Malignant Tumors of the Small Intestine

The small bowel, like the stomach, is a common site for primary lymphoma. Tumors may originate from B lymphocytes (particularly mucosa-associated lym-phoid tissue (MALT) lymphoma, which in the small intestine is termed immunoproliferative small intestinal disease (IPSID), Burkitt's lymphoma and immunodeficiency-related lymphomas, or T lymphocytes (particularly enteropathy-associated T cell lymphoma (EATL)), or it may mimic any of the lymphomas which arise in lymph nodes distant from the intestine, such as diffuse large B cell lymphoma and mantle cell lymphomas.

Intestinal lymphomas are another interesting example of disease originating from the interplay between the intestinal mucosa and the intestinal flora. In the stomach, MALT lymphoma is closely related to Helicobacter pylori colonization and may be cured by H. pylori's eradication. IPSID may be responsive to antibiotics, also suggesting a relationship with small intestinal flora. EATL results from chronic malabsorption, most commonly celiac disease, and occurs mainly in the jejunum. It usually involves multiple segments of the small bowel and may therefore be difficult to resect surgically.

Small intestinal tumors are rare. The majority are adenocarcinomas that develop most commonly in the proximal small bowel. Metastasis by hemato-genous or lymphatic spread is common with peritoneal seedlings. Rarely, secondaries from primary tumors elsewhere can be found in the small bowel.

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