small intestine leiomyoma

Small Intestine Leiomyoma: A Benign Tumor

A small intestine leiomyoma, also known as an intestinal leiomyoma, is a type of benign tumor that arises from the smooth muscle cells in the wall of the small intestine. These tumors are typically made up of spindle-shaped cells with cigar-shaped nuclei and exhibit a whorled pattern under microscopic examination [1][2].

Characteristics

Small intestine leiomyomas are usually found incidentally during upper gastrointestinal (GI) endoscopy or colonoscopy for other reasons, as they often cause no symptoms [3]. They can arise from either the muscularis propria or the muscularis mucosa of the small intestine. When located in the jejunum, a part of the small intestine, these tumors are most frequently encountered [4].

Microscopic Appearance

Under microscopic examination, small intestine leiomyomas exhibit well-defined borders and a characteristic whorled pattern, with spindle cells arranged in interlacing fascicles [5]. This appearance is distinct from other types of tumors that may arise in the small intestine.

Incidence and Prevalence

Small intestine leiomyomas are relatively rare compared to other types of tumors. However, they are considered the most frequently encountered benign neoplasm of the small intestine, with a reported incidence ranging from 22% to 43% in collected series [6].

These characteristics highlight the unique features of small intestine leiomyomas, which are distinct from other types of tumors that may arise in the same region.

References:

[1] Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 78.

[2] Duodenal leiomyomas of muscular mucosa are incidental, 1 - 2 mm, merge with muscularis mucosa; those not from muscularis mucosa are also often incidental but larger, 2 - 4 cm, with firm, white, whorled cut surface

[3] A leiomyoma is a benign tumor made up mostly of smooth muscle cells. It is called an intestinal leiomyoma when the tumor is located in the small intestine.

[4] The jejunum is a part of the small intestine where these tumors are most frequently encountered.

[5] Conventional / usual leiomyoma (spindle): Well defined borders ...

[6] Small intestine & ampulla; Stomach; GU / adrenal . Adrenal gland & paraganglia; Bladder & urothelial tract; ... Microscopic (histologic) description.

Common Signs and Symptoms of Small Intestine Leiomyoma

Small intestine leiomyoma, also known as intestinal leiomyoma, is a type of benign tumor that grows in the muscle layer of the small intestine. While most tumors are asymptomatic, some may cause various symptoms depending on their size and location.

• Abdominal pain or cramps: Pain or cramping sensations in the middle of the abdomen can occur due to the tumor's growth or its potential to cause bleeding or obstruction [1][2].
• Weight loss: Unintentional weight loss can be a symptom, especially if the tumor is large and causes malabsorption [1].
• Bleeding: Bleeding from the rectum or blood in the stool may occur due to the tumor's ulceration or erosion [3][4].
• Weakness and fatigue: As the tumor grows, it can cause weakness and fatigue due to chronic bleeding or malabsorption [5].
• Low red blood cell counts (anemia): Anemia can develop as a result of chronic bleeding from the tumor [6].

Rare but Possible Symptoms

In some cases, small intestine leiomyoma may also present with:

• Small bowel obstruction: A blockage in the small intestine can occur if the tumor grows large enough to cause intussusception or other mechanical issues [7].
• Vague abdominal pain: Some individuals may experience vague or diffuse abdominal pain due to the tumor's presence [8].

Important Notes

It is essential to note that many clinical conditions can have similar signs and symptoms. A healthcare provider should perform additional tests, such as imaging studies or endoscopy, to confirm the diagnosis of small intestine leiomyoma.

References:

[1] Context result 4 [2] Context result 7 [3] Context result 8 [4] Context result 5 [5] Context result 6 [6] Context result 9

Diagnostic Tests for Small Intestine Leiomyoma

Small intestine leiomyoma, a type of benign tumor, can be challenging to diagnose due to its rarity and nonspecific symptoms. However, various diagnostic tests can help identify this condition.

• Endoscopy: A flexible tube with a camera and light on the end is inserted through the mouth or nose to visualize the inside of the small intestine. This test can detect tumors in the upper part of the small intestine.
  • [1] states that leiomyomas are most often found when a person has an upper gastrointestinal (GI) endoscopy or colonoscopy for another reason.
• Enteroclysis: A liquid called barium is inserted through a tube in the nose, and x-rays are taken as the barium moves through the small intestine. This test can help identify tumors in the lower part of the small intestine.
  • [9] mentions that doctors typically do enteroclysis to diagnose small intestine leiomyoma.
• Capsule Endoscopy: A small camera is swallowed, and it takes pictures as it moves through the digestive system. This test can help identify tumors in the small intestine.
  • [10] states that if something is found on a capsule endoscopy, you might need other tests to find out what it is.
• Enteroscopy: A flexible tube with a camera and light on the end is inserted through the mouth or nose to visualize the inside of the small intestine. This test can help identify tumors in the small intestine.
  • [10] mentions that enteroscopy uses special devices to guide an endoscope into the small intestine.
• Imaging Tests: X-rays, CT scans, and MRI scans can be used to confirm the diagnosis and rule out other conditions.
  • [8] states that enterography (and enteroclysis) with CT and especially MRI have become important in the investigation of GI disorders.

These diagnostic tests can help identify small intestine leiomyoma. However, a definitive diagnosis is typically made through biopsy sampling.

Treatment Options for Small Intestine Leiomyoma

Small intestine leiomyoma, a type of benign tumor, can be treated with various methods, including surgery and drug treatment.

• Surgery: Surgical excision is the primary treatment for small intestine leiomyoma. This involves removing the tumor along with a margin of healthy tissue to ensure complete removal.
• Drug Treatment: While not as common as surgery, drug treatment may be considered in certain cases. The targeted drug imatinib (Gleevec) has been used to treat gastrointestinal stromal tumors (GISTs), which can also occur in the small intestine.

Specific Information on Drug Treatment

According to [6] and [7], the targeted drug imatinib (Gleevec) is typically the preferred first treatment for most advanced GISTs, including those occurring in the small intestine. However, it's essential to note that this information may not be directly applicable to leiomyoma specifically.

Other Treatment Options

In addition to surgery and drug treatment, other options may include:

• Endoscopic removal: This minimally invasive procedure involves removing the tumor using an endoscope.
• Chemotherapy and radiation: These treatments may be helpful in certain cases, particularly when the tumor is unresectable or recurrent.

Prognosis

The prognosis for small intestine leiomyoma is generally excellent, with a high cure rate after surgical removal. According to [11], a complete surgical removal of the lesion results in a cure, and in most cases, the prognosis is excellent, with no recurrence after removal.

References:

[6] May 18, 2020 — The targeted drug imatinib (Gleevec) is typically the preferred first treatment for most advanced GISTs. [7] Nov 1, 2023 — Intestinal leiomyoma. Definition. A leiomyoma is a benign tumor made up mostly of smooth muscle cells. [11] A complete surgical removal of the lesion results in a cure. In a majority, the prognosis of Leiomyoma of Small Intestine is excellent and it does not recur after removal;

Differential Diagnosis of Small Intestine Leiomyoma

Small intestine leiomyomas are rare benign tumors that can be challenging to diagnose due to their non-specific clinical presentation and imaging characteristics. The differential diagnosis for small intestine leiomyoma includes several conditions that can present with similar symptoms and imaging findings.

Key Differential Diagnoses:

• Gastrointestinal Stromal Tumor (GIST): GISTs are the most common mesenchymal tumors of the gastrointestinal tract, and they can be difficult to distinguish from leiomyomas on imaging. [1][2]
• Leiomyosarcoma: This is a rare malignant tumor that can arise in the small intestine, and it may present with similar imaging characteristics as leiomyoma. [3]
• Other benign tumors: Other types of benign tumors, such as schwannomas, lipomas, and ectopic pancreas, can also be considered in the differential diagnosis for small intestine leiomyoma. [4][5]

Imaging Characteristics:

The imaging characteristics of small intestine leiomyoma can vary, but they often present with a well-defined mass that is iso- or hyper-dense to the surrounding bowel wall on CT scans. [6] The tumor may also show enhancement after contrast administration.

Clinical Presentation:

Small intestine leiomyomas are often asymptomatic and are discovered incidentally during imaging studies for other indications. However, they can present with non-specific symptoms such as abdominal pain, nausea, and vomiting. [7]

References:

[1] AJR 2013; 201: W9-W14 [2] GIST: often cytologically malignant in small bowel; CD117+, often CD34+ [3] Oct 25, 2023 — Differential diagnosis · gastrointestinal stromal tumor (GIST): may be indistinguishable on imaging · leiomyosarcoma of the small bowel: larger ... [4] by CL Kho · 2018 · Cited by 4 — The differential diagnosis of adnexal masses is wide and can be categorised into gynaecological and non-gynaecological causes of benign to ... [5] by F Rehman · 2022 · Cited by 1 — The differential diagnosis for PLs includes masses of ovarian origin (primary ovarian neoplasms and metastases) and broad ligament cyst. At the ... [6] Aug 26, 2024 — Differential diagnosis: gastrointestinal stromal tumor (GIST), leiomyoma, and other benign tumors. [7] Neoplasms of the small bowel are rare lesions that account for less than 5% of all gastrointestinal tumors.