Small intestine cancer differential diagnosis

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

Overview

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

Differential Diagnosis

Table for Differential Diagnosis of Small Intestine Cancer

ABBREVIATIONS:

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

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

Frequency

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

of

small

intestine[1]

↑↓ + +/- CEA+ Biopsy and histopathological analysis
Carcinoids[2][3][4][5][6] +/- + Infiltrating, ulcerating or fungating lesions in the wall of colon
  • Well-defined single or multiple lesions
  • Round or ovoid in shape
  • Variable in size ranges between 2-5 cm
  • Peripheral nuclear palisading
  • Granular eosinophilic cytoplasm.
Biopsy and histopathological analysis
Intestinal Lymphoma[7][8] - +/- +
  • Weight loss
Non-Hodgkin lymphomas: CD-20 Biopsy and histopathological analysis
Gastrointestinal

Stromal

Tumors (GIST)

[9][10][11]

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

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

syndrome[16]

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

↑↓ + + N/A
Juvenile

Polyposis

Coli

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

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

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

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

Submucosal caseation granulomas

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

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

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

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

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

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

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

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

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

/- + Melena + Biopsy and histopathological analysis

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

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

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

Mild

+ + + +

Dermatitis

Diarrhea

Dementia

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

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

Pathognomonic radiological sign of midgut NET.

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

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

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

Perioidic

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

•Related to defecation

•Associated with a change in stool frequency

•Associated with a change in stool form (appearance)

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

For metastasis

-


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