Introduction
From a common man’s prescriptive, tumors are potentially life-threatening. But not all tumors are cancers. Benign tumors are noncancerous tissue growth. Any tumor in the small intestine is difficult to diagnose and identify because of its potentially complex anatomical locations. Benign tumors or benign neoplasms are rare and only encompass two percent of cases. Proper knowledge of anatomical structures and clinical conditions is necessary to identify these neoplasms.
What Are the Benign Neoplasms?
The benign neoplasm includes the following:
Adenoma - This is the most common benign type of neoplasm of the small intestine that arises from the glandular type. They are usually observed in the duodenum, particularly near the ampulla of Vater (the portion where the common bile duct and pancreatic duct meet). This is also commonly found in the ileum. Based on morphological patterns, these neoplasms can be divided into tubular, villous, or tubulovillous. Adenomatous polyps can be seen in different medical conditions:
- Familial Adenomatous Polyposis - This is an inherited condition caused by the mutation of the APC gene. In this condition, duodenal polyps develop. Other than this, benign bone growth and masses around the abdomen are also seen.
- Gardner Syndrome - Multiple colorectal polyps can be seen in this condition. Dental abnormalities, skin disorders, and benign bone growth can also be observed.
- Turcot Syndrome - In this condition, polyps are developed in the colons and the rectum. Also, brain tumors can be found in these conditions.
Hamartoma - This is the second most common neoplasm of the small intestine. These are local malformations of different types of cells. In most cases, small intestine hamartomas contain vascular, neural, and muscular cells. Y Fernando and McGovern first described these in the year 1982. These are most commonly found in the jejunum, followed by the ileum and duodenum. Though the chance of malignant transformations is less, it is associated with an increased risk of intestinal adenocarcinoma.
Lipoma - These are the third most common neoplasm of the intestine. These neoplasms are mainly composed of matured adipose tissues. These tumors are mainly found on the ilium. These are large encapsulated masses. The usual size of such lesions is more than two centimeters. As these lesions arise within the submucosa, compression of the lumen occurs due to the large size. Fat necrosis may occur in some cases because the amount of vasculature is less in these tumors.
Benign Gastrointestinal Stromal Tumor - These are mesenchymal tumors arising from Cajal's interstitial cells. Such tumors are most commonly found in the duodenum or the jejunum. These are well-circumscribed mass often contain calcification. Lesions that are more than five centimeters in diameter have malignant potential.
Leiomyomas - These are a group of smooth muscle tumors closely related to muscularis and composed of smooth muscle cells. Such tumors are usually seen around the fifth decade of life Usually. The surface of such neoplasms is smooth and nonulcerated. Though these tumors are well-circumscribed, connective tissue capsules around such tumors are usually absent. Stretching of the mucosa of the gastrointestinal tract, expansion, and compression of the lumen is responsible for the growth in the size of such tumors. Bleeding occurs in such tumors due to the compromise of attenuated blood vessels. The ulcerated lesions are dumbbell shaped. The percentage of malignant transformation of such tumors is less, but sometimes hyalinization can be observed. Such cases can be diagnosed as fibromyoma or myofibroma. Apart from these, some very rare benign neoplasms are also found in the small intestine. These are:
Fibromas - These are the benign growth of the connective tissues. Fibromas of the small intestine contain collagen fibers and fibroblasts. These are extremely rare and mainly seen in the ileum. The benign proliferation of myofibroblast cells causes intra-abdominal fibromatosis. These are also called desmoid tumors. In this condition, a homogenous proliferation of wavy spindle cells separated by collagen fibers can be seen.
Angiomas - These are benign well-circumscribed masses of blood vessels and lymphatic tissues. These are often misdiagnosed as arteriovenous malformations. These are commonly found in Osler-Weber-Rendu syndrome (inherited disorders of blood vessels).
What Are the Symptoms of Benign Small Intestine Neoplasms?
In most cases, benign tumors are asymptomatic. Symptoms only develop if the tumor grows significantly grow in size or if ulceration develops. The common symptoms are:
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Pain in the abdomen.
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Abdominal cramps.
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Indignation.
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Loss of appetite.
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Yellowish discoloration of the skin due to obstructive jaundice.
What Are the Diagnostic Methods of Benign Small Intestine Neoplasms?
Such tumors are extremely difficult to diagnose because of their anatomical locations. Also, in most cases, these are asymptomatic or have conflicting symptoms. The diagnostic modalities are:
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Small Bowel Follow-Through - This is a fluoroscopic method to obtain high-resolution images of the small intestine.
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Ultrasound - In this method, sound waves are used to obtain images of the lower abdomen.
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CT- Scan - Ionizing radiation is used to obtain images of the small intestine.
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Magnetic Resonance Imaging (MRI) - Magnetic resonance imaging uses a magnetic field and radio waves to obtain images of the small intestine.
What Are the Clinical Complications of Benign Small Intestine Neoplasms?
The common complications of such conditions are:
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Obstruction - This is the most common complication caused by tumors. This may cause abdominal pain, constipation, and loss of appetite. Difficulty in bowel movement or passing gas can also be associated with this condition.
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Hemorrhage - Rupture of the tumor's blood vessels or ulcer may cause hemorrhage. This is commonly associated with leiomyomas and angiomas. This is associated with blood in the vomit, rectal bleeding, and tarry stool.
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Pain - Pain and abdominal cramps are commonly seen in most cases.
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Weight Loss - These are most commonly seen in duodenal tumors. Obstruction in the small intestine causes improper absorption of food and nutrition and loss of weight.
How to Treat Benign Small Intestine Neoplasms?
Surgical resection of the neoplasm is the choice of treatment. Usually, for benign lesions small-area of removal is adequate. Small lesions can be removed using the laparoscopic method. Diathermy can be used to remove leiomyomas. Colonoscopy resection is done to remove lipomas. Large-size adenomas required complete resection by the open method. Pathological examinations of samples should be done to remove any chances of carcinoma.
Conclusion
Benign neoplasms of the small intestine are rare entities. The sign and symptoms are such conditions usually undermined during the early stages. With the help of modern diagnostic methods, identifying such tumors is possible. However, these are potentially harmless pathological entities but may cause clinical complications. Some of these tumors may turn into malignant conditions also. Timely diagnosis and surgical excision can avoid any medical complications.
