Small intestine cancer differential diagnosis

Jump to navigation Jump to search

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

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

Table for Differential Diagnosis of Small Intestine Cancer

ABBREVIATIONS:

N/A: Not available, NL: Normal, Hb: Hemoglobin, Abd: Abdominal

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel

Frequency

Blood in stool Abd pain Other symptoms Hb Tumor marker Endoscopy CT scan Other diagnostic study
Adenocarcinoma

of

small

intestine[1]

↑↓ + +/- CEA+ Biopsy and histopathological analysis
Carcinoids[2][3][4][5][6] +/- + 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
  • Peripheral nuclear palisading
  • Granular eosinophilic cytoplasm.
Biopsy and histopathological analysis
Intestinal Lymphoma[7][8] - +/- +
  • Weight loss
Non-Hodgkin lymphomas: CD-20 Biopsy and histopathological analysis
Gastrointestinal

Stromal

Tumors (GIST)

[9][10][11]

[12][13][14][15]

↑↓ +/- -
  • Mostly asymptomatic
  • Are discovered incidentally
  • Non-specific symptoms
  • Early satiety and bloating
/- Endoscopic ultrasound withBiopsy and histopathological analysis
Peutz-Jeghers

syndrome[16]

[17][18][19][20]

↑↓ + + N/A
Juvenile

Polyposis

Coli

[21][22][23][24][25]

+ + N/A
  • If any of the following positive:
    • More than five juvenile polyps of the colorectum
    • Multiple juvenile polyps throughout the GI tract
    • Any number of juvenile polyps and a family history of juvenile polyposis
    • Heterozygous pathogenic variant in SMAD4 or BMPR1A
Kaposi's sarcoma[26] + + Localized purpuric lesion N/A Biopsy
Arteriovenous malformation[27] - + -
  • N/A
N/A
  • Bright red, flat lesions
  • Rarely, polypoid
N/A N/A Accidental fining
Infectious colitis[28] + + - N/A N/A N/A Stool culture
Hamartoma[29] + + - S100 (mucosal Schwann cell hamartoma (MSCH) Large polypoid mass Biopsy
Ulcerative colitis[30][31] + + N/A N/A N/A
  • Mucosal and submucosal inflammation
  • Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
  • Distorted crypts
  • Crypt abscess
Endoscopy and a mucosal biopsy
Crohn's disease[30] + + N/A N/A N/A Endoscopy and a mucosal biopsy
Irritable bowel syndrome[32] ↑↓ + + - N/A Not recommended N/A Diagnosis of exclusion with fulfillment of Rome criteria N/A Clinical diagnosis (Rome criteria)
Bowel endometriosis[33] + +
  • Dyschezia
  • Tenesmus
N/A N/A N/A N/A Transvaginal ultrasonography
Intestinal tuberculosis[34]

[35][36][37][38][39]

Chronic +/- +
  • Fever
  • Fatigue,
  • Weight loss
  • Anorexia
  • Night sweats
  • Bowel obstruction
  • Abdominal distension
  • Lymph node enlargement
N/A
  • Forms on endoscopy:
    • Hypertrophic
    • Ulcerative

Submucosal caseation granulomas

Endoscopic biopsy and histopathology analysis
Peptic ulcer disease[40][41]

[42][43][44][45]

↑↓ + Melena + N/A Endoscopic biopsy sample may show positive H. Pylori by H&E stain Endoscopic visualization of ulcer
Pancreatic cancer[46][47][48]

[49][50][51][52][53]

[54][55][55][56]

Chronic + + Cancer-associated antigen 19-9 (CA 19-9) Biopsy and histological analysis
Gastric cancer

[57][58][59][60][61]

[62][63][64][65][66]

[67][68][69][70]

/- + Melena + Biopsy and histopathological analysis

Differentiating small intestine cancer from other causes of abdominal pain and diarrhea

Small intestine cancer must be differentiated from other causes of abdominal pain and diarrhea.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abdominal pain Diarrhea Flushing Dyspnea Palpitations Other symptoms Wheezing Telangiectasia Hypotension Tachycardia Systolic murmur of tricuspid regurgitation Other physical findings Urinary 5-hydroxyindoleacetic acid (5-HIAA) Serum Chromogranin A (CgA) Other markers Abdominal computed tomography (CT) Abdominal MRI Somatostatin receptor scintigraphy [SRS], or Octreoscan Metaiodobenzylguanidine (MIBG) scintigraphy Other diagnostic studies Transthoracic echocardiography
Carcinoid Syndrome[71][72][73][74][75][76][77][78][79] Neuroendocrine tumor of midgut [80][81][6][82] +

Mild

+ + + +

Dermatitis

Diarrhea

Dementia

Metastatic tumors in the liver: Right upper quadrant pain, hepatomegaly, and early satiety

+ +/- +/- + + - + + + +
  • Valve thickening with retraction and reduction in the mobility of the tricuspid valve

Pathognomonic radiological sign of midgut NET.

Neuroendocrine tumor of lung[83][84][85][86] + + + + +
+ +/- +/- + + - + + Sensitive for detection of liver metastases if present + + - Typical low-grade:bland cells containing regular round nuclei with finely dispersed chromatin and inconspicuous small nucleoli.Mitotic figures are scarce and necrosis is absent.

Intermediate-grade atypical: presence of Neuroendocrine morphology and either necrosis or 2 to 10 mitoses per 10 HPF

Irritable Bowel Syndrome[87][88][89][90] +

Perioidic

- - - - - - - - - - - - - - - - Rome IV criteria
  • Recurrent abdominal pain, at least 1day/week in the last 3 months, a/s with 2 or more of the following criteria:

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

Malignant neoplasms of small intestine[91][92][93] +/- +/- - - +/- - - +/- - * Abdominal mass - + Abdominal CT scan may be diagnostic of small intestine cancer. Findings on CT scan suggestive of small intestine cancer include intrinsic mass with a short segment of bowel wall thickening MRI and MRI enteroscopy are other advance modalities to diagnose and stage small intestinal cancers - - Enteroscopy, capsule endoscopy and double balloon enteroscopy Biopsy and histopathology
Crohn disease[94][95][96][97] +/- - - - - - - - - - - - - -
  • Focal ulcerations and acute and chronic inflammation
Benign cutaneous flushing[98] - - + - - - - - - - - - - - - - - - - - - -
Systemic mastocytosis[99][100][101][102][103] + + + + - +/- +/- + - - - - - -
Asthma exacerbation[104][105][106][107] - - - + + + - - + -
  • Tachypnea
  • Prolonged expiratory phase of respiration (decreased I:E ratio)
  • Seated position with use of extended arms to support the upper chest (tripod position)
  • +/- Pulsus paradoxus
- - - -- - - - Chest X ray -
  • Loss of the normal pseudostratified structure of airway epithelium
  • Increase in the proportion of goblet cells
  • Fibrotic thickening of the sub-epithelial reticular basement membrane
  • Increased numbers of myofibroblasts
  • Increased vascularity
  • Increased airway smooth muscle mass
  • Increased extracellular matrix
Anaphylaxis[108][109][110][111][112] + -/+ + + + +/- - + + - - - - - - - - - - History of exposure to insect stings,food alllergy,rubber latex,food additives,,allergy to medications,physical factors such s excercise and cold
Histaminergic Angioedema[113][114][115][116][117] +/- +/- + + + + - + + - - - - - - - - - -
  • Take proper clinical history of previous similar episodes
  • Medication history
  • Any allergy to insects stings , foods or any ingestion within previous 24 hours
Medullary Thyroid Carcinoma[118][119][120][121] - +/- +/- +/- - - - - - - - - - - - -

For metastasis

-


References

  1. Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
  2. Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
  3. Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
  4. Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B (May 2012). "TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study". J. Natl. Cancer Inst. 104 (10): 764–77. doi:10.1093/jnci/djs208. PMID 22525418.
  5. Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
  6. 6.0 6.1 Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  7. Quayle FJ, Lowney JK (May 2006). "Colorectal lymphoma". Clin Colon Rectal Surg. 19 (2): 49–53. doi:10.1055/s-2006-942344. PMC 2780105. PMID 20011310.
  8. Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
  9. Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  10. Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  11. Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD (July 2004). "KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications". Am. J. Surg. Pathol. 28 (7): 889–94. PMID 15223958.
  12. Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K (November 2005). "18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors". World J Surg. 29 (11): 1429–35. doi:10.1007/s00268-005-0045-6. PMID 16222452.
  13. Miettinen M, Sobin LH, Lasota J (January 2005). "Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up". Am. J. Surg. Pathol. 29 (1): 52–68. PMID 15613856.
  14. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  15. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  16. Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
  17. Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  18. Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
  19. Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
  20. Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  21. Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
  22. Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
  23. Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  24. Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  25. Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  26. Arora M, Goldberg EM (July 2010). "Kaposi sarcoma involving the gastrointestinal tract". Gastroenterol Hepatol (N Y). 6 (7): 459–62. PMC 2933764. PMID 20827371.
  27. Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
  28. DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
  29. Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
  30. 30.0 30.1 Fakhoury M, Negrulj R, Mooranian A, Al-Salami H (2014). "Inflammatory bowel disease: clinical aspects and treatments". J Inflamm Res. 7: 113–20. doi:10.2147/JIR.S65979. PMC 4106026. PMID 25075198.
  31. Collins P, Rhodes J (August 2006). "Ulcerative colitis: diagnosis and management". BMJ. 333 (7563): 340–3. doi:10.1136/bmj.333.7563.340. PMC 1539087. PMID 16902215.
  32. Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
  33. Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.
  34. Bhansali SK (April 1977). "Abdominal tuberculosis. Experiences with 300 cases". Am. J. Gastroenterol. 67 (4): 324–37. PMID 879148.
  35. Das P, Shukla HS (December 1976). "Clinical diagnosis of abdominal tuberculosis". Br J Surg. 63 (12): 941–6. PMID 1009343.
  36. Petrosyan M, Mason RJ (February 2006). "Tuberculous enteritis presenting as small-bowel obstruction". Clin. Gastroenterol. Hepatol. 4 (2): xxiii. PMID 16469667.
  37. Balthazar EJ, Gordon R, Hulnick D (March 1990). "Ileocecal tuberculosis: CT and radiologic evaluation". AJR Am J Roentgenol. 154 (3): 499–503. doi:10.2214/ajr.154.3.2106212. PMID 2106212.
  38. Rathi P, Gambhire P (February 2016). "Abdominal Tuberculosis". J Assoc Physicians India. 64 (2): 38–47. PMID 27730779.
  39. Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R (April 2005). "Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital". Endoscopy. 37 (4): 351–6. doi:10.1055/s-2005-861116. PMID 15824946.
  40. Ramakrishnan K, Salinas RC (October 2007). "Peptic ulcer disease". Am Fam Physician. 76 (7): 1005–12. PMID 17956071.
  41. Lu CL, Chang SS, Wang SS, Chang FY, Lee SD (July 2004). "Silent peptic ulcer disease: frequency, factors leading to "silence," and implications regarding the pathogenesis of visceral symptoms". Gastrointest. Endosc. 60 (1): 34–8. PMID 15229422.
  42. Chung KT, Shelat VG (January 2017). "Perforated peptic ulcer - an update". World J Gastrointest Surg. 9 (1): 1–12. doi:10.4240/wjgs.v9.i1.1. PMC 5237817. PMID 28138363.
  43. Cotton PB, Shorvon PJ (May 1984). "Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease". Clin Gastroenterol. 13 (2): 383–403. PMID 6378443.
  44. Tonolini M, Ierardi AM, Bracchi E, Magistrelli P, Vella A, Carrafiello G (October 2017). "Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis". Insights Imaging. 8 (5): 455–469. doi:10.1007/s13244-017-0562-5. PMC 5621988. PMID 28677101.
  45. Cotton PB, Shorvon PJ (May 1984). "Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease". Clin Gastroenterol. 13 (2): 383–403. PMID 6378443.
  46. Hruban RH, Adsay NV, Albores-Saavedra J, Compton C, Garrett ES, Goodman SN, Kern SE, Klimstra DS, Klöppel G, Longnecker DS, Lüttges J, Offerhaus GJ (May 2001). "Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions". Am. J. Surg. Pathol. 25 (5): 579–86. PMID 11342768.
  47. Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, Biankin SA, Compton C, Fukushima N, Furukawa T, Goggins M, Kato Y, Klöppel G, Longnecker DS, Lüttges J, Maitra A, Offerhaus GJ, Shimizu M, Yonezawa S (August 2004). "An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms". Am. J. Surg. Pathol. 28 (8): 977–87. PMID 15252303.
  48. Karlson BM, Ekbom A, Lindgren PG, Källskog V, Rastad J (October 1999). "Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis". Radiology. 213 (1): 107–11. doi:10.1148/radiology.213.1.r99oc25107. PMID 10540649.
  49. Nino-Murcia M, Jeffrey RB, Beaulieu CF, Li KC, Rubin GD (March 2001). "Multidetector CT of the pancreas and bile duct system: value of curved planar reformations". AJR Am J Roentgenol. 176 (3): 689–93. doi:10.2214/ajr.176.3.1760689. PMID 11222206.
  50. Fulcher AS, Turner MA (1999). "MR pancreatography: a useful tool for evaluating pancreatic disorders". Radiographics. 19 (1): 5–24, discussion 41–4, quiz 148–9. doi:10.1148/radiographics.19.1.g99ja045. PMID 9925389.
  51. Niederau C, Grendell JH (1992). "Diagnosis of pancreatic carcinoma. Imaging techniques and tumor markers". Pancreas. 7 (1): 66–86. PMID 1557348.
  52. Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK (May 1989). "Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer". Ann. Intern. Med. 110 (9): 704–9. PMID 2930108.
  53. Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX (June 2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
  54. Kalser MH, Barkin J, MacIntyre JM (July 1985). "Pancreatic cancer. Assessment of prognosis by clinical presentation". Cancer. 56 (2): 397–402. PMID 4005804.
  55. 55.0 55.1 Bakkevold KE, Arnesjø B, Kambestad B (April 1992). "Carcinoma of the pancreas and papilla of Vater: presenting symptoms, signs, and diagnosis related to stage and tumour site. A prospective multicentre trial in 472 patients. Norwegian Pancreatic Cancer Trial". Scand. J. Gastroenterol. 27 (4): 317–25. PMID 1589710.
  56. Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX (June 2005). "Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage". Clin Transl Oncol. 7 (5): 189–97. PMID 15960930.
  57. Siegel RL, Miller KD, Jemal A (2016). "Cancer statistics, 2016". CA Cancer J Clin. 66 (1): 7–30. doi:10.3322/caac.21332. PMID 26742998.
  58. Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C; et al. (2013). "Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines". J Natl Compr Canc Netw. 11 (5): 531–46. PMID 23667204.
  59. Luo T, Chen W, Wang L, Zhao H (2016). "CA125 is a potential biomarker to predict surgically incurable gastric and cardia cancer: A retrospective study". Medicine (Baltimore). 95 (51): e5297. doi:10.1097/MD.0000000000005297. PMC 5181804. PMID 28002320.
  60. Ucar E, Semerci E, Ustun H, Yetim T, Huzmeli C, Gullu M (2008). "Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer". Adv Ther. 25 (10): 1075–84. doi:10.1007/s12325-008-0100-4. PMID 18821070.
  61. Kono K, Amemiya H, Sekikawa T, Iizuka H, Takahashi A, Fujii H; et al. (2002). "Clinicopathologic features of gastric cancers producing alpha-fetoprotein". Dig Surg. 19 (5): 359–65, discussion 365. doi:10.1159/000065838. PMID 12435906.
  62. Graham DY, Schwartz JT, Cain GD, Gyorkey F (February 1982). "Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma". Gastroenterology. 82 (2): 228–31. PMID 7054024.
  63. Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM; et al. (1988). "Gastric adenocarcinoma: CT versus surgical staging". Radiology. 167 (2): 335–40. doi:10.1148/radiology.167.2.3357941. PMID 3357941.
  64. Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ; et al. (2009). "Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer". Radiology. 253 (2): 407–15. doi:10.1148/radiol.2532082272. PMID 19789243.
  65. http://radiopaedia.org/articles/gastric-carcinoma
  66. Keogan MT, Edelman RR (August 2001). "Technologic advances in abdominal MR imaging". Radiology. 220 (2): 310–20. doi:10.1148/radiology.220.2.r01au22310. PMID 11477231.
  67. Yun M, Lim JS, Noh SH, Hyung WJ, Cheong JH, Bong JK; et al. (2005). "Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT". J Nucl Med. 46 (10): 1582–8. PMID 16204706.
  68. Hallinan JT, Venkatesh SK (May 2013). "Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response". Cancer Imaging. 13: 212–27. doi:10.1102/1470-7330.2013.0023. PMC 3667568. PMID 23722535.
  69. Yashiro M, Chung YS, Nishimura S, Inoue T, Sowa M (November 1995). "Establishment of two new scirrhous gastric cancer cell lines: analysis of factors associated with disseminated metastasis". Br. J. Cancer. 72 (5): 1200–10. PMC 2033934. PMID 7577468.
  70. Kunz PL, Gubens M, Fisher GA, Ford JM, Lichtensztajn DY, Clarke CA (October 2012). "Long-term survivors of gastric cancer: a California population-based study". J. Clin. Oncol. 30 (28): 3507–15. doi:10.1200/JCO.2011.35.8028. PMID 22949151.
  71. Rubin de Celis Ferrari AC, Glasberg J, Riechelmann RP (August 2018). "Carcinoid syndrome: update on the pathophysiology and treatment". Clinics (Sao Paulo). 73 (suppl 1): e490s. doi:10.6061/clinics/2018/e490s. PMC 6096975. PMID 30133565.
  72. Hegyi J, Schwartz RA, Hegyi V (January 2004). "Pellagra: dermatitis, dementia, and diarrhea". Int. J. Dermatol. 43 (1): 1–5. PMID 14693013.
  73. Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  74. Savelli G, Lucignani G, Seregni E, Marchianò A, Serafini G, Aliberti G, Villano C, Maccauro M, Bombardieri E (May 2004). "Feasibility of somatostatin receptor scintigraphy in the detection of occult primary gastro-entero-pancreatic (GEP) neuroendocrine tumours". Nucl Med Commun. 25 (5): 445–9. PMID 15100502.
  75. Bora, ManashKumar; Vithiavathi, S (2012). "Primary bronchial carcinoid: A rare differential diagnosis of pulmonary koch in young adult patient". Lung India. 29 (1): 59. doi:10.4103/0970-2113.92366. ISSN 0970-2113.
  76. Yazıcıoğlu A, Yekeler E, Bıcakcıoğlu P, Ozaydın E, Karaoğlanoğlu N (December 2012). "Synchronous bilateral multiple typical pulmonary carcinoid tumors: a unique case with 10 typical carcinoids". Balkan Med J. 29 (4): 450–2. doi:10.5152/balkanmedj.2012.081. PMC 4115868. PMID 25207053.
  77. Krausz Y, Keidar Z, Kogan I, Even-Sapir E, Bar-Shalom R, Engel A, Rubinstein R, Sachs J, Bocher M, Agranovicz S, Chisin R, Israel O (November 2003). "SPECT/CT hybrid imaging with 111In-pentetreotide in assessment of neuroendocrine tumours". Clin. Endocrinol. (Oxf). 59 (5): 565–73. PMID 14616879.
  78. van der Lely, Aart J.; Herder, Wouter W. de (2005). "Carcinoid syndrome: diagnosis and medical management". Arquivos Brasileiros de Endocrinologia & Metabologia. 49 (5): 850–860. doi:10.1590/S0004-27302005000500028. ISSN 0004-2730.
  79. Halperin DM, Shen C, Dasari A, Xu Y, Chu Y, Zhou S, Shih YT, Yao JC (April 2017). "Frequency of carcinoid syndrome at neuroendocrine tumour diagnosis: a population-based study". Lancet Oncol. 18 (4): 525–534. doi:10.1016/S1470-2045(17)30110-9. PMC 6066284. PMID 28238592.
  80. Sjöblom SM (September 1988). "Clinical presentation and prognosis of gastrointestinal carcinoid tumours". Scand. J. Gastroenterol. 23 (7): 779–87. PMID 3227292.
  81. Ganeshan D, Bhosale P, Yang T, Kundra V (October 2013). "Imaging features of carcinoid tumors of the gastrointestinal tract". AJR Am J Roentgenol. 201 (4): 773–86. doi:10.2214/AJR.12.9758. PMID 24059366.
  82. Modlin IM, Kidd M, Latich I, Zikusoka MN, Shapiro MD (May 2005). "Current status of gastrointestinal carcinoids". Gastroenterology. 128 (6): 1717–51. PMID 15887161.
  83. Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM (July 2008). "Bronchopulmonary neuroendocrine tumors". Cancer. 113 (1): 5–21. doi:10.1002/cncr.23542. PMID 18473355.
  84. Jeung, Mi-Young; Gasser, Bernard; Gangi, Afshin; Charneau, Dominique; Ducroq, Xavier; Kessler, Romain; Quoix, Elisabeth; Roy, Catherine (2002). "Bronchial Carcinoid Tumors of the Thorax: Spectrum of Radiologic Findings". RadioGraphics. 22 (2): 351–365. doi:10.1148/radiographics.22.2.g02mr01351. ISSN 0271-5333.
  85. Nessi R, Basso Ricci P, Basso Ricci S, Bosco M, Blanc M, Uslenghi C (April 1991). "Bronchial carcinoid tumors: radiologic observations in 49 cases". J Thorac Imaging. 6 (2): 47–53. PMID 1649924.
  86. Melmon KL, Sjoerdsma A, Mason DT (October 1965). "Distinctive clinical and therapeutic aspects of the syndrome associated with bronchial carcinoid tumors". Am. J. Med. 39 (4): 568–81. PMID 5831899.
  87. Ford AC, Forman D, Bailey AG, Axon AT, Moayyedi P (May 2008). "Irritable bowel syndrome: a 10-yr natural history of symptoms and factors that influence consultation behavior". Am. J. Gastroenterol. 103 (5): 1229–39, quiz 1240. doi:10.1111/j.1572-0241.2007.01740.x. PMID 18371141.
  88. Simren M, Palsson OS, Whitehead WE (April 2017). "Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice". Curr Gastroenterol Rep. 19 (4): 15. doi:10.1007/s11894-017-0554-0. PMC 5378729. PMID 28374308.
  89. "American Gastroenterological Association medical position statement: irritable bowel syndrome". Gastroenterology. 123 (6): 2105–7. December 2002. doi:10.1053/gast.2002.37095b. PMID 12454865.
  90. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R (February 2016). "Bowel Disorders". Gastroenterology. doi:10.1053/j.gastro.2016.02.031. PMID 27144627.
  91. McLaughlin PD, Maher MM (July 2013). "Primary malignant diseases of the small intestine". AJR Am J Roentgenol. 201 (1): W9–14. doi:10.2214/AJR.12.8492. PMID 23789703.
  92. Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, Longo WE (March 2007). "Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry". Arch Surg. 142 (3): 229–35. doi:10.1001/archsurg.142.3.229. PMID 17372046.
  93. Lepage C, Bouvier AM, Manfredi S, Dancourt V, Faivre J (December 2006). "Incidence and management of primary malignant small bowel cancers: a well-defined French population study". Am. J. Gastroenterol. 101 (12): 2826–32. doi:10.1111/j.1572-0241.2006.00854.x. PMID 17026561.
  94. Hara AK, Swartz PG (2009). "CT enterography of Crohn's disease". Abdom Imaging. 34 (3): 289–95. doi:10.1007/s00261-008-9443-1. PMID 18649092.
  95. Baumgart, Daniel C; Sandborn, William J (2012). "Crohn's disease". The Lancet. 380 (9853): 1590–1605. doi:10.1016/S0140-6736(12)60026-9. ISSN 0140-6736.
  96. Feuerstein, Joseph D.; Cheifetz, Adam S. (2017). "Crohn Disease: Epidemiology, Diagnosis, and Management". Mayo Clinic Proceedings. 92 (7): 1088–1103. doi:10.1016/j.mayocp.2017.04.010. ISSN 0025-6196.
  97. García-Bosch, O.; Ordás, I.; Aceituno, M.; Rodríguez, S.; Ramírez, A. M.; Gallego, M.; Ricart, E.; Rimola, J.; Panes, J. (2016). "Comparison of Diagnostic Accuracy and Impact of Magnetic Resonance Imaging and Colonoscopy for the Management of Crohn's Disease". Journal of Crohn's and Colitis. 10 (6): 663–669. doi:10.1093/ecco-jcc/jjw015. ISSN 1873-9946.
  98. Izikson, Leonid; English, Joseph C.; Zirwas, Matthew J. (2006). "The flushing patient: Differential diagnosis, workup, and treatment". Journal of the American Academy of Dermatology. 55 (2): 193–208. doi:10.1016/j.jaad.2005.07.057. ISSN 0190-9622.
  99. Hartmann, Karin; Escribano, Luis; Grattan, Clive; Brockow, Knut; Carter, Melody C.; Alvarez-Twose, Ivan; Matito, Almudena; Broesby-Olsen, Sigurd; Siebenhaar, Frank; Lange, Magdalena; Niedoszytko, Marek; Castells, Mariana; Oude Elberink, Joanna N.G.; Bonadonna, Patrizia; Zanotti, Roberta; Hornick, Jason L.; Torrelo, Antonio; Grabbe, Jürgen; Rabenhorst, Anja; Nedoszytko, Boguslaw; Butterfield, Joseph H.; Gotlib, Jason; Reiter, Andreas; Radia, Deepti; Hermine, Olivier; Sotlar, Karl; George, Tracy I.; Kristensen, Thomas K.; Kluin-Nelemans, Hanneke C.; Yavuz, Selim; Hägglund, Hans; Sperr, Wolfgang R.; Schwartz, Lawrence B.; Triggiani, Massimo; Maurer, Marcus; Nilsson, Gunnar; Horny, Hans-Peter; Arock, Michel; Orfao, Alberto; Metcalfe, Dean D.; Akin, Cem; Valent, Peter (2016). "Cutaneous manifestations in patients with mastocytosis: Consensus report of the European Competence Network on Mastocytosis; the American Academy of Allergy, Asthma & Immunology; and the European Academy of Allergology and Clinical Immunology". Journal of Allergy and Clinical Immunology. 137 (1): 35–45. doi:10.1016/j.jaci.2015.08.034. ISSN 0091-6749.
  100. Lee, Jason K; Whittaker, Scott J; Enns, Robert A; Zetler, Peter (2008). "Gastrointestinal manifestations of systemic mastocytosis". World Journal of Gastroenterology. 14 (45): 7005. doi:10.3748/wjg.14.7005. ISSN 1007-9327.
  101. Horan RF, Austen KF (March 1991). "Systemic mastocytosis: retrospective review of a decade's clinical experience at the Brigham and Women's Hospital". J. Invest. Dermatol. 96 (3): 5S–13S, discussion 13S–14S. PMID 2002264.
  102. Sokol, Harry; Georgin-Lavialle, Sophie; Grandpeix-Guyodo, Catherine; Canioni, Danielle; Barete, Stéphane; Dubreuil, Patrice; Lortholary, Olivier; Beaugerie, Laurent; Hermine, Olivier (2010). "Gastrointestinal involvement and manifestations in systemic mastocytosis". Inflammatory Bowel Diseases. 16 (7): 1247–1253. doi:10.1002/ibd.21218. ISSN 1078-0998.
  103. Bedeir A, Jukic DM, Wang L, Mullady DK, Regueiro M, Krasinskas AM (November 2006). "Systemic mastocytosis mimicking inflammatory bowel disease: A case report and discussion of gastrointestinal pathology in systemic mastocytosis". Am. J. Surg. Pathol. 30 (11): 1478–82. doi:10.1097/01.pas.0000213310.51553.d7. PMID 17063092.
  104. Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C (March 2012). "Asthma outcomes: exacerbations". J. Allergy Clin. Immunol. 129 (3 Suppl): S34–48. doi:10.1016/j.jaci.2011.12.983. PMC 3595577. PMID 22386508.
  105. Limb SL, Brown KC, Wood RA, Wise RA, Eggleston PA, Tonascia J, Adkinson NF (December 2005). "Irreversible lung function deficits in young adults with a history of childhood asthma". J. Allergy Clin. Immunol. 116 (6): 1213–9. doi:10.1016/j.jaci.2005.09.024. PMID 16337448.
  106. Aldington S, Beasley R (May 2007). "Asthma exacerbations. 5: assessment and management of severe asthma in adults in hospital". Thorax. 62 (5): 447–58. doi:10.1136/thx.2005.045203. PMC 2117186. PMID 17468458.
  107. Dougherty RH, Fahy JV (February 2009). "Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype". Clin. Exp. Allergy. 39 (2): 193–202. doi:10.1111/j.1365-2222.2008.03157.x. PMC 2730743. PMID 19187331.
  108. Peavy RD, Metcalfe DD (August 2008). "Understanding the mechanisms of anaphylaxis". Curr Opin Allergy Clin Immunol. 8 (4): 310–5. doi:10.1097/ACI.0b013e3283036a90. PMC 2683407. PMID 18596587.
  109. Tupper J, Visser S (October 2010). "Anaphylaxis: A review and update". Can Fam Physician. 56 (10): 1009–11. PMC 2954079. PMID 20944042.
  110. Kemp SF, Lockey RF (September 2002). "Anaphylaxis: a review of causes and mechanisms". J. Allergy Clin. Immunol. 110 (3): 341–8. PMID 12209078.
  111. Bjornsson HM, Graffeo CS (December 2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
  112. "Usefulness and Limitations of Sequential Serum Tryptase for the Diagnosis of Anaphylaxis in 102 Patients - FullText - International Archives of Allergy and Immunology 2013, Vol. 160, No. 2 - Karger Publishers".
  113. Busse PJ, Smith T (August 2017). "Histaminergic Angioedema". Immunol Allergy Clin North Am. 37 (3): 467–481. doi:10.1016/j.iac.2017.03.001. PMID 28687103.
  114. Hahn J, Hoffmann TK, Bock B, Nordmann-Kleiner M, Trainotti S, Greve J (July 2017). "Angioedema". Dtsch Arztebl Int. 114 (29–30): 489–496. doi:10.3238/arztebl.2017.0489. PMC 5569554. PMID 28818177.
  115. Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J (December 2017). "Angioedema in the emergency department: a practical guide to differential diagnosis and management". Int J Emerg Med. 10 (1): 15. doi:10.1186/s12245-017-0141-z. PMC 5389952. PMID 28405953.
  116. Bernstein JA, Moellman J (November 2012). "Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema". Int J Emerg Med. 5 (1): 39. doi:10.1186/1865-1380-5-39. PMC 3518251. PMID 23131076.
  117. Kaplan AP (June 2008). "Angioedema". World Allergy Organ J. 1 (6): 103–13. doi:10.1097/WOX.0b013e31817aecbe. PMC 3651192. PMID 23282406.
  118. Pacini F, Castagna MG, Cipri C, Schlumberger M (August 2010). "Medullary thyroid carcinoma". Clin Oncol (R Coll Radiol). 22 (6): 475–85. doi:10.1016/j.clon.2010.05.002. PMID 20627492.
  119. Roy M, Chen H, Sippel RS (2013). "Current understanding and management of medullary thyroid cancer". Oncologist. 18 (10): 1093–100. doi:10.1634/theoncologist.2013-0053. PMC 3805151. PMID 24037980.
  120. Mian C, Perrino M, Colombo C, Cavedon E, Pennelli G, Ferrero S, De Leo S, Sarais C, Cacciatore C, Manfredi GI, Verga U, Iacobone M, De Pasquale L, Pelizzo MR, Vicentini L, Persani L, Fugazzola L (May 2014). "Refining calcium test for the diagnosis of medullary thyroid cancer: cutoffs, procedures, and safety". J. Clin. Endocrinol. Metab. 99 (5): 1656–64. doi:10.1210/jc.2013-4088. PMID 24552221.
  121. Bae YJ, Schaab M, Kratzsch J (2015). "Calcitonin as Biomarker for the Medullary Thyroid Carcinoma". Recent Results Cancer Res. 204: 117–37. doi:10.1007/978-3-319-22542-5_5. PMID 26494386.

Template:WikiDoc Sources