Clinicopathologic datas on fourteen patients with primary malignant tumor of the small inte-stine covering a twelve year period from April, 1963 to October, 1974 at the (department of surgery of Seoul National University Hospital are presented and the literature is reviewed.
Males outnumbered females by about 1.3 to 1 (eight males and six females) with an age range of 15-66 years and the average age who had the lesion in the jejunum was 50 years and in the ileum was 34 years. The average age who had adenocarcinoma was 48 years and malignant lymphoma was 32 years.
Malignant lymphoma accounted for 9 cases of which one located in the jejunum and 8 in the ileum and adenocarcinoma formed 4 cases of which 2 in the jejunum and 2 in the ileum and leiomyosarcoma comprised 1 case which located in the jejunum. All of the ten primary malignant neoplasms of the ileum were located within 120 cm from the ileocecal valve and in the 7 cases the primary malignant neoplasms of the ileum were located within 15 cm from the ileocecal valve.
The Clinical manifestations caused by the primary malignant tumors of the small intestine in the 12 cases were abdominal pain (12 cases), palpable abdominal mass (8 cases) vomiting (7 cases), bowel dysfunction such as diarrhea or constipation (6 cases), tenderness (5 cases), weight loss (4 cases), abdominal distension (3 cases), anorexia (3 cases) and anemia (2 cases). The initial symptom was abdominal pain in 11 cases and melena in one case and the abdominal mass was, palpated about one to twelve months after the onset of initial symptom.
The duration of symptoms before seeking our hospital for operation varied between one to ten months with the average duration of 5 months and 8 patients were admitted about 1 to 3 months after the onset of initial symptom.
Among the ten patients with malignancies in the ileum, four were operated upon with a mis-diagnosis as a appendicitis prior to admission to our hospital and another one was operated at our hospital under the impression of chronic appendicitis which revealed exudative appendicitis with Hodgkin´s disease at the terminal ileum.
One patient who had leiomyosarcoma in the jejunum presented, with strangulation and three
Patients who had polypoid malignant lymphoma in the distal ileum presented with intussusception. Eleven cases out of fourteen showed metastatic invasion or spread to surrounding lymphnodes or organs at laparotomy.-
Right hemicolectomy was performed in 6 patients who had malignant lymphoma in the terminal ileum and in another 8´ cases segmental resection was performed.
Among the 66 cases with primary malignant tumors of the small intestine which were reported on the literatures in Korea Until October, 1974 (Table 3), malignant lymphoma comprised 40 cases (60.5%), adenocarcinoma accounted for 15 cases (23%) and leiomyosarcoma formed 7 cases (10, 5%). Carcinoid tumor comprised only 3 cases (4.5%).
All measures should be taken at the start of treatment to eradicate the disease. In the cases of malignant lymphoma use of wide-field abdominal irradiation and adding systemic combined chemotheraphy early in the course of the disease must be considered.
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