10 Questions
Where does lymphoma of the small bowel typically arise?
Primary gastrointestinal tumor or as a manifestation of generalized lymphomatous disease
What is the typical decade of life when small bowel lymphoma presents?
Fifth decade
Which of the following is not a common presentation of small bowel lymphoma?
Diarrhea
What is the usual treatment for small bowel lymphoma unless there are particular surgical complications?
Chemotherapy
In which part of the gastrointestinal tract do carcinoid tumors occur most frequently?
Appendix, ileum, and rectum
What is the common site of metastasis for carcinoid tumors?
Liver
What is the common vasoactive peptide produced by carcinoid tumors?
5-hydroxytryptamine (serotonin)
Which of the following diseases is susceptible to gastrointestinal lymphoma?
Crohn’s disease
What is the typical location of small bowel lymphomas?
Ileum
What is the characteristic of primary gastrointestinal lymphoma?
There is no peripheral or mediastinal lymphadenopathy or splenomegaly
Study Notes
Lymphoma of the Small Bowel
- Primary gastrointestinal lymphoma arises in the small bowel, with limited mesenteric lymph node involvement, normal white blood cell count, and no peripheral or mediastinal lymphadenopathy or splenomegaly.
- Small bowel lymphomas occur predominantly in the ileum.
- Peak incidence is in the fifth decade of life.
- Susceptible patients include those with Crohn’s disease, coeliac disease, and immunosuppressive diseases such as AIDS.
- Common presentations include abdominal mass, obstruction, perforation, intussusception, hemorrhage, and malabsorption.
- Chemotherapy is the primary treatment, unless there are surgical complications.
Carcinoid Tumor
- Carcinoid tumors occur throughout the gastrointestinal tract, most commonly in the appendix, ileum, and rectum.
- The primary tumor is usually small, but liver metastases are common, leading to the carcinoid syndrome.
- The tumor produces vasoactive peptides, including 5-hydroxytryptamine (serotonin).
- Clinical syndrome characteristics include:
- Flushing (90%) with attacks of cyanosis and chronic red-faced appearance
- Diarrhea (70%) with noisy borborygmi
- Bronchospasm (asthmatic attacks)
- Abdominal pain (due to mesenteric fibrosis and partial obstruction)
- Hepatomegaly and palpable abdominal mass
- Sometimes pulmonary and tricuspid stenosis
- Treatment involves surgical resection in early cases, and symptomatic relief with synthetic somatostatin analogue, sandostatin, being the most effective therapy.
This quiz covers the characteristics and manifestations of lymphoma in the small bowel, including primary gastrointestinal tumors and generalized lymphomatous disease.
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