THE CONTINUING CLINICAL DILEMMA OF PRIMARY TUMORS OF THE SMALL-INTESTINE

Small intestinal tumors are relatively rare, notoriously difficult to diagnose, and often advanced at the time of definitive treatment. The purpose of this study is to compare the differences between benign and malignant tumors of the small intestine and between symptomatic and asymptomatic tumors with respect to their clinical presentation, efficacy of diagnostic procedures, and surgical management with correlation to pathologic findings. Forty-nine patients with primary small intestinal tumors between 1981-1993 had 17 benign and 32 malignant tumors. Benign tumors more commonly presented with acute gastrointestinal hemorrhage (29% versus 6%, P < 0.05), and were often asymptomatic (47% versus 6%, P < 0.05). Malignant tumors more commonly presented with abdominal pain (63% versus 24%, P < 0.05) and weight loss (38% versus 0%, P < 0.05). The total number of diagnostic tests/patient averaged 2.3 +/- 0.3, and the average time from onset of symptoms to resection was 30.2 +/-6.6 weeks. Upper endoscopy, angiography, and upper gastrointestinal contrast studies had the most useful sensitivity rates. Surgical treatment of tumors included biopsy/excision, limited bowel resection, segmental resection with regional lymphadenectomy, or a bypass procedure. The most common types of benign and malignant tumors were leiomyoma (41%) and adenocarcinoma (53%), respectively. Histologically, tumors were evenly distributed throughout the small intestine. Small intestinal tumors remain difficult to diagnose because of an atypical presentation and renew the need for appropriate suspicion when treating patients with vague abdominal symptoms. Multiple diagnostic procedures are needed with surgical resection, the mainstay for both benign and malignant tumors.