Small Bowel Carcinoma

Michael P. Federle, MD, FACR

Key Facts

Imaging

Most commonly in jejunum, within 30 cm of ligament of Treitz
Infiltrating tumor: “Apple core” or annular lesion
- Short, well-demarcated, circumferential narrowing
- Irregular lumen, overhanging edges, ± ulceration
- Narrow, rigid stricture with prestenotic dilatation
Polypoid sessile tumor: Small plaque-like growth
Often presents with intussusception
± enlarged mesenteric nodes; perivascular invasion
± metastases: Liver, peritoneal surfaces, ovaries

Top Differential Diagnoses

Intestinal metastases and lymphoma
- NHL: Bulky mass, luminal narrowing or aneurysmal dilation
- Usually with large mesenteric nodes
- Metastases: Multiple, from colon or melanoma
Intestinal GIST
- Usually larger, more exophytic mass
- May cavitate, ± aneurysmal dilation of lumen
Carcinoid tumor
- Hypervascular submucosal mass, mesenteric invasion
- Primary often difficult to detect; metastases more obvious
- Mesenteric mass: Ca++ and desmoplastic reaction
Crohn disease

Pathology

Adult celiac disease, Crohn disease, Peutz-Jeghers syndrome, familial polyposis syndromes
- All associated with ↑ prevalence of SBC

Clinical Issues

Malignant tumors of SB are < 2% of all GI tumors

(Left) Spot film from a SBFT in a 44-year-old woman with abdominal pain and CT evidence of intussusception (not shown) shows dilated bowel with abrupt change in caliber due to an intussusception. Note the thin string of barium