TUMEURS GRELIQUES QUELLES DIVERSITES HISTOLOGIQUE ?

Primary malignant tumors of the small intestine are rare tumors. They represent 1 to 5% of all tumors of the digestive tract. The multiplicity of histological types associated with the rarity of these tumors. The small intestine is considered as a clinically silent area and this results in a delay in diagnosis and therefore a non-optimal treatment and a severe prognosis. The objective of our work is to report the epidemiological, diagnostic characteristics of patients with small bowel tumors as well as their endoscopic and histological aspects collected in the hepato-gastroenterology department of the Hassan II University Hospital of Fez. Patient and method:We retrospectively analyzed the clinical records of 8 patients with the diagnosis of small bowel malignancies admitted to our training over a period of 11 years. Results: The average age of our patients was 42 years,The sex ratio M/F was 3, the tumor was revealed by an upper GI hemorrhage in 50%(N: 4) followed by abdominal pain in 37%(N: 3) and koening syndrome in 12%(N: 1). The CT scan showed a parietal thickening in all the cases, of which 1 case showed a mass. Double balloon enteroscopy was performed in 8 patients (100%), the endoscopic aspect revealed an ulcerating process in 75% (N: 6), a tumor of sub-mucosal appearance in 12% (N: 1). An ulcerated jejunal stenosis that could not be crossed in 12% (N:1).the biopsy by enteroscopy had allowed to make the diagnosis in 100% of the cases (N: 8).the histological examination had objectified: lymphomas in 37%( N: 3), GIST in 25% cases (N: 2), adenocarcinomas in 25% cases (N: 2) and neuroendocrine tumor in 12% (N: 1). The evolution was unfavorable in all our cases with a median survival rate of 10 months. Conclusion: Small bowel tumors are rare but interesting because of their great histological diversity. The diagnosis is difficult because of the non-specific symptomatology, In our study the couple imaging -enteroscopy had allowed to establish the diagnosis in all our cases, with predominance of the anatomopathological aspect of lymphoma in 37% of the cases.