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__NOTOC__
__NOTOC__


{{CMG}}; {{AE}}


== tab ==
{{CMG}}; {{AE}}{{Qurrat}}


{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Comments
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constipation/Diarrhea
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor marker
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Endoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other imaging study
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma]]
| style="background: #F5F5F5; padding: 5px;" | +/-
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| style="background: #F5F5F5; padding: 5px;" | +/-
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* [[Tenesmus]]
* Diminished caliber of stools
* [[Mucus]] in stools
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[CEA]]+
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* [[Sigmoidoscopy]] may show [[Polyp|polyps]], [[Ulceration|ulcerating]] and infiltrating [[lesions]]
* [[Colonoscopy]]<ref name="pmid27733426">{{cite journal |vauthors=Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH |title=Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study |journal=Gut |volume=67 |issue=2 |pages=291–298 |date=February 2018 |pmid=27733426 |doi=10.1136/gutjnl-2016-312712 |url=}}</ref> can reveal detail images of [[polyps]] and [[cancerous]] [[lesions]]
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*Luminal narrowing and [[bowel obstruction]]
*Circumferential thickening of the bowel wall
*[[Enlarged lymph nodes]]
*Pulmonary [[metastases]]
*Peritoneal metastases
*[[Metastases|Hepatic metastases]]
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* [[PET scan|PET scans]] for detailed images
* [[MRI]]
* [[Barium enema]] shows the [[luminal]] abnormalities
* [[Genetic testing]] to see hereditary etiology<ref name="RathoreHussain2013">{{cite journal|last1=Rathore|first1=Saima|last2=Hussain|first2=Mutawarra|last3=Ali|first3=Ahmad|last4=Khan|first4=Asifullah|title=A Recent Survey on Colon Cancer Detection Techniques|journal=IEEE/ACM Transactions on Computational Biology and Bioinformatics|volume=10|issue=3|year=2013|pages=545–563|issn=1545-5963|doi=10.1109/TCBB.2013.84}}</ref>
* On gross pathology:<ref name="pmid21969498">{{cite journal| author=Weiss JM, Pfau PR, O'Connor ES, King J, LoConte N, Kennedy G et al.| title=Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results--Medicare data. | journal=J Clin Oncol | year= 2011 | volume= 29 | issue= 33 | pages= 4401-9 | pmid=21969498 | doi=10.1200/JCO.2011.36.4414 | pmc=3221523 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21969498  }}</ref>
** [[Polyp|Polypoid]] or fungating exophytic lesion (right-sided colorectal tumors)


**Circumferential and annular lesions producing an "apple-core" appearance on [[barium enema]] x-ray (left-sided tumors).
==Managemnet of Congenital melanocytic Nevi==
| style="background: #F5F5F5; padding: 5px;" |Glandular structures, consisting of:<ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
 
* Sheets or cords of malignant cells,
https://www.uptodate.com/contents/congenital-melanocytic-nevi?search=melanocytic%20nevus%20pathophysiology&sectionRank=1&usage_type=default&anchor=H2&source=machineLearning&selectedTitle=1~44&display_rank=1#H2
* Cellular atypia, Pleomorphism
 
* High mitotic rate
MANAGEMENT
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[histopathological]] analysis
 
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Small/medium CMN — Small and medium-sized CMN are managed on an individual basis depending on factors that affect ease of monitoring (eg, color, thickness/topography, and location), clinical history, parents' anxiety, and cosmetic concerns [4]. As an example, a multinodular black CMN on the scalp that is partially obscured by dense hair growth would be difficult to follow clinically, whereas a thin light brown lesion on the face would be relatively simple to observe. However, the latter might be removed for cosmetic reasons, and the former may spontaneously lighten during childhood.
|-
 
| style="background: #DCDCDC; padding: 5px; text-align: center;" |AVM<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref>
Periodic evaluation of small- and medium-sized CMN is most important after puberty, since the risk of melanoma arising within these lesions during childhood is extremely low. Baseline photographs can be helpful, and dermoscopy represents a useful tool for assessing changes. (See "Dermoscopic evaluation of skin lesions".)
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Patients and parents should be instructed to perform skin self-examinations and to bring focal changes in color, border, or topography (eg, a red or black papule, nodule, or crust) to the clinician's attention. (See "Screening and early detection of melanoma in adults and adolescents", section on 'Patient self-examination'.)
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Large CMN — Early surgical removal is often desired for large CMN because of their cosmetic and psychosocial sequelae and concern for possible malignant transformation. Complete excision is difficult to achieve; however, resection of bulky and cumbersome portions of large CMN can be beneficial for some patients. Elimination of every nevus cell may be impossible because of the large area of skin affected, the anatomic site (eg, distal extremity, periocular area, genitalia), and involvement of deeper structures (eg, fat, fascia, muscle). Even theoretically complete surgical excision cannot completely eliminate future risk of melanoma, as some melanomas in these patients may develop in the CNS or retroperitoneum. In many cases, close clinical observation with no surgical removal of the lesion is a reasonable choice.
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Factors that affect the decision to perform surgery as well as to determine the timing of surgery include the size and location of the large CMN, the technical difficulty of the procedure(s) required, and anesthesia options. When possible, complete removal of large CMN usually necessitates staged excision with the use of tissue expanders and, occasionally, skin grafting [45].
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When surgical excision is not feasible, cosmetic benefit may potentially be obtained from procedures such as curettage, dermabrasion, and ablative laser therapy (eg, carbon dioxide or erbium:yttrium aluminum garnet lasers, sometimes combined with pigment-directed lasers). During the neonatal period, there is a lower risk of excessive scarring following such interventions, and nevus cells are more accessible because they are concentrated in the upper dermis [46,47]. Curettage can be performed during the first two weeks of life, taking advantage of a cleavage plane between the upper and mid-dermis exclusive to neonatal skin. However, nevus cells remain in the dermis after all of these procedures, as evidenced by frequent repigmentation as well as several reports of the subsequent development of melanoma in treated areas [48-52]. This underscores the need for lifelong clinical observation.
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Regardless of the treatments employed, patients with large CMN (or scars after their excision) should be followed with periodic skin and general physical examinations. Palpation of the nevus and/or scars is essential for detection of focal induration. Histologic evaluation is indicated for firm nodules or indurated areas. Even theoretically complete removal of a large CMN does not eliminate the risk of melanoma, since melanoma of the CNS and other visceral primary sites (eg, the retroperitoneum) may still occur [53].
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Proliferative nodules that develop within large CMN during infancy can have histologic features of melanoma yet behave in a benign manner. Techniques such as comparative genomic hybridization can help to distinguish proliferative nodules (usually having no chromosomal aberrations or only numeric changes) from melanoma (typically demonstrating gains/losses of chromosomal fragments) [40]. Mass spectroscopy imaging proteomic analysis may also help differentiate proliferative nodules from melanoma [29]. (See 'Proliferative nodules' above.)
|-
 
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Diverticulitis<ref name="pmid16187597">{{cite journal |vauthors=Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH |title=Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting |journal=J Chin Med Assoc |volume=68 |issue=9 |pages=411–8 |date=September 2005 |pmid=16187597 |doi=10.1016/S1726-4901(09)70156-X |url=}}</ref>
Surveillance for neurocutaneous melanosis — Patients with a large CMN plus multiple (especially >20) satellite nevi or with multiple medium-sized CMN are at risk for NCM and should be followed with serial head circumference measurements, neurologic examinations, and developmental assessments [3,37,39]. This monitoring includes evaluation for signs and symptoms of increased intracranial pressure, mass lesions, and spinal cord compression [3,39].
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* Fever+/- chills
* Nausea+/- vomiting
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* Leukocytosis
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* Evidence of inflammation
* Outpouchings of the colonic wall
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhoid
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Anal fissure
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infectious colitis
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome]]<ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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* [[Mucocutaneous]]  [[hyperpigmentation]] (mouth, hands, and feet)<ref name="KopacovaTacheci20092">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref><ref name="GiardielloTrimbath2006">{{cite journal|last1=Giardiello|first1=F|last2=Trimbath|first2=J|title=Peutz-Jeghers Syndrome and Management Recommendations|journal=Clinical Gastroenterology and Hepatology|volume=4|issue=4|year=2006|pages=408–415|issn=15423565|doi=10.1016/j.cgh.2005.11.005}}</ref><ref name="urlPeutz-Jeghers syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/7378/peutz-jeghers-syndrome#ref_8500 |title=Peutz-Jeghers syndrome &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
* [[Fatigue]]
* [[Weight loss]]
* [[Rectal prolapse]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartomatous intestinal polyposis|Multiple polyps]] <ref name="urlPeutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf2">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1266/#pjs.Diagnosis |title=Peutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
* [[mucocutaneous]] [[pigmentation]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyps|Multiple polyps]]
*[[Intussusception]]
*[[Bowel obstruction]]<ref name="urlPeutz-Jeghers syndrome | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/peutz-jeghers-syndrome-2 |title=Peutz-Jeghers syndrome &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>
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* [[Barium enema]]
* [[PET scan|PET-CT]]
* [[MRI]]
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* Multiple [[hamartomatous]] [[polyps]] on [[Histological|histological analysis]]<ref name="urlPeutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1266/#pjs.Diagnosis |title=Peutz-Jeghers Syndrome - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref>
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*[[Genetic testing]] for [[STK11]]
Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spine should be performed in any high-risk patient exhibiting neurologic symptoms, and we suggest that asymptomatic high-risk patients also be screened for NCM with gadolinium-enhanced MRI of the brain and spine, ideally during the first six months of life before myelination, which may obscure evidence of melanosis [42]. For very young infants, it may be possible to obtain initial high-quality MRI images without general anesthesia using "feed and wrap" techniques that allow a swaddled infant to sleep during the imaging procedure [54].
*[[Colonoscopy]] <ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref>
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|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Comments
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Constipation/Diarrhea
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor Markers
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Colonoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other imaging
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoid|Carcinoids]]<ref name="pmid20011309">{{cite journal |vauthors=Chung TP, Hunt SR |title=Carcinoid and neuroendocrine tumors of the colon and rectum |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=45–8 |date=May 2006 |pmid=20011309 |pmc=2780103 |doi=10.1055/s-2006-942343 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
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*[[Flushing (physiology)|Flushing]]<ref name="symptoms">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref>
*[[Wheezing]]
*[[Shortness of breath]]
*[[Palpitations]]
*[[Weight gain]]
*[[Hirsutism]]
*[[Weakness]]
*[[Leg edema]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* Urinary [[5-hydroxyindoleacetic acid]] (5-HIAA)<ref name="diagnostics">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref>
* Chromogranin A (CgA)
* Other biochemical markers include:
**[[Substance P]]
**[[Neurotensin]]
**[[Bradykinin]]
**[[Human chorionic gonadotropin]]
**Neuropeptide L
**[[Pancreatic polypeptide]]
| style="background: #F5F5F5; padding: 5px;" |
* Infiltrating, ulcerating or fungating lesions in the wall of colon
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* Well-defined single or multiple lesions
* Round or ovoid in shape
* Variable in size ranges between 2-5 cm
| style="background: #F5F5F5; padding: 5px;" |
* [[PET scan]]
* [[MRI]]
* Ki-67 index<ref name="pmid22525418">{{cite journal |vauthors=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 |title=TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study |journal=J. Natl. Cancer Inst. |volume=104 |issue=10 |pages=764–77 |date=May 2012 |pmid=22525418 |doi=10.1093/jnci/djs208 |url=}}</ref>
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* Solid or spongy nests of cells accentuated by neatly outlined luminal spaces <ref name="pmid28637502">{{cite journal |vauthors=Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J |title=Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China |journal=Chin J Cancer |volume=36 |issue=1 |pages=51 |date=June 2017 |pmid=28637502 |pmc=5480192 |doi=10.1186/s40880-017-0218-3 |url=}}</ref>


* Peripheral nuclear palisading
Given the poor prognosis, aggressive surgical procedures for CMN removal should be postponed in patients with symptomatic NCM. NCM in an asymptomatic patient does not necessarily preclude skin surgery.
* Granular eosinophilic cytoplasm.
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* [[Biopsy]] and [[Histopathology|histopathological analysis]]
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Juvenile polyposis syndrome|Juvenile Polyposis Coli]]<ref name="pmid7054044">{{cite journal |vauthors=Grotsky HW, Rickert RR, Smith WD, Newsome JF |title=Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred |journal=Gastroenterology |volume=82 |issue=3 |pages=494–501 |date=March 1982 |pmid=7054044 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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* Prolapsing [[polyp]]<ref name="pmid22171123">{{cite journal |vauthors=Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ |title=Juvenile polyposis syndrome |journal=World J. Gastroenterol. |volume=17 |issue=44 |pages=4839–44 |date=November 2011 |pmid=22171123 |pmc=3235625 |doi=10.3748/wjg.v17.i44.4839 |url=}}</ref>
* [[Intussusception]]
* [[Macrocephalus]]
* [[Hypotonia]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
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* >5 juvenile [[Polyp|polyps]] in the [[colon]] and [[rectum]]<ref name="pmid22965402">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
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* Will show [[Polyps|multiple polyps]] in [[gastrointestinal tract]]
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* [[PET scan]]


* [[MRI]]
| style="background: #F5F5F5; padding: 5px;" |[[Hamartomatous intestinal polyposis|Hamartomatous polyps]] on [[Histopathology|histopathological analysis]]
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* Visualization of multiple [[polyps]] in [[gastrointestinal tract]] by [[endoscopy]]
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* Individuals who meet clinical criteria  should get genetic testing  germline mutation in the ''BMPR1A'' and ''SMAD4'' genes.<ref name="pmid229654022">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>


* Increased risk of colorectal and gastric cancer<ref name="pmid229654023">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
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* Mostly [[asymptomatic]]<ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
* Are discovered incidentally
* Non-specific symptoms
* Early satiety and bloating
| style="background: #F5F5F5; padding: 5px;" | +/-
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* KIT protein
* [[CD117|CD 117 antigen]]
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* Subepithelial round masses
* Smooth margins
* Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
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* Study of choice
* Evaluate extent and dimensions
* Evaluate metastatic disease
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* [[MRI]]
* [[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]
* [[PET scan]]<ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref>
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**[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=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 |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=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 |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
**[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested<ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref>
**On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]] and [[Histopathological|histopathological analysis]]
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* [[Cytological|Cytologic analysis]], and [[immunohistochemistry]] for KIT protein expression confirms the [[diagnosis]] of these [[Lesion|lesions]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hamartoms
| style="background: #F5F5F5; padding: 5px;" |in progress
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Colorectal Lymphoma<ref name="pmid20011310">{{cite journal |vauthors=Quayle FJ, Lowney JK |title=Colorectal lymphoma |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=49–53 |date=May 2006 |pmid=20011310 |pmc=2780105 |doi=10.1055/s-2006-942344 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |ccomplete
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Kaposi's sarcoma]]
| style="background: #F5F5F5; padding: 5px;" |complete
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|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Diarrhea
| style="background: #F5F5F5; padding: 5px;" |<big>+</big>
| style="background: #F5F5F5; padding: 5px;" |LLQ<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
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* Vitamin B12 defi. anemia<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* Autoimmune hemolytic anemia
| style="background: #F5F5F5; padding: 5px;" |
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* Continuous lesions, presence of crypts, formation of residual mucosal tissue<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
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* Mucosal and submucosal inflammation<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
* Distorted crypts
* Crypt abscess
| style="background: #F5F5F5; padding: 5px;" |
* Endoscopy and a mucosal biopsy<ref name="pmid16902215" />
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Crohn's disease<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |Diarrhea
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |LRQ<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Vitamin B12 defi. anemia<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* Autoimmune hemolytic anemia
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Discontinuous lesions, strictures, linear ulcerations<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
* Transmural pattern of inflammation<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
* Mucosal damage
* Focal infiltration of leukocytes into the epithelium
* Granulomas
| style="background: #F5F5F5; padding: 5px;" |
* Endoscopy and a mucosal biopsy<ref name="pmid16902215">{{cite journal |vauthors=Collins P, Rhodes J |title=Ulcerative colitis: diagnosis and management |journal=BMJ |volume=333 |issue=7563 |pages=340–3 |date=August 2006 |pmid=16902215 |pmc=1539087 |doi=10.1136/bmj.333.7563.340 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Irritable bowel syndrome
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendicitis]]
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Physical exam 1
!Lab 1
!Lab 2
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Strangulated hernia]]
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|-
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |<nowiki/>
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Bowel endometriosis
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|}




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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary Nodule(benign)
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary Nodule (malignant)
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infection
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!Additional findings
!Additional findings
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Abscess'''
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Septic emboli'''
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Fungi'''
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==Table for Differential Diagnosis of Small Intestine Cancer==
==Table for Differential Diagnosis of Small Intestine Cancer==
'''<small>ABBREVIATIONS''':
'''<small>ABBREVIATIONS''':


'''N/A''': Not available, '''NL''': Normal,</small>
'''N/A''': Not available, '''NL''': Normal,</small><small><nowiki/></small><small><nowiki/></small>
{| class="wikitable"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bowel
Frequency
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abd pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tumor marker
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Endoscopy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other diagnostic study
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adenocarcinoma|<small>Adenocarcinoma</small>]]
<small>of</small>
 
<small>small</small>
 
<small>intestine</small><ref name="pmid8265100">{{cite journal |vauthors=Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C |title=Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum |journal=Oncology |volume=51 |issue=1 |pages=30–4 |date=1994 |pmid=8265100 |doi=10.1159/000227306 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |↑↓
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
*[[Tenesmus|<small>Tenesmus</small>]]
*<small>Diminished caliber of stools</small>
*<small>[[Mucus]] in stools</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>[[CEA]]+</small>
| style="background: #F5F5F5; padding: 5px;" |
*<small>[[Polyp|Polyps]] (villous, tubular, tubulo-villous)</small>
*[[Ulcer|<small>Ulcerating polyps</small>]]
*<small>[[cancerous]] [[lesions]]</small>
| style="background: #F5F5F5; padding: 5px;" |
*<small>Luminal narrowing and [[bowel obstruction]]</small>
*<small>Circumferential thickening of the bowel wall</small>
*[[Enlarged lymph nodes|<small>Enlarged lymph nodes</small>]]
*<small>Pulmonary [[metastases]]</small>
*<small>Peritoneal metastases</small>
*[[Metastases|<small>Hepatic metastases</small>]]
| style="background: #F5F5F5; padding: 5px;" |
*<small>[[PET scan|PET scans]]: Detailed images and metastasis</small>
*<small>[[Barium enema]]: Cancer or a precancerous polyp</small>
*<small>[[Genetic testing]]: [[hereditary nonpolyposis colorectal cancer]] (HNPCC) or [[familial adenomatous polyposis]] (FAP)</small>
| style="background: #F5F5F5; padding: 5px;" |
* Different grades of differentiation of glandular structures
** Sheets or cords of malignant cells,
**Cellular atypia, pleomorphism
**High mitotic rate
* Necrotic debris in glandular lumina
* Desmoplastic reaction (sign of invasion)
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[histopathological]] analysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Carcinoid|C<small>arcinoids</small>]]<small><ref name="pmid20011309">{{cite journal |vauthors=Chung TP, Hunt SR |title=Carcinoid and neuroendocrine tumors of the colon and rectum |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=45–8 |date=May 2006 |pmid=20011309 |pmc=2780103 |doi=10.1055/s-2006-942343 |url=}}</ref><ref name="diagnostics">Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq</ref><ref name="pmid22525418">{{cite journal |vauthors=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 |title=TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study |journal=J. Natl. Cancer Inst. |volume=104 |issue=10 |pages=764–77 |date=May 2012 |pmid=22525418 |doi=10.1093/jnci/djs208 |url=}}</ref><ref name="pmid28637502">{{cite journal |vauthors=Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J |title=Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China |journal=Chin J Cancer |volume=36 |issue=1 |pages=51 |date=June 2017 |pmid=28637502 |pmc=5480192 |doi=10.1186/s40880-017-0218-3 |url=}}</ref><ref name="symptoms">Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq</ref></small>
| style="background: #F5F5F5; padding: 5px;" |↑
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
*[[Flushing (physiology)|<small>Flushing</small>]]
*[[Wheezing|<small>Wheezing</small>]]
*[[Shortness of breath|<small>Shortness of breath</small>]]
*[[Palpitations|<small>Palpitations</small>]]
*[[Weight gain|<small>Weight gain</small>]]
*[[Hirsutism|<small>Hirsutism</small>]]
*[[Weakness|<small>Weakness</small>]]
*[[Leg edema|<small>Leg edema</small>]]
| style="background: #F5F5F5; padding: 5px;" | [[Anemia of chronic disease|↓]]
| style="background: #F5F5F5; padding: 5px;" |
* <small>Urinary [[5-hydroxyindoleacetic acid]] (5-HIAA)</small>
* <small>Chromogranin A (CgA)</small>
* <small>Other biochemical markers include:</small>
**[[Substance P|<small>Substance P</small>]]
**[[Neurotensin|<small>Neurotensin</small>]]
**[[Bradykinin|<small>Bradykinin</small>]]
**[[Human chorionic gonadotropin|<small>Human chorionic gonadotropin</small>]]
**<small>Neuropeptide L</small>
**[[Pancreatic polypeptide|<small>Pancreatic polypeptide</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>Infiltrating, [[Ulceration|ulcerating]] or fungating [[Lesion|lesions]] in the wall of [[colon]]</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Well-defined single or multiple lesions</small>
* <small>Round or ovoid in shape</small>
* <small>Variable in size ranges between 2-5 cm</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[PET scan]] 11C-5-hydroxytryptophan (11C-5-HTP): Deetects metastasis</small>
* <small>[[MRI]]:</small>
** <small>Nodular mass originating from the bowel wall or regional uniform bowel wall thickening with moderate intense enhancement on post gadolinium T1-weighted fat-suppressed images</small>
** <small>Mesenteric metastases presents as nodular masses with [[mesenteric]] stranding</small>
** <small>[[Liver]] metastases may show hypointense precontrast T1- and hyperintense T2-weighted images</small>
** <small>[[Liver]] metastases are commonly hypervascular</small>
* <small>Ki-67 index</small>
| style="background: #F5F5F5; padding: 5px;" |
* Solid or spongy nests of cells accentuated by neatly outlined luminal spaces
 
* Peripheral nuclear palisading
* Granular eosinophilic cytoplasm.
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[MALT lymphoma|Intestinal Lymphoma]]<ref name="pmid20011310">{{cite journal |vauthors=Quayle FJ, Lowney JK |title=Colorectal lymphoma |journal=Clin Colon Rectal Surg |volume=19 |issue=2 |pages=49–53 |date=May 2006 |pmid=20011310 |pmc=2780105 |doi=10.1055/s-2006-942344 |url=}}</ref></small><ref name="QuayleLowney2006">{{cite journal|last1=Quayle|first1=Frank|last2=Lowney|first2=Jennifer|title=Colorectal Lymphoma|journal=Clinics in Colon and Rectal Surgery|volume=19|issue=2|year=2006|pages=049–053|issn=1531-0043|doi=10.1055/s-2006-942344}}</ref>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>Weight loss</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia of chronic disease|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>Non-Hodgkin’s lymphomas: CD-20</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Polyp|Polypoid]] or ulcerated [[mass]], intramural [[lesion]], aphthous [[Ulcer|ulcer,]] [[stricture]], extraluminal mass, or diffuse, multiple [[Polyp|polypoi]]<nowiki/>d [[Lesion|lesions]]</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>CT scan: polypoid mass, circumferential-cavitary lesions, focal mucosal nodularity, diffuse ulcerative or nodular lesions, regional lymph node involvement</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Biopsy:</small>
** [[Diffuse large B cell lymphoma|<small>Diffuse large B-cell lymphoma</small>]]
** [[MALT lymphoma|<small>Extranodal marginal zone lymphoma (MALT)</small>]]
** [[Mantle cell lymphoma|<small>Mantle cell lymphoma</small>]]
** [[Burkitt's lymphoma|<small>Burkitt’s lymphoma</small>]]
** [[Follicular lymphoma|<small>Follicular lymphoma</small>]]
* <small>Double-contrast enema: Subtle mucosal changes, gross tumor morphology</small>
| style="background: #F5F5F5; padding: 5px;" |
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:
* [[MALT lymphoma|Extranodal marginal zone lymphoma (MALT)]]
* [[Mantle cell lymphoma]]
* [[Burkitt's lymphoma|Burkitt’s lymphoma]]
* [[Follicular lymphoma]]
*
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[histopathological]] analysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|<small>Gastrointestinal</small>]]
 
[[Gastrointestinal stromal tumor|<small>Stromal</small>]]
 
[[Gastrointestinal stromal tumor|<small>Tumors (GIST)</small>]]
 
<small><ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref></small>
 
<small><ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref><ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref><ref name="pmid12075401">{{cite journal |vauthors=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 |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=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 |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" | ↑↓
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* <small>Mostly [[asymptomatic]]</small>
* <small>Are discovered incidentally</small>
* <small>Non-specific symptoms</small>
* <small>Early satiety and bloating</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]/-
| style="background: #F5F5F5; padding: 5px;" |
* <small>KIT protein</small>
* [[CD117|<small>CD 117 antigen</small>]]
| style="background: #F5F5F5; padding: 5px;" |
* <small>Subepithelial round masses</small>
* <small>Smooth margins</small>
* <small>Normal overlying [[mucosa]] may be intact or [[Ulcerated lesion|ulcerated]]</small>
* <small>Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and have an [[intraluminal]] pattern of growth.</small>
* <small>Intermediate GIST (size of 5-10 cms) are [[heterogeneous]] with irregular borders and [[Intraluminal|intra]] or extra-luminal pattern of [[growth]].</small>
* <small>Large GISTs (>10 cms) are [[heterogeneous]] with irregular borders and have local or distant spread</small>
* <small>Malignant GIST with metastasis:</small>
** <small>Size greater than 10 cm</small>
** [[Calcification|<small>Calcifications</small>]]
** <small>Irregular margins</small>
** <small>[[Heterogeneous]] and lobulated</small>
** [[Lymphadenopathy|<small>Lymphadenopathy</small>]]
** [[Ulceration|<small>Ulceration</small>]]
** <small>Extraluminal and [[mesenteric]] fat infiltration</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[MRI]]: [[Hemorrhage]], [[necrosis]], surrounding structures and [[metastasis]].</small>
* <small>[[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]:</small>
** <small>[[Mucosal]] [[ulceration]] or [[bleeding]]</small>
** <small>Smooth [[submucosal]] mass as hypoechoic mass</small>
** <small>[[Malignant]] GIST lesions present with:</small>
*** <small>[[Heterogeneous]] mass >4 cm in size</small>
*** <small>Irregular borders</small>
*** <small>[[Intraluminal|Intra]] and extraluminal growth</small>
*** <small>Multiple [[cysts]] within the main [[lesion]]</small>
| style="background: #F5F5F5; padding: 5px;" |
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
| style="background: #F5F5F5; padding: 5px;" |Endoscopic ultrasound with[[Biopsy]] and [[Histopathological|histopathological analysis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Peutz-Jeghers syndrome|<small>Peutz-Jeghers</small>]]
 
<small>[[Peutz-Jeghers syndrome|syndrome]]<ref name="pmid27298573">{{cite journal |vauthors=Zhong ME, Niu BZ, Ji WY, Wu B |title=Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer |journal=World J. Gastroenterol. |volume=22 |issue=22 |pages=5293–6 |date=June 2016 |pmid=27298573 |doi=10.3748/wjg.v22.i22.5293 |url=}}</ref></small>
 
<small><ref name="KopacovaTacheci20092">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref><ref name="GiardielloTrimbath2006">{{cite journal|last1=Giardiello|first1=F|last2=Trimbath|first2=J|title=Peutz-Jeghers Syndrome and Management Recommendations|journal=Clinical Gastroenterology and Hepatology|volume=4|issue=4|year=2006|pages=408–415|issn=15423565|doi=10.1016/j.cgh.2005.11.005}}</ref><ref name="BeggsLatchford2010">{{cite journal|last1=Beggs|first1=A. D.|last2=Latchford|first2=A. R.|last3=Vasen|first3=H. F. A.|last4=Moslein|first4=G.|last5=Alonso|first5=A.|last6=Aretz|first6=S.|last7=Bertario|first7=L.|last8=Blanco|first8=I.|last9=Bulow|first9=S.|last10=Burn|first10=J.|last11=Capella|first11=G.|last12=Colas|first12=C.|last13=Friedl|first13=W.|last14=Moller|first14=P.|last15=Hes|first15=F. J.|last16=Jarvinen|first16=H.|last17=Mecklin|first17=J.-P.|last18=Nagengast|first18=F. M.|last19=Parc|first19=Y.|last20=Phillips|first20=R. K. S.|last21=Hyer|first21=W.|last22=Ponz de Leon|first22=M.|last23=Renkonen-Sinisalo|first23=L.|last24=Sampson|first24=J. R.|last25=Stormorken|first25=A.|last26=Tejpar|first26=S.|last27=Thomas|first27=H. J. W.|last28=Wijnen|first28=J. T.|last29=Clark|first29=S. K.|last30=Hodgson|first30=S. V.|title=Peutz-Jeghers syndrome: a systematic review and recommendations for management|journal=Gut|volume=59|issue=7|year=2010|pages=975–986|issn=0017-5749|doi=10.1136/gut.2009.198499}}</ref><ref name="KopacovaTacheci20093">{{cite journal|last1=Kopacova|first1=Marcela|last2=Tacheci|first2=Ilja|last3=Rejchrt|first3=Stanislav|last4=Bures|first4=Jan|title=Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach|journal=World Journal of Gastroenterology|volume=15|issue=43|year=2009|pages=5397|issn=1007-9327|doi=10.3748/wjg.15.5397}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |↑↓
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Mucocutaneous]]  [[hyperpigmentation]] (mouth, hands, and feet)</small>
* [[Fatigue|<small>Fatigue</small>]]
* [[Weight loss|<small>Weight loss</small>]]
* [[Rectal prolapse|<small>Rectal prolapse</small>]]
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartomatous intestinal polyposis|Multiple polyps]]
* [[mucocutaneous]] [[pigmentation]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Polyps|<small>Multiple polyps</small>]]
*[[Intussusception|<small>Intussusception</small>]]
*[[Bowel obstruction|<small>Bowel obstruction</small>]]
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Barium enema]]: Multiple [[Polyp|polyps]].</small>
* <small>[[MRI]]: Multiple [[Hamartoma|hamartomatous]] polyps</small>
| style="background: #F5F5F5; padding: 5px;" |
** [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with central core of branching smooth muscle associated with mucosa
** Smaller [[Polyp|polyps]] may lack the prominent arborizing smooth muscle
| style="background: #F5F5F5; padding: 5px;" |
* [[Genetic testing]] for [[STK11]]
 
* [[Colonoscopy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Juvenile polyposis syndrome|<small>Juvenile</small>]]
 
[[Juvenile polyposis syndrome|<small>Polyposis</small>]]
 
[[Juvenile polyposis syndrome|<small>Coli</small>]]
 
<small><ref name="pmid7054044">{{cite journal |vauthors=Grotsky HW, Rickert RR, Smith WD, Newsome JF |title=Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred |journal=Gastroenterology |volume=82 |issue=3 |pages=494–501 |date=March 1982 |pmid=7054044 |doi= |url=}}</ref><ref name="pmid22171123">{{cite journal |vauthors=Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ |title=Juvenile polyposis syndrome |journal=World J. Gastroenterol. |volume=17 |issue=44 |pages=4839–44 |date=November 2011 |pmid=22171123 |pmc=3235625 |doi=10.3748/wjg.v17.i44.4839 |url=}}</ref><ref name="pmid22965402">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654023">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref><ref name="pmid229654022">{{cite journal |vauthors=Latchford AR, Neale K, Phillips RK, Clark SK |title=Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome |journal=Dis. Colon Rectum |volume=55 |issue=10 |pages=1038–43 |date=October 2012 |pmid=22965402 |doi=10.1097/DCR.0b013e31826278b3 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>Prolapsing [[polyp]]</small>
* [[Intussusception|<small>Intussusception</small>]]
* [[Macrocephalus|<small>Macrocephalus</small>]]
* [[Hypotonia|<small>Hypotonia</small>]]
* [[Intestinal obstruction|<small>Bowel obstruction</small>]]
* <small>Heart or brain abnormalities</small>
* <small>Cleft palate</small>
* <small>Polydactyly</small>
* <small>Abnormalities of the genitalia or urinary tract.</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* >5 juvenile [[Polyp|polyps]] in the [[colon]] and [[rectum]]
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
| style="background: #F5F5F5; padding: 5px;" |
* <small>M[[Polyps|ultiple polyps]] in [[gastrointestinal tract]]</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Barium]] study: Multiple polyps in GI tract</small>
* <small>[[Stool]] [[DNA test]]: ''SMAD4'' or ''BMPR1A''</small>
* <small>Diagnose if any of the following positive:</small>
** <small>More than five [[Polyps|juvenile polyps]] of the [[Colon|colorectum]]</small>
** <small>Multiple juvenile [[Polyp|polyps]] throughout the [[GI tract]]</small>
** <small>Any number of juvenile [[polyps]] and a family history of [[Juvenile polyposis syndrome|juvenile polyposis]]</small>
** <small>Heterozygous pathogenic variant in ''SMAD4'' or ''BMPR1A''</small>
| style="background: #F5F5F5; padding: 5px;" |
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
* Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils and neutrophils
* Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
* Areas of conventional dysplasia
| style="background: #F5F5F5; padding: 5px;" |
* 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''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Kaposi's sarcoma]]<ref name="pmid20827371">{{cite journal |vauthors=Arora M, Goldberg EM |title=Kaposi sarcoma involving the gastrointestinal tract |journal=Gastroenterol Hepatol (N Y) |volume=6 |issue=7 |pages=459–62 |date=July 2010 |pmid=20827371 |pmc=2933764 |doi= |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Melena|<small>Melena</small>]]
 
* [[Hematochezia|<small>Hematochezia</small>]]
* [[Abdominal pain|<small>Abdominal pain</small>]]
* [[Nausea and vomiting|<small>N/V</small>]]
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |
* [[CD34|<small>CD34</small>]]
* [[CD31|<small>CD31</small>]]
* [[D2-40|<small>D2-40</small>]]
* [[HHV-8|<small>HHV-8</small>]]
* <small>[[FHI-1]] antibody</small>
* [[LANA-1|<small>LANA-1</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>Localized purpuric [[lesion]]</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Electrophoresis]]: [[antibodies]] against [[Kaposi sarcoma]] [[Herpes virus|herpes virus  (HHV-8)]]</small>
* <small>[[Biopsy|Biopsy:]] [[Vascular]] proliferation, [[red blood cell]] and [[hemosiderin]] extravasation,[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]], neovascular [[lesion]] wrapped around a pre-existing space, intracytoplasmic [[PAS stain|PAS]] +ve [[hyaline]] globules</small>
| style="background: #F5F5F5; padding: 5px;" |
* [[Vascular]] proliferation
* Red blood cell and [[hemosiderin]] extravasation
* [[Lymphocyte|Lymphocytes]] and [[Monocyte|monocytes]]
* Premonitory sign (a neovascular lesion wrapped around a pre-existing space)
* Intracytoplasmic PAS +ve [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |Biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Arteriovenous malformation]]<ref name="pmid28139503">{{cite journal |vauthors=Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS |title=Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review |journal=Saudi J Gastroenterol |volume=23 |issue=1 |pages=67–70 |date=2017 |pmid=28139503 |pmc=5329980 |doi=10.4103/1319-3767.199111 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
* <small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Bright red, flat lesions</small>
* <small>Rarely, polypoid</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
* Arteries directly connected to veins without capillary beds
| style="background: #F5F5F5; padding: 5px;" |Accidental fining
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Infectious colitis|Infectious <small>colitis</small>]]<small><ref name="pmid22080825">{{cite journal |vauthors=DuPont HL |title=Approach to the patient with infectious colitis |journal=Curr. Opin. Gastroenterol. |volume=28 |issue=1 |pages=39–46 |date=January 2012 |pmid=22080825 |doi=10.1097/MOG.0b013e32834d3208 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Fever]], [[Rigor|chills]]</small>
* [[Nausea and vomiting|<small>N/V</small>]]
* [[Bloating|<small>Bloating</small>]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Patchy or diffuse [[Erythematous|erythematous mucosa]]</small>
* <small>Edema, [[hemorrhage]], with or without [[ulcers]] of mucosa</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Stool culture|Stool cultures]] in adequate [[culture media]]</small>
* <small>[[Stool test|Stool analysis]]: [[Leukocytosis]]</small>
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Stool culture
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Hamartoma]]<ref name="pmid26672891">{{cite journal |vauthors=Cauchin E, Touchefeu Y, Matysiak-Budnik T |title=Hamartomatous Tumors in the Gastrointestinal Tract |journal=Gastrointest Tumors |volume=2 |issue=2 |pages=65–74 |date=September 2015 |pmid=26672891 |pmc=4668787 |doi=10.1159/000437175 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus|<small>Tenesmus</small>]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<small>S100 (mucosal Schwann cell hamartoma (MSCH)</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Large polypoid mass</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Isodense or hypodense solid [[Mass|masses]]</small>
* <small>[[Heterogeneous]] mass</small>
* <small>Presence of [[fat]] in a well circumscribed nodule</small>
* [[Calcification|<small>Calcification</small>]]
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Biopsy]]: Proliferation of bland [[spindle cells]] in the [[lamina]] propria ([[mucosa]]<nowiki/>l [[schwann cell]] [[hamartoma]] (MSCH))</small>
| style="background: #F5F5F5; padding: 5px;" |
* poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
* The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct
* Involvement of mucosa but never the submucosa
| style="background: #F5F5F5; padding: 5px;" |Biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ulcerative colitis|Ulcerative <small>colitis</small>]]<small><ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref><ref name="pmid16902215">{{cite journal |vauthors=Collins P, Rhodes J |title=Ulcerative colitis: diagnosis and management |journal=BMJ |volume=333 |issue=7563 |pages=340–3 |date=August 2006 |pmid=16902215 |pmc=1539087 |doi=10.1136/bmj.333.7563.340 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" |<big>+</big>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>[[Diarrhea]] mixed with blood and [[mucus]]</small>
* <small>W[[Weight loss|eight loss]]</small>
* <small>Urgency</small>
* [[Tenesmus|<small>Tenesmus</small>]]
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Continuous lesions</small>
* <small>[[Erythema]] (or redness of the [[mucosa]]) and friability of the [[mucosa]]</small>
* <small>Crypts, formation of residual mucosal tissue</small>
* [[Polyp (medicine)|<small>Pseudopolyps</small>]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Mucosal and submucosal inflammation
* Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
* Distorted crypts
* Crypt abscess
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus|<small>Tenesmus</small>]]
* [[Nausea and vomiting|<small>N/V</small>]]
* [[Bowel obstruction|<small>Bowel obstruction</small>]]
* [[Fever|<small>Fever</small>]]
*
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* <small>Discontinuous lesions</small>
* <small>Strictures</small>
* <small>Linear ulcerations</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |
* Transmural pattern of inflammation
* Mucosal damage
* Focal infiltration of leukocytes into the epithelium
* Granulomas
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |↑↓
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>Straining during [[defecation]]</small>
* [[Urgency|<small>Urgency</small>]]
* <small>Sensation of incomplete evacuation</small>
* <small>[[Mucus]] passage</small>
* [[Bloating|<small>Bloating</small>]]
* <small>Weight loss</small>
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |<small>Not recommended</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* Diagnosis of exclusion with fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Clinical diagnosis  ([[Irritable bowel syndrome Diagnostic Study of Choice|Rome criteria]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Endometriosis|Bowel endometriosis]]<ref name="pmid25400445">{{cite journal |vauthors=Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A |title=Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team |journal=World J. Gastroenterol. |volume=20 |issue=42 |pages=15616–23 |date=November 2014 |pmid=25400445 |pmc=4229526 |doi=10.3748/wjg.v20.i42.15616 |url=}}</ref></small>
| style="background: #F5F5F5; padding: 5px;" |[[Constipation|↓]][[Diarrhea|↑]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
* <small>Dyschezia</small>
* <small>Tenesmus</small>
| style="background: #F5F5F5; padding: 5px;" | [[Anemia|↓]]
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |<small>N/A</small>
| style="background: #F5F5F5; padding: 5px;" |
* Transvaginal ultrasonography: heterogeneous, hypoechoic, spiculated mass
* Barium enema: Extrinsic mass compressing the bowel, fine crenulation of the mucosa, bowel strictures at the rectosigmoid junction
* T1-weighted or fat-suppression T1-weighted MRIs: Contrast enhanced mass or hyperintense foci, hemorrhagic foci or hyperintense cavities
| style="background: #F5F5F5; padding: 5px;" |
* N/A
| style="background: #F5F5F5; padding: 5px;" |Transvaginal ultrasonography
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>Intestinal [[tuberculosis]]<ref name="pmid879148">{{cite journal |vauthors=Bhansali SK |title=Abdominal tuberculosis. Experiences with 300 cases |journal=Am. J. Gastroenterol. |volume=67 |issue=4 |pages=324–37 |date=April 1977 |pmid=879148 |doi= |url=}}</ref></small>
 
<small><ref name="pmid1009343">{{cite journal |vauthors=Das P, Shukla HS |title=Clinical diagnosis of abdominal tuberculosis |journal=Br J Surg |volume=63 |issue=12 |pages=941–6 |date=December 1976 |pmid=1009343 |doi= |url=}}</ref><ref name="pmid16469667">{{cite journal |vauthors=Petrosyan M, Mason RJ |title=Tuberculous enteritis presenting as small-bowel obstruction |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=2 |pages=xxiii |date=February 2006 |pmid=16469667 |doi= |url=}}</ref><ref name="pmid2106212">{{cite journal |vauthors=Balthazar EJ, Gordon R, Hulnick D |title=Ileocecal tuberculosis: CT and radiologic evaluation |journal=AJR Am J Roentgenol |volume=154 |issue=3 |pages=499–503 |date=March 1990 |pmid=2106212 |doi=10.2214/ajr.154.3.2106212 |url=}}</ref><ref name="pmid27730779">{{cite journal |vauthors=Rathi P, Gambhire P |title=Abdominal Tuberculosis |journal=J Assoc Physicians India |volume=64 |issue=2 |pages=38–47 |date=February 2016 |pmid=27730779 |doi= |url=}}</ref><ref name="pmid15824946">{{cite journal |vauthors=Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R |title=Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital |journal=Endoscopy |volume=37 |issue=4 |pages=351–6 |date=April 2005 |pmid=15824946 |doi=10.1055/s-2005-861116 |url=}}</ref></small>
|[[Chronic diarrhea|Chronic]] [[diarrhea|↑]]
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|
* <small>Fever</small>
* <small>Fatigue,</small>
* <small>Weight loss</small>
* <small>Anorexia</small>
* <small>Night sweats</small>
* <small>Bowel obstruction</small>
 
* <small>Abdominal distension</small>
* <small>Lymph node enlargement</small>
|[[Anemia|↓]]
|<small>N/A</small>
|
* <small>To get sample for histolopathology and culture</small>
 
* <small>Forms on endoscopy:</small>
** <small>Hypertrophic</small>
** <small>Ulcerative</small>
 
* <small>[[Endoscopy|Endoscopic]] findings:</small>
** <small>[[Ulcers]] in [[mucosa]]</small>
** [[Nodules|<small>Nodules in mucosa</small>]]
** <small>[[Strictures]] in [[intestinal wall]]</small>
** <small>[[Pseudopolyps]] formation</small>
** [[Adhesions|<small>Adhesions</small>]]
** [[Fistulas|<small>Fistulas</small>]]
** <small>Deformed [[ileocecal valve]]</small>
|
* <small>Concentric thickening at the site of lesion with proximal intestinal dilatation</small>
* <small>asymmetric thickening of the intestinal wall</small>
* <small>Lymphadenopathy</small>
* <small>Thickening of the peritoneum</small>
* <small>Ascites</small>
|
*[[Small bowel follow-through]] or [[barium enema]]:
** [[Mucosal]] [[ulcerations]]
**Strictures in the [[intestinal wall]]
**[[Cecum|Cecal]] deformations
**Incompetency of [[ileocecal valve]]
*[[Ultrasound]]:
** [[Bowel]] thickening
** [[Peritoneal]] nodules
** [[Peritoneal|Peritoneal thickening]]
**[[Lymphadenopathy]]
*[[Ascites Paracentesis|Ascitic fluid]] analysis:
** Straw-colored ascites
**[[Lymphocytes]] in ascitic fluid
**Cell count is 150 to 4000 cells/mcL with [[Leukocyte|leukocyte count]] of 150 to 4000 cells/mm3
**[[AFB|AFB smear]]
**ADA level
**Protein >3.0 g/dL
**Mycobacterial culture
**[[NAAT]] for ''M. tuberculosis''
**[[SAAG]] <1.1 g/dL
*Ascitic fluid [[NAAT]]
*Ascitic fluid [[Polymerase chain reaction|polymerase chain reaction (PCR)]]
|
* [[Submucosal]] [[Granuloma|caseation granulomas]]
|[[Endoscopy|Endoscopic]] [[biopsy]] and [[Histopathology|histopathology analysis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Peptic ulcer disease]]<ref name="pmid17956071">{{cite journal |vauthors=Ramakrishnan K, Salinas RC |title=Peptic ulcer disease |journal=Am Fam Physician |volume=76 |issue=7 |pages=1005–12 |date=October 2007 |pmid=17956071 |doi= |url=}}</ref><ref name="pmid15229422">{{cite journal |vauthors=Lu CL, Chang SS, Wang SS, Chang FY, Lee SD |title=Silent peptic ulcer disease: frequency, factors leading to "silence," and implications regarding the pathogenesis of visceral symptoms |journal=Gastrointest. Endosc. |volume=60 |issue=1 |pages=34–8 |date=July 2004 |pmid=15229422 |doi= |url=}}</ref></small>
 
<small><ref name="pmid28138363">{{cite journal |vauthors=Chung KT, Shelat VG |title=Perforated peptic ulcer - an update |journal=World J Gastrointest Surg |volume=9 |issue=1 |pages=1–12 |date=January 2017 |pmid=28138363 |pmc=5237817 |doi=10.4240/wjgs.v9.i1.1 |url=}}</ref><ref name="pmid6378443">{{cite journal |vauthors=Cotton PB, Shorvon PJ |title=Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease |journal=Clin Gastroenterol |volume=13 |issue=2 |pages=383–403 |date=May 1984 |pmid=6378443 |doi= |url=}}</ref><ref name="pmid28677101">{{cite journal |vauthors=Tonolini M, Ierardi AM, Bracchi E, Magistrelli P, Vella A, Carrafiello G |title=Non-perforated peptic ulcer disease: multidetector CT findings, complications, and differential diagnosis |journal=Insights Imaging |volume=8 |issue=5 |pages=455–469 |date=October 2017 |pmid=28677101 |pmc=5621988 |doi=10.1007/s13244-017-0562-5 |url=}}</ref><ref name="pmid63784432">{{cite journal |vauthors=Cotton PB, Shorvon PJ |title=Analysis of endoscopy and radiography in the diagnosis, follow-up and treatment of peptic ulcer disease |journal=Clin Gastroenterol |volume=13 |issue=2 |pages=383–403 |date=May 1984 |pmid=6378443 |doi= |url=}}</ref></small>
|↑↓
|<nowiki>+ </nowiki>[[Melena]]
|<nowiki>+</nowiki>
|
* [[Heartburn|<small>Heartburn</small>]]
* <small>Asymptomatic</small>
 
* [[Chest discomfort|<small>Chest discomfort</small>]]
 
* <small>Early [[satiety]]</small>
* [[Nausea and vomiting|<small>Nausea and vomiting</small>]]
* [[Anorexia|<small>Anorexia</small>]]
* [[Bloating|<small>Bloating</small>]]
* [[Perforation|<small>Perforation</small>]]
|[[Anemia|↓]]
|<small>N/A</small>
|
* <small>Smooth [[ulcers]] in [[mucosa]] of [[intestine]]</small>
* <small>[[Ulcers]] with round edges</small>
* <small>Flat [[ulcer]] base filled with exudate</small>
|
* <small>Shows [[ulcers]] ([[Perforated ulcer|perforated]] or non-perforated) when done for the investigation of [[abdominal]] pain</small>
|
* .[[Barium swallow]] (infrequent)
* ''[[Helicobacter pylori|H. Pylori]]'' testing
* [[Hydrogen Breath Test|Hydrogen breath test]]
|
* Endoscopic biopsy sample may show positive [[Helicobacter pylori|H. Pylori]] by [[H&E stain]]
|Endoscopic visualization of ulcer
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Pancreatic cancer]]<ref name="pmid11342768">{{cite journal |vauthors=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 |title=Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions |journal=Am. J. Surg. Pathol. |volume=25 |issue=5 |pages=579–86 |date=May 2001 |pmid=11342768 |doi= |url=}}</ref><ref name="pmid15252303">{{cite journal |vauthors=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 |title=An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms |journal=Am. J. Surg. Pathol. |volume=28 |issue=8 |pages=977–87 |date=August 2004 |pmid=15252303 |doi= |url=}}</ref><ref name="pmid10540649">{{cite journal |vauthors=Karlson BM, Ekbom A, Lindgren PG, Källskog V, Rastad J |title=Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis |journal=Radiology |volume=213 |issue=1 |pages=107–11 |date=October 1999 |pmid=10540649 |doi=10.1148/radiology.213.1.r99oc25107 |url=}}</ref></small>
<small><ref name="pmid11222206">{{cite journal |vauthors=Nino-Murcia M, Jeffrey RB, Beaulieu CF, Li KC, Rubin GD |title=Multidetector CT of the pancreas and bile duct system: value of curved planar reformations |journal=AJR Am J Roentgenol |volume=176 |issue=3 |pages=689–93 |date=March 2001 |pmid=11222206 |doi=10.2214/ajr.176.3.1760689 |url=}}</ref><ref name="pmid9925389">{{cite journal |vauthors=Fulcher AS, Turner MA |title=MR pancreatography: a useful tool for evaluating pancreatic disorders |journal=Radiographics |volume=19 |issue=1 |pages=5–24; discussion 41–4; quiz 148–9 |date=1999 |pmid=9925389 |doi=10.1148/radiographics.19.1.g99ja045 |url=}}</ref><ref name="pmid1557348">{{cite journal |vauthors=Niederau C, Grendell JH |title=Diagnosis of pancreatic carcinoma. Imaging techniques and tumor markers |journal=Pancreas |volume=7 |issue=1 |pages=66–86 |date=1992 |pmid=1557348 |doi= |url=}}</ref><ref name="pmid2930108">{{cite journal |vauthors=Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK |title=Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer |journal=Ann. Intern. Med. |volume=110 |issue=9 |pages=704–9 |date=May 1989 |pmid=2930108 |doi= |url=}}</ref><ref name="pmid159609302">{{cite journal |vauthors=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 |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |date=June 2005 |pmid=15960930 |doi= |url=}}</ref></small>
 
<small><ref name="pmid4005804">{{cite journal |vauthors=Kalser MH, Barkin J, MacIntyre JM |title=Pancreatic cancer. Assessment of prognosis by clinical presentation |journal=Cancer |volume=56 |issue=2 |pages=397–402 |date=July 1985 |pmid=4005804 |doi= |url=}}</ref><ref name="pmid1589710">{{cite journal |vauthors=Bakkevold KE, Arnesjø B, Kambestad B |title=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 |journal=Scand. J. Gastroenterol. |volume=27 |issue=4 |pages=317–25 |date=April 1992 |pmid=1589710 |doi= |url=}}</ref><ref name="pmid1589710" /><ref name="pmid15960930">{{cite journal |vauthors=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 |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |date=June 2005 |pmid=15960930 |doi= |url=}}</ref></small>
|[[Chronic]] [[diarrhea|↑]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* <small>[[Asthenia]] and [[depression]]</small>
 
* [[Jaundice|<small>Jaundice</small>]]
* [[Anorexia|<small>Anorexia</small>]]
* [[Weight loss|<small>Weight loss</small>]]
* [[Nausea and vomiting|<small>Nausea and vomiting</small>]]
* [[Steatorrhea|<small>Steatorrhea</small>]]
* [[Dark urine|<small>Dark urine</small>]]
* [[Back pain|<small>Back pain</small>]]
* [[Thrombophlebitis|<small>Thrombophlebitis</small>]]
|[[Anemia|↓]]
|<small>Cancer-associated antigen 19-9 ([[CA 19-9]])</small>
|
* <small>[[Endoscopic retrograde cholangiopancreatography]] (ERCP) is used:</small>
** <small>To collect tissue sample</small>
** <small>For imaging of [[biliary tree]] and [[Pancreatic duct|pancreatic ducts]]</small>
** <small>[[Obstruction]] and [[strictures]] of [[common bile duct]] and [[pancreatic duct]] is suggestive of cancer ("double duct" sign)</small>
|
* <small>Mass within the [[Pancreas|pancreatic]] [[parenchyma]] or [[Pancreatic duct|duct]]</small>
* <small>[[Atrophy]] of the [[parenchyma]]</small>
*
|
* [[Ultrasound|Transabdominal US]]
** [[Bile duct|Billiary]] dilatation
** Mass in [[pancreas]]
** Hypoechoic hypovascular mass with irregular borders
* [[Magnetic resonance cholangiopancreatography]](MRCP) :
** Better than CT to visualize [[Pancreas|pancreatic]] and [[Bile duct|billiary]] anatomy and [[hepatic]] lesions
* [[Biopsy]]:
** [[Percutaneous]] [[FNA|FNA biopsy]]
** Transduodenal Endo US-guided [[FNA|FNA biopsy]]
|
* [[Pancreatic tumor]] can show two type of [[histology]] depending on the location:
 
* Intraductal [[papillary]] mucinous [[neoplasms]]
** [[Papilla|Papillary]] lesions
** Disseminated or segmental dilation of the [[pancreatic duct]]
* Pancreatic ductal adenocarcinoma
** Duct-like structures
** Mucin production
** Cell atypia
** Dense [[stromal]] fibrosis
|[[Biopsy]] and [[histological]] analysis
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastric cancer|<small>Gastric cancer</small>]]
 
<small><ref name="pmid26742998">{{cite journal| author=Siegel RL, Miller KD, Jemal A| title=Cancer statistics, 2016. | journal=CA Cancer J Clin | year= 2016 | volume= 66 | issue= 1 | pages= 7-30 | pmid=26742998 | doi=10.3322/caac.21332 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26742998  }}</ref><ref name="pmid23667204">{{cite journal| author=Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C et al.| title=Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. | journal=J Natl Compr Canc Netw | year= 2013 | volume= 11 | issue= 5 | pages= 531-46 | pmid=23667204 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23667204  }}</ref><ref name="pmid280023202">{{cite journal| author=Luo T, Chen W, Wang L, Zhao H| title=CA125 is a potential biomarker to predict surgically incurable gastric and cardia cancer: A retrospective study. | journal=Medicine (Baltimore) | year= 2016 | volume= 95 | issue= 51 | pages= e5297 | pmid=28002320 | doi=10.1097/MD.0000000000005297 | pmc=5181804 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28002320  }}</ref><ref name="pmid18821070">{{cite journal| author=Ucar E, Semerci E, Ustun H, Yetim T, Huzmeli C, Gullu M| title=Prognostic value of preoperative CEA, CA 19-9, CA 72-4, and AFP levels in gastric cancer. | journal=Adv Ther | year= 2008 | volume= 25 | issue= 10 | pages= 1075-84 | pmid=18821070 | doi=10.1007/s12325-008-0100-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18821070  }}</ref><ref name="pmid12435906">{{cite journal| author=Kono K, Amemiya H, Sekikawa T, Iizuka H, Takahashi A, Fujii H et al.| title=Clinicopathologic features of gastric cancers producing alpha-fetoprotein. | journal=Dig Surg | year= 2002 | volume= 19 | issue= 5 | pages= 359-65; discussion 365 | pmid=12435906 | doi=10.1159/000065838 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12435906  }}</ref></small>
 
<small><ref name="pmid7054024">{{cite journal |vauthors=Graham DY, Schwartz JT, Cain GD, Gyorkey F |title=Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma |journal=Gastroenterology |volume=82 |issue=2 |pages=228–31 |date=February 1982 |pmid=7054024 |doi= |url=}}</ref><ref name="pmid3357941">{{cite journal| author=Sussman SK, Halvorsen RA, Illescas FF, Cohan RH, Saeed M, Silverman PM et al.| title=Gastric adenocarcinoma: CT versus surgical staging. | journal=Radiology | year= 1988 | volume= 167 | issue= 2 | pages= 335-40 | pmid=3357941 | doi=10.1148/radiology.167.2.3357941 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3357941  }}</ref><ref name="pmid19789243">{{cite journal| author=Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ et al.| title=Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. | journal=Radiology | year= 2009 | volume= 253 | issue= 2 | pages= 407-15 | pmid=19789243 | doi=10.1148/radiol.2532082272 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19789243  }}</ref><ref>http://radiopaedia.org/articles/gastric-carcinoma</ref><ref name="pmid11477231">{{cite journal |vauthors=Keogan MT, Edelman RR |title=Technologic advances in abdominal MR imaging |journal=Radiology |volume=220 |issue=2 |pages=310–20 |date=August 2001 |pmid=11477231 |doi=10.1148/radiology.220.2.r01au22310 |url=}}</ref></small>
 
<small><ref name="pmid16204706">{{cite journal| author=Yun M, Lim JS, Noh SH, Hyung WJ, Cheong JH, Bong JK et al.| title=Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT. | journal=J Nucl Med | year= 2005 | volume= 46 | issue= 10 | pages= 1582-8 | pmid=16204706 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16204706  }}</ref><ref name="pmid23722535">{{cite journal |vauthors=Hallinan JT, Venkatesh SK |title=Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response |journal=Cancer Imaging |volume=13 |issue= |pages=212–27 |date=May 2013 |pmid=23722535 |pmc=3667568 |doi=10.1102/1470-7330.2013.0023 |url=}}</ref><ref name="pmid7577468">{{cite journal |vauthors=Yashiro M, Chung YS, Nishimura S, Inoue T, Sowa M |title=Establishment of two new scirrhous gastric cancer cell lines: analysis of factors associated with disseminated metastasis |journal=Br. J. Cancer |volume=72 |issue=5 |pages=1200–10 |date=November 1995 |pmid=7577468 |pmc=2033934 |doi= |url=}}</ref><ref name="pmid22949151">{{cite journal |vauthors=Kunz PL, Gubens M, Fisher GA, Ford JM, Lichtensztajn DY, Clarke CA |title=Long-term survivors of gastric cancer: a California population-based study |journal=J. Clin. Oncol. |volume=30 |issue=28 |pages=3507–15 |date=October 2012 |pmid=22949151 |doi=10.1200/JCO.2011.35.8028 |url=}}</ref></small>
|[[constipation|↓]]/-
|<nowiki>+ </nowiki>[[Melena]]
|<nowiki>+</nowiki>
|
* [[Weight loss|<small>Weight loss</small>]]
* [[Early satiety|<small>Early satiety</small>]]
* [[Dysphagia|<small>Dysphagia</small>]]
* [[Anorexia|<small>Anorexia</small>]]
* <small>[[Weakness]] and [[Fatigue (physical)|fatigue]]</small>
|[[Anemia|↓]]
|
* <small>[[Carcinoembryonic antigen]] ([[CEA]])</small>
* [[CA-125|<small>Glycoprotein CA 125</small>]]
* <small>[[CA19-9|Carbohydrate antigen 19-9]] ([[CA 19-9]])</small>
* <small>[[Alpha-fetoprotein]] ([[Alpha-fetoprotein|AFP]])</small>
*
|
* <small>On [[endoscopy]] [[gastric cancer]] may appear as:</small>
** <small>[[Polyp|Polypoid]] mass</small>
** <small>[[Ulcerated lesion|Ulcerating]] lesion</small>
** <small>Infiltrating lesion</small>
** <small>Diffuse thickening</small>
**
|
* <small>[[Computed tomography|CT]] is used to stage the disease extent</small>
* <small>[[Computed tomography|CT]] can also visulaize</small>
* <small>primary lesion:</small>
** <small>[[Polypoidy|Polypoid]] [[mass]]</small>
** <small>Ulcerating lesion</small>
** <small>Diffuse thickening (''tunica plastica'')</small>
** <small>Infiltrating mass</small>
|
* [[Positron emission tomography|PET scan]]:
** Useful to confirm [[malignant]] involvement of [[Computed tomography|CT]]-detected [[lymphadenopathy]].
** Directly visualizes the [[liver]] surface, the [[peritoneum]], and local [[Lymph node|lymph nodes]] for metastasis
* [[MRI]]:
** Better T [[Cancer staging|staging]] of [[stomach cancer]] (better soft tissue visualization and of individual layers of stomach wall)
* [[Ultrasonography]]
|
* [[Histologically]], there are two major types of [[gastric cancer]]:
** Intestinal type adenocarcinoma
*** Irregular tubular structures
*** Multiple lumens
*** Reduced [[stroma]]
*** [[Intestinal|ntestinal]] [[metaplasia]]
*** [[cellular]] [[pleomorphism]]
***
** Diffuse type [[adenocarcinoma]]
*** Discohesive
*** Secrete [[mucus]]
*** Pools of [[Mucus|mucus/]][[colloid]]
*** [[Signet ring cell]] appearance
|[[Biopsy]] and [[Histopathology|histopathological analysis]]
|}
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 16:22, 17 May 2019


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


Managemnet of Congenital melanocytic Nevi

https://www.uptodate.com/contents/congenital-melanocytic-nevi?search=melanocytic%20nevus%20pathophysiology&sectionRank=1&usage_type=default&anchor=H2&source=machineLearning&selectedTitle=1~44&display_rank=1#H2

MANAGEMENT

Small/medium CMN — Small and medium-sized CMN are managed on an individual basis depending on factors that affect ease of monitoring (eg, color, thickness/topography, and location), clinical history, parents' anxiety, and cosmetic concerns [4]. As an example, a multinodular black CMN on the scalp that is partially obscured by dense hair growth would be difficult to follow clinically, whereas a thin light brown lesion on the face would be relatively simple to observe. However, the latter might be removed for cosmetic reasons, and the former may spontaneously lighten during childhood.

Periodic evaluation of small- and medium-sized CMN is most important after puberty, since the risk of melanoma arising within these lesions during childhood is extremely low. Baseline photographs can be helpful, and dermoscopy represents a useful tool for assessing changes. (See "Dermoscopic evaluation of skin lesions".)

Patients and parents should be instructed to perform skin self-examinations and to bring focal changes in color, border, or topography (eg, a red or black papule, nodule, or crust) to the clinician's attention. (See "Screening and early detection of melanoma in adults and adolescents", section on 'Patient self-examination'.)

Large CMN — Early surgical removal is often desired for large CMN because of their cosmetic and psychosocial sequelae and concern for possible malignant transformation. Complete excision is difficult to achieve; however, resection of bulky and cumbersome portions of large CMN can be beneficial for some patients. Elimination of every nevus cell may be impossible because of the large area of skin affected, the anatomic site (eg, distal extremity, periocular area, genitalia), and involvement of deeper structures (eg, fat, fascia, muscle). Even theoretically complete surgical excision cannot completely eliminate future risk of melanoma, as some melanomas in these patients may develop in the CNS or retroperitoneum. In many cases, close clinical observation with no surgical removal of the lesion is a reasonable choice.

Factors that affect the decision to perform surgery as well as to determine the timing of surgery include the size and location of the large CMN, the technical difficulty of the procedure(s) required, and anesthesia options. When possible, complete removal of large CMN usually necessitates staged excision with the use of tissue expanders and, occasionally, skin grafting [45].

When surgical excision is not feasible, cosmetic benefit may potentially be obtained from procedures such as curettage, dermabrasion, and ablative laser therapy (eg, carbon dioxide or erbium:yttrium aluminum garnet lasers, sometimes combined with pigment-directed lasers). During the neonatal period, there is a lower risk of excessive scarring following such interventions, and nevus cells are more accessible because they are concentrated in the upper dermis [46,47]. Curettage can be performed during the first two weeks of life, taking advantage of a cleavage plane between the upper and mid-dermis exclusive to neonatal skin. However, nevus cells remain in the dermis after all of these procedures, as evidenced by frequent repigmentation as well as several reports of the subsequent development of melanoma in treated areas [48-52]. This underscores the need for lifelong clinical observation.

Regardless of the treatments employed, patients with large CMN (or scars after their excision) should be followed with periodic skin and general physical examinations. Palpation of the nevus and/or scars is essential for detection of focal induration. Histologic evaluation is indicated for firm nodules or indurated areas. Even theoretically complete removal of a large CMN does not eliminate the risk of melanoma, since melanoma of the CNS and other visceral primary sites (eg, the retroperitoneum) may still occur [53].

Proliferative nodules that develop within large CMN during infancy can have histologic features of melanoma yet behave in a benign manner. Techniques such as comparative genomic hybridization can help to distinguish proliferative nodules (usually having no chromosomal aberrations or only numeric changes) from melanoma (typically demonstrating gains/losses of chromosomal fragments) [40]. Mass spectroscopy imaging proteomic analysis may also help differentiate proliferative nodules from melanoma [29]. (See 'Proliferative nodules' above.)

Surveillance for neurocutaneous melanosis — Patients with a large CMN plus multiple (especially >20) satellite nevi or with multiple medium-sized CMN are at risk for NCM and should be followed with serial head circumference measurements, neurologic examinations, and developmental assessments [3,37,39]. This monitoring includes evaluation for signs and symptoms of increased intracranial pressure, mass lesions, and spinal cord compression [3,39].

Gadolinium-enhanced magnetic resonance imaging (MRI) of brain and spine should be performed in any high-risk patient exhibiting neurologic symptoms, and we suggest that asymptomatic high-risk patients also be screened for NCM with gadolinium-enhanced MRI of the brain and spine, ideally during the first six months of life before myelination, which may obscure evidence of melanosis [42]. For very young infants, it may be possible to obtain initial high-quality MRI images without general anesthesia using "feed and wrap" techniques that allow a swaddled infant to sleep during the imaging procedure [54].

Given the poor prognosis, aggressive surgical procedures for CMN removal should be postponed in patients with symptomatic NCM. NCM in an asymptomatic patient does not necessarily preclude skin surgery.




Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 1
Differential Diagnosis 2
Differential Diagnosis 3
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

Table for Differential Diagnosis of Small Intestine Cancer

ABBREVIATIONS:

N/A: Not available, NL: Normal,

References