been substantial. Most patients were symptomatic at diagnosis - with severe complications (occlusion, hemorrhage, perforation) in 55.4% of the cases, despite advances in CDM over the years. In this study, 65.9% of MNDJI were diagnosed in the last 10 years of the follow-up, which validates the growing incidence of small bowel neoplasms described in the literature. Noteworthy, the diagnosis of each histological neoplasm type differed significantly statistically over the years (p=0.016), with neuroendocrine tumors being the most diagnosed in recent years.
