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Benign Neoplasm of the Small Intestine

  • Author: Shawn M Terry, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Nov 06, 2015
 

Background

Benign tumors of the small bowel are rare clinical entities that often remain asymptomatic throughout life.[1, 2, 3, 4] Despite comprising 75% of the length and 90% of the surface area of the gastrointestinal (GI) tract, the small bowel harbors relatively few primary neoplasms and fewer than 2% of GI malignancies.[5]

Benign small-bowel tumors may develop as a single lesion or as multiple lesions of several subtypes. Subtypes include hyperplastic polyps, adenomas, gut stromal tumors, lipomas, hemangiomas, and those associated with Peutz-Jeghers syndrome.[6]

These tumors are generally characterized by slow growth and delayed clinical presentation. They often remain inherently asymptomatic, only to be discovered incidentally at autopsy.

Strict medical management currently has no role in benign small bowel tumors. Surgical excision of small bowel tumors remains the recommended therapy. (See Treatment.)

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Pathophysiology

Benign small-bowel tumors may be found throughout the duodenum, jejunum, and ileum (in order of increasing frequency). Tumors may be single, multiple, or widespread, that is, as part of a polyposis syndrome. Three growth patterns have been identified, as follows:

  • Intraluminal
  • Infiltrative
  • Serosal

Intraluminal lesions are most often associated with the development of secondary bowel obstruction and intussusception, whereas serosal lesions are linked to small-bowel volvulus.

Several factors have been suggested to explain both the scarcity of small-bowel lesions and the infrequency of their malignant transformation.[7] First, rapid intestinal transit through the small bowel limits contact time to the small bowel mucosa. Second, greater fluidity of small-bowel chyme may dilute luminal irritants. Third, alkaline pH may play a role, as may the low bacterial colony counts of the small bowel. Finally, higher levels of benzyl peroxidase (thought to detoxify potential carcinogens) have been detected in the small bowel.

Together, with increased levels of immunoglobulin A and widespread gut lymphoid tissue, these factors may impede the growth and development of tumors and their malignant transformation.

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Epidemiology

Benign small-bowel lesions have been documented in persons of all age groups, though the mean age of presentation reportedly is between the fifth and sixth decades of life. Several series have noted a slight predominance in males compared to females. No racial or ethnic predisposition has been discovered.

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Contributor Information and Disclosures
Author

Shawn M Terry, MD, FACS Clinical Assistant Professor of Surgery, Penn State University College of Medicine; Consulting Staff, Department of Trauma and Emergency General Surgery, Community Medical Center

Shawn M Terry, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Pennsylvania Medical Society, Society of Critical Care Medicine, Eastern Association for the Surgery of Trauma

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Santora, MD Professor and Vice-Chair for Clinical Affairs, Department of Surgery, Temple University Hospital, Temple University School of Medicine

Thomas Santora, MD is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, American College of Surgeons, American Trauma Society, Association for Academic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Amy L Friedman, MD Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse

Amy L Friedman, MD is a member of the following medical societies: Association for Academic Surgery, International College of Surgeons, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, Association of Women Surgeons, International Liver Transplantation Society, Transplantation Society, American College of Surgeons, American Medical Association, American Medical Womens Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

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Benign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
Benign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.
Benign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.
 
 
 
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