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Annular malignancies of the small bowel
Gastrointestinal Radiology
|January 1, 1987
Summary
Radiographic diagnosis of small bowel annular malignancies often misidentifies metastatic lesions as primary adenocarcinoma. Pathologic review reveals diverse origins, necessitating surgical biopsy for definitive diagnosis.
Area of Science:
- Gastroenterology
- Radiology
- Pathology
Background:
- Annular malignancies in the small bowel with mucosal destruction are typically attributed to primary adenocarcinoma.
- Radiographic findings can be ambiguous, making definitive diagnosis challenging.
Purpose of the Study:
- To evaluate the accuracy of radiographic diagnosis for small bowel annular malignancies.
- To compare the radiographic and pathologic characteristics of primary and metastatic annular small bowel lesions.
Main Methods:
- Retrospective review of 18 cases of small bowel annular malignancies diagnosed between 1977 and 1984.
- Analysis of enteroclysis and small bowel follow-through studies.
- Correlation of radiographic findings with surgical resection or biopsy pathology reports.
Main Results:
- Pathologic data revealed only 4 primary adenocarcinomas among 18 annular malignancies.
- Metastatic lesions (10 cases) were more common than primary adenocarcinomas.
- Distinct radiographic features differentiated primary adenocarcinomas, metastases, leiomyosarcomas, lymphoma, and carcinoid tumors, though overlap existed.
Conclusions:
- Radiographic diagnosis of small bowel annular malignancies can be misleading, with metastases frequently mimicking primary adenocarcinoma.
- Metastatic lesions often present as highly obstructing, while primary adenocarcinomas are typically shorter and less obstructive.
- Definitive diagnosis of small bowel annular malignancies requires surgical resection or biopsy.