Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Small Bowel Tumors Spermatocele 1359

■Lymphomas – optimal treatments have not been defined due to large

variety and rarity of these tumors; treatments include (alone or in

combination): antibiotics, surgical resection, chemotherapy, radia-

tion therapy, nutritional support, bone marrow transplantation

■Sarcomas – treatment of choice is surgical resection with wide

excision; palliative resection or bypass for extensive disease; min-

imal or no benefit to adjuvant chemotherapy or radiotherapy

■Metastatic tumors – palliative treatment with surgical resection or

intestinal bypass

follow-up

■Continued clinical and/or endoscopic surveillance for indetermi-

nate periods indicated due to aggressive or indolent nature of these

tumors

complications and prognosis

Complications

■Endoscopic therapy

➣bleeding, perforation, cardiopulmonary

■Surgery

➣bleeding, infections, obstruction, death

■Chemotherapy

➣variable by chemotherapeutic agent

■Radiation therapy

➣fatigue, nausea, nephritis; bleeding and perforation rare

Prognosis

■Most favorable for surgically or endoscopically resected early carci-

noids, sarcomas, lymphomas and benign neoplasms

■Prognosis of malignant bowel tumors is determined by resectability,

status of surgical margins, histologic grade, lymph node involve-

ment, and metastases

■Poor prognosis for late presentations of adenocarcinomas, high

grade smooth muscle tumors and cancers metastatic to small bowel

SPERMATOCELE

ARTHUR I. SAGALOWSKY, MD

history & physical

■painless cystic mass containing sperm

■usually in head of epididymis

■asymptomatic unless large