Benign Neoplasm of the Small Intestine
- Author: Shawn M Terry, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
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.
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.
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.)
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 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. 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.
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.
Ashley SW, Wells SA Jr. Tumors of the small intestine. Semin Oncol. 1988 Apr. 15(2):116-28. [Medline].
Blanchard DK, Budde JM, Hatch GF 3rd, et al. Tumors of the small intestine. World J Surg. 2000 Apr. 24(4):421-9. [Medline].
Minardi AJ Jr, Zibari GB, Aultman DF, et al. Small-bowel tumors. J Am Coll Surg. 1998 Jun. 186(6):664-8. [Medline].
Braasch JW, Denbo HE. Tumors of the small intestine. Surg Clin North Am. 1964 Jun. 44:791-809. [Medline].
Zollinger RM Jr. Primary neoplasms of the small intestine. Am J Surg. 1986 Jun. 151(6):654-8. [Medline].
McGarrity TJ, Kulin HE, Zaino RJ. Peutz-Jeghers syndrome. Am J Gastroenterol. 2000 Mar. 95(3):596-604. [Medline].
Genta RM, Feagins LA. Advanced precancerous lesions in the small bowel mucosa. Best Pract Res Clin Gastroenterol. 2013 Apr. 27(2):225-33. [Medline].
Merine D, Jones B, Ghahremani GG, et al. Hyperplasia of Brunner glands: the spectrum of its radiographic manifestations. Gastrointest Radiol. 1991 Spring. 16(2):104-8. [Medline].
Rüfenacht H, Kasper M, Heitz PU, et al. "Brunneroma": hamartoma or tumor?. Pathol Res Pract. 1986 Mar. 181(1):107-11. [Medline].
Bremer EH, Battaile WG, Bulle PH. Villous tumors of the upper gastrointestinal tract. Clinical review and report of a case. Am J Gastroenterol. 1968 Aug. 50(2):135-43. [Medline].
Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg. 1997 May. 173(5):390-4. [Medline].
He LJ, Wang BS, Chen CC. Smooth muscle tumours of the digestive tract: report of 160 cases. Br J Surg. 1988 Feb. 75(2):184-6. [Medline].
Morgan BK, Compton C, Talbert M, et al. Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience. Ann Surg. 1990 Jan. 211(1):63-6. [Medline].
Amin MB, Ma CK, Linden MD, et al. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol. 1993 Oct. 100(4):428-32. [Medline].
Nincheri Kunz M, Evaristi L, Spadoni R, et al. [Lipoma of the small intestine as a rare cause of intestinal occlusion]. Minerva Chir. 1994 Sep. 49(9):859-65. [Medline].
Kim YS, Chun HJ, Jeen YT, et al. Small bowel capillary hemangioma. Gastrointest Endosc. 2004 Oct. 60(4):599. [Medline].
Ramanujam PS, Venkatesh KS, Bettinger L, et al. Hemangioma of the small intestine: case report and literature review. Am J Gastroenterol. 1995 Nov. 90(11):2063-4. [Medline].
Boyle L, Lack EE. Solitary cavernous hemangioma of small intestine. Case report and literature review. Arch Pathol Lab Med. 1993 Sep. 117(9):939-41. [Medline].
Drolet BA, Pope E, Juern AM, Sato T, Howell B, Puttgen KB, et al. Gastrointestinal bleeding in infantile hemangioma: a complication of segmental, rather than multifocal, infantile hemangiomas. J Pediatr. 2012 Jun. 160(6):1021-6.e3. [Medline].
Barkay O, Moshkowitz M, Fireman Z, et al. Initial experience of videocapsule endoscopy for diagnosing small-bowel tumors in patients with GI polyposis syndromes. Gastrointest Endosc. 2005 Sep. 62(3):448-52. [Medline].
Ziegler KM, Flamm CR, Aronson N. Wireless capsule endoscopy in patients with obscure small-intestinal bleeding. J Am Coll Radiol. 2005 Oct. 2(10):818-20. [Medline].
Wang H, Luo T, Liu WQ, Huang Y, Wu XT, Wang XJ. Clinical presentations and surgical approach of acute intussusception caused by peutz-jeghers syndrome in adults. J Gastrointest Surg. 2011 Dec. 15(12):2218-25. [Medline].
Cochet B, Carrel J, Desbaillets L, et al. Peutz-Jeghers syndrome associated with gastrointestinal carcinoma. Report of two cases in a family. Gut. 1979 Feb. 20(2):169-75. [Medline].
Perko Z, Krnic D, Pogorelic Z, Druzijanic N, Simunic M, Bilan K, et al. Peutz-Jeghers syndrome complicated with intussusception: enteroscopic polyps resections through laparotomy. Coll Antropol. 2013 Mar. 37(1):293-6. [Medline].
Latchford AR, Neale K, Phillips RK, Clark SK. Peutz-jeghers syndrome: intriguing suggestion of gastrointestinal cancer prevention from surveillance. Dis Colon Rectum. 2011 Dec. 54(12):1547-51. [Medline].
Metzger PP, Slappy AL, Chua HK. Ileal lipoma. Surg Rounds. 2005. 28(2):84-6.
Fujita M, Manabe N, Honda K, Murao T, Osawa M, Kawai R, et al. Usefulness of Ultrasonography for Diagnosis of Small Bowel Tumors: A Comparison Between Ultrasonography and Endoscopic Modalities. Medicine (Baltimore). 2015 Oct. 94 (40):e1464. [Medline].
Newlin ME, Ruiz OR, Taxier M. Using intraoperative enteroscopy for SBD. Cont Surg. 2005. 61(7):340-5.
Karargyris A, Bourbakis N. Detection of small bowel polyps and ulcers in wireless capsule endoscopy videos. IEEE Trans Biomed Eng. 2011 Oct. 58(10):2777-86. [Medline].
Rana SS, Bhasin DK, Singh K. Colonic lesions in patients undergoing small bowel capsule endoscopy. Int J Colorectal Dis. 2011 Jun. 26(6):699-702. [Medline].
Kopylov U, Seidman EG. Diagnostic modalities for the evaluation of small bowel disorders. Curr Opin Gastroenterol. 2015 Mar. 31 (2):111-7. [Medline].
Calabrese C, Gionchetti P, Calafiore A, Pagano N, Campieri M, Rizzello F. Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. Intern Emerg Med. 2015 Oct. 10 (7):781-5. [Medline].
Ackerman LV, Rosai J, eds. Ackerman's Surgical Pathology. 8th ed. St Louis, Mo: Mosby-Year Book; 1996. 663-4.
Toya Y, Endo M, Orikasa S, Sugai T, Matsumoto T. Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol. 2014 Dec. 7 (6):502-5. [Medline].
Lee CM, Kim HH. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol. 2014 Sep 28. 20 (36):13035-43. [Medline].
Tang SJ, Zanati S, Dubcenco E, et al. Capsule endoscopy regional transit abnormality: a sign of underlying small bowel pathology. Gastrointest Endosc. 2003 Oct. 58(4):598-602. [Medline].
ReMine WH, Brown PW Jr, Gomes MM, et al. Polypoid hamartomas of Brunner's glands. Report of six surgical cases. Arch Surg. 1970 Mar. 100(3):313-6. [Medline].