{"id":749,"date":"2026-07-23T07:55:34","date_gmt":"2026-07-23T07:55:34","guid":{"rendered":"https:\/\/hjs.gr\/?p=749"},"modified":"2026-07-23T11:26:06","modified_gmt":"2026-07-23T11:26:06","slug":"62-3-2-2-2-2-6-2","status":"publish","type":"post","link":"https:\/\/hjs.gr\/?p=749","title":{"rendered":"Small Intestinal Tumours: Histopathological Findings in Enterectomy Specimens. A Ten-Year Experience from a Tertiary Surgical Center in Greece and Review of the Literature"},"content":{"rendered":"

Original Article<\/span><\/p>\n

Hell J Surg. 2025 Apr-Jun;95(5):55\u201367
\ndoi: 10.59869\/25062<\/span><\/p>\n

Panagiotis Theodoropoulos1<\/sup>, Georgios Floros1<\/sup>, Georgios Giannos1<\/sup>, Stavroula Papaeleftheriou1<\/sup>, Vasiliki Tseliou1<\/sup>, Konstantinos Bikas1<\/sup>, Dimitrios Matsagkos1<\/sup>, Athina Chrysikopoulou1<\/sup>, Ioannis Tsiampas1<\/sup>, Teresa Bidetti1<\/sup>, Aikaterini Starka1<\/sup>, Stavroula Katsimente1<\/sup>, Marietta Lavrentaki1<\/sup>, Georgios Taibiris1<\/sup>, Aggeliki Koltsida1<\/sup>, Nestoras Georgakakos1<\/sup>, Nikolaos Chatziathanasiou1<\/sup>, Achilleas Koulaksidis1<\/sup>, Evangelos Velaoras1<\/sup>, Panagiotis Psychas1<\/sup>, Filalithis Mamakis1<\/sup>, Konstantina Sitouni1<\/sup>, Nikolaos Kochilas1<\/sup>, Konstantinos Sfakianakis1<\/sup>, Dimitrios Chasiotis1<\/sup>, Panagiotis Prigkouris1<\/sup>, Georgios Papadopoulos1<\/sup>, Charalambos Kokkinos1<\/sup>, Dimitrios Manganas1<\/sup>, Konstantinos Toutouzas5<\/sup>, Christos Kontovounisios1,2,3,4<\/sup><\/p>\n

1<\/sup>2nd<\/sup> Surgical Department Evaggelismos Athens General Hospital, Athens, Greece
\n2<\/sup>Department of Surgery and Cancer, Imperial College London, London, UK
\n3<\/sup>Department of General Surgery, Chelsea and Westminster Hospital, London, UK
\n4<\/sup>Department of Surgery, The Royal Marsden Hospital, London, UK
\n5<\/sup>First Department of Propaedeutic Surgery, \u201cHippokration\u201d General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece<\/p>\n

\"\"<\/a><\/p>\n

<\/p>\n

\n

Correspondence:\u00a0 <\/em>Theodoropoulos Panagiotis, MD, MSc, 2nd Surgical Department, Evaggelismos General Hospital, 45-47 Ipsilantou St. 106 76 Athens, Greece. Tel.: +30 6938 28 97 34, e-mail: pantheo335@gmail.com<\/a><\/p>\n

\n
Abstract<\/strong><\/h5>\n

Introduction: <\/strong>Small intestine tumours represent ~3% of gastrointestinal neoplasms and 0.6% of all cancers, despite the extensive intestinal surface. Diagnosis is often delayed (up to two years for malignant tumours) due to non-specific symptoms, necessitating heightened clinical awareness and improved diagnostics.<\/p>\n

Purpose: <\/strong>This study investigated the prevalence, characteristics, and clinical presentation of small intestine tumours in patients undergoing enterectomy.<\/p>\n

Methodology: <\/strong>A retrospective study was conducted at the Surgical Department of a tertiary center in Athens, including patients who underwent primarily emergency enterectomy during the period 2014\u20132024. All relevant medical records and pathology reports were evaluated, and statistical analysis was performed using IBM SPSS Statistics Version 26. A literature review (2000\u20132025) was also conducted.<\/p>\n

Results: <\/strong>Among the participants (N=62), 37.1% underwent enterectomy for obstruction and 29% for incidental tumor detection. The mean resection length and mean tumour size were 30.1 and 5.7 cm, respectively. Malignancy was detected in 79% of cases, with lymph node metastases in 25% and pT4 staging in 42.9%. Histological types included gastrointestinal stromal tumours (21%), metastatic tumours (17.7%), neuroendocrine tumours (14.5%), lymphomas (9.7%), and adenocarcinomas (9.7%). R0 resection was achieved in 88.1% of cases. Procedures were mostly emergency-based in patients with advanced disease at diagnosis.<\/p>\n

Conclusions: <\/strong>Small intestine tumours are rare but clinically significant, often presenting late. Our findings align with the current literature, confirming the predominance of malignancy and emergency presentations. Geographic and histological variations may reflect genetic and environmental influences. Early diagnosis and tailored surgical management could improve outcomes.<\/p>\n

Key Words:<\/strong><\/em> Small intestine, neoplasm, tumour, enterectomy, histopathology<\/p>\n

\n

Submission: 07.08.2025, Acceptance: 20.02.2026<\/span><\/p>\n

\n
Introduction<\/strong><\/h5>\n

Small bowel neoplasms are thought to account for as few as 4 to 13 hospital admissions per 100,000 patients [1]. They represent approximately 0.6% of all new cancer cases and 3% of all gastrointestinal tumours in the United States [2], with a rising incidence, particularly for neuroendocrine tumours. Although the small intestine comprises over 90% of the gastrointestinal surface [3], diagnosing small bowel tumours (SBTs) is challenging mainly due to their non-specific symptoms.<\/p>\n

While most patients – especially in cases of malignancy- are asymptomatic, SBTs often present with intermittent abdominal pain, nausea, vomiting, anaemia, and weight loss [4]. Complications may include gastrointestinal bleeding, bowel obstruction, perforation, and jaundice, with larger tumours more likely to cause obstructive symptoms. Due to the small bowel\u2019s ability to compensate, even advanced lesions may present subtly, as incomplete ileus involving two-thirds of the lumen [5].<\/p>\n

Histological types also vary according to tumour location: adenocarcinomas are more frequently found in the duodenum and jejunum, whereas neuroendocrine tumours are predominantly located in the ileum [3].<\/p>\n

Regarding the molecular pathogenesis of SBTs, data remain scarce. However, KRAS mutations\u2014commonly observed in colorectal cancer\u2014are frequently detected in small bowel adenocarcinomas [6,7]. Allelic losses involving tumour suppressor genes have been reported, particularly at 5q (APC gene), 17q (p53), and 18q (DCC and SMAD4) chromosomal sites [8]. Approximately 15% of small bowel adenocarcinomas are also microsatellite instability-high (MSI-H) cancers, typically due to inactivation of DNA mismatch repair genes [9]. MSI-H status is often seen in coeliac disease-associated tumours, resulting from abnormal methylation of CpG \u00a0\u00a0\u00a0\u00a0\u00a0(cytosine-guanine) islands [10]. Furthermore, gene expression studies suggest that common mediators of oncogenic pathways such as the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor (VEGF) correlate with a significant proportion of small intestinal tumours [11].<\/p>\n

Although literature reports regarding small bowel neoplasms are expanding, published data on broader, postoperative cohorts from Greece remain limited. The aim of this study was to present a ten-year retrospective case series of patients who underwent enterectomy for small bowel tumours at a tertiary university hospital and to review current literature on their epidemiology, pathology, and clinical behaviour. In addition, the study aimed to evaluate the stage of the tumour at the time of diagnosis.<\/p>\n

Materials and Methods<\/strong><\/h5>\n

Study Design and Setting<\/strong><\/p>\n

This is a single-centre, retrospective, observational study conducted at the Surgical Department of a tertiary university hospital in Athens, Greece. The study covered a ten-year period, from January 2014 to August 2024, and aimed to investigate the prevalence, histopathological characteristics, and clinical features of patients undergoing enterectomy for small bowel tumours. In addition, a systematic review of the literature was conducted following PRISMA guidelines in order to assess our findings.<\/p>\n

Inclusion and Exclusion Criteria of the Study<\/strong><\/p>\n

Patients of any gender or age who underwent segmental small bowel resection (enterectomy) for a histologically confirmed primary or metastatic neoplastic lesion of the small intestine during the study period were included. Only complete enterectomies either performed electively or, more commonly, on an emergency basis were included in our analysis.<\/p>\n

Patients who underwent small bowel resection combined with resection of another organ for a different primary pathology or patients whose enterectomy did not involve a tumour or tumourous lesion of the small intestine, including operations for ischaemic or inflammatory bowel conditions were excluded from the cohort. The latter included cases such as ischaemic necrosis, Crohn\u2019s disease, non-neoplastic perforation, adhesions, mesh erosion, or local extension of extraintestinal malignancies.<\/p>\n

Patient Sample and Data Collection<\/strong><\/p>\n

During the study period, a total of 192 enterectomies were performed by twelve different general surgeons at the Surgical Department. Of these, 130 cases were excluded for not meeting the inclusion criteria, resulting in a final sample of 62 patients with histologically confirmed small bowel tumours or tumourous lesions.<\/p>\n

A structured review of medical records, operative reports, and pathology files was conducted to extract the following variables:<\/p>\n