1. SB Tumor Mazen M. Hassanain

2. Introduction 1-3% of GI malignancy. 1-3% of GI malignancy. Benign lesion in autopsy 0.2%, 15 times more than the OR incidence. Benign lesion in autopsy 0.2%, 15 times more than the OR incidence. Alkaline, dilute liquid. Alkaline, dilute liquid. Low Bacterial number. Low Bacterial number. Rapid transient time. Rapid transient time. Lymphoid tissue with IgA. Lymphoid tissue with IgA.

3. Types Benign : Benign : GIST 45% GIST 45% Lipoma 15% Lipoma 15% Adenoma 15% Adenoma 15% Malignant: Malignant: Adenoca 40% Adenoca 40% Carcinoid 30% Carcinoid 30% NHL 30% NHL 30%

4. Pre- malignant lesions Chron`s disease : 100 fold, unusual location. Chron`s disease : 100 fold, unusual location. FAB : leading cause of death. FAB : leading cause of death. Celiac sprue Celiac sprue Immunosuppression Immunosuppression 20-30% 2 nd primary malignancy. 20-30% 2 nd primary malignancy. Colorectal and breast Colorectal and breast 30-50% in Carcinoid 30-50% in Carcinoid

5. Clinical presentation Benign Benign Asymptomatic 50% Asymptomatic 50% Abd pain 30% Abd pain 30% GIB 25% GIB 25% Anemia 30% Anemia 30% SBO 15% SBO 15% Malignant: Malignant: Asymptomatic 10% Abd pain 70% GIB 20% Anemia 25% Wt loss 45% N / V 45% Mass 25%

6. Diagnosis Accurate Dx 40%. Accurate Dx 40%. CT : SB wall thicker than 1.5cm CT : SB wall thicker than 1.5cm

7. Adenoma Brunner`s gland. Brunner`s gland. Very min malignant transformation. Very min malignant transformation. Classification Classification Periampullary Periampullary >2 cm >2 cm

8. GIST The most common form of mesenchymal tumor of the gastrointestinal tract. The most common form of mesenchymal tumor of the gastrointestinal tract. Commonly found in the stomach 60%, 30% from the small intestine. Commonly found in the stomach 60%, 30% from the small intestine. >5cm, Necrosis, 5 mitosis HPF & mets. >5cm, Necrosis, 5 mitosis HPF & mets. Surgery, Imatinib mesylate, Radiotherapy. Surgery, Imatinib mesylate, Radiotherapy.

9. Lipoma Polypoid, compressible intraluminal lesions. Polypoid, compressible intraluminal lesions. 2 cm 2 cm

10. Adenoca 80% in duodenum. 80% in duodenum. Respectability 55%. Respectability 55%. Stage 1, 5 year 70% Stage 1, 5 year 70% Stage 4, 10% Stage 4, 10%

11. NHL GI most common extrtanodal 15% GI most common extrtanodal 15% Stomach, SB, Colon. Stomach, SB, Colon. Primary : No superficial, Mediastinal LN, Normal WBC, No splenic or Hepatic involvement. Primary : No superficial, Mediastinal LN, Normal WBC, No splenic or Hepatic involvement. Mostly B-cell type. Mostly B-cell type. MALT MALT

12. Staging 1- Confined to GI single or multiple. 1- Confined to GI single or multiple. 2- LN or direct invasion below diaphragm. 2- LN or direct invasion below diaphragm. 3- Supra-diaphragmatic. 3- Supra-diaphragmatic. 4- Disseminated. 4- Disseminated.

13. Treatment Complete surgical resection 30%. Complete surgical resection 30%. Local control and control of symptoms. Local control and control of symptoms. Adjuvant therapy for > stage 1 Adjuvant therapy for > stage 1 Debulking Debulking Post chemo perforation 15%. Post chemo perforation 15%.

14. Carcinoid Neuroendocrine from enterochromaffin cells at the base of the crypts of Lieberkuhn. (APUD system ) Neuroendocrine from enterochromaffin cells at the base of the crypts of Lieberkuhn. (APUD system ) 80% GI (appendix, SB), 10% lung. 80% GI (appendix, SB), 10% lung. Distal 2 feet of ileum. Distal 2 feet of ileum. 35% SB multicentric. 35% SB multicentric. Carcinoid syndrome (5-HIAA). Carcinoid syndrome (5-HIAA).

15. Metastasis Lung Lung Breast Breast Melanoma Melanoma Direct Direct Peritoneal Peritoneal