Small intestine cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Qurrat-ul-ain Abid, M.D.[2]Parminder Dhingra, M.D. [3]

Overview

Small intestine cancer must be differentiated from Crohn's disease, intestinal tuberculosis, ulcerative colitis, large intestine cancer, peptic ulcer disease, and irritable bowel syndrome (IBS).

Differential Diagnosis

tab

Diseases Clinical manifestations Para-clinical findings Gold standard Comments
Symptoms
Lab Findings Imaging Histopathology
Constipation/Diarrhea Blood in stool Abdominal pain Other symptoms Anemia Tumor marker Endoscopy CT scan Other imaging study
Adenocarcinoma +/- + +/- + CEA+
    • Circumferential and annular lesions producing an "apple-core" appearance on barium enema x-ray (left-sided tumors).
Glandular structures, consisting of:[4]
  • Sheets or cords of malignant cells,
  • Cellular atypia, Pleomorphism
  • High mitotic rate
Biopsy and histopathological analysis
AVM[5]
Diverticulitis[6] +
  • Fever+/- chills
  • Nausea+/- vomiting
  • Leukocytosis
  • Evidence of inflammation
  • Outpouchings of the colonic wall
Hemorrhoid
Anal fissure
Infectious colitis
Peutz-Jeghers syndrome[7] +/- + + + +/-
Diseases Clinical manifestations Para-clinical findings Gold standard Comments
Symptoms
Lab Findings Imaging Histopathology
Constipation/Diarrhea Blood in stool Abdominal pain Other symptoms Anemia Tumor Markers Colonoscopy CT scan Other imaging
Carcinoids[16] Diarrhea +/- + +
  • Infiltrating, ulcerating or fungating lesions in the wall of colon
  • Well-defined single or multiple lesions
  • Round or ovoid in shape
  • Variable in size ranges between 2-5 cm
  • Solid or spongy nests of cells accentuated by neatly outlined luminal spaces [20]
  • Peripheral nuclear palisading
  • Granular eosinophilic cytoplasm.
Juvenile Polyposis Coli[21] Diarrhea + + + - Hamartomatous polyps on histopathological analysis
  • Individuals who meet clinical criteria should get genetic testing germline mutation in the BMPR1A and SMAD4 genes.[24]
  • Increased risk of colorectal and gastric cancer[25]
Gastrointestinal Stromal Tumors (GIST)[26][27] +/- +/- +/-
  • Mostly asymptomatic[28]
  • Are discovered incidentally
  • Non-specific symptoms
  • Early satiety and bloating
+/-
  • Study of choice
  • Evaluate extent and dimensions
  • Evaluate metastatic disease
Hamartoms in progress
Colorectal Lymphoma[33] ccomplete
Kaposi's sarcoma complete
Ulcerative colitis[34] Diarrhea + LLQ[34]
  • Vitamin B12 defi. anemia[34]
  • Autoimmune hemolytic anemia
  • Continuous lesions, presence of crypts, formation of residual mucosal tissue[34]
  • Mucosal and submucosal inflammation[34]
  • Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
  • Distorted crypts
  • Crypt abscess
  • Endoscopy and a mucosal biopsy[35]
Crohn's disease[34] Diarrhea LRQ[34]
  • Vitamin B12 defi. anemia[34]
  • Autoimmune hemolytic anemia
  • Discontinuous lesions, strictures, linear ulcerations[34]
  • Transmural pattern of inflammation[34]
  • Mucosal damage
  • Focal infiltration of leukocytes into the epithelium
  • Granulomas
  • Endoscopy and a mucosal biopsy[35]
Irritable bowel syndrome
Appendicitis
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Lab 1 Lab 2 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Strangulated hernia
Bowel endometriosis

References

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References

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