{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:07:02Z","timestamp":1789470422272,"version":"build-2803163510"},"reference-count":65,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy of Craiova, Romania","award":["86\/0842\/3\/07"],"award-info":[{"award-number":["86\/0842\/3\/07"]}]},{"award":["86\/0842\/3\/07"],"award-info":[{"award-number":["86\/0842\/3\/07"]}],"id":[{"id":"https:\/\/ror.org\/031d5vw30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Small-bowel tumors are a heterogeneous and relatively uncommon group of neoplasms whose definitive diagnosis frequently cannot be established before surgery. Their common jejunal or ileal location limits conventional endoscopic access, and stenosing, predominantly extraluminal, or complicated presentations may render preoperative biopsy impossible. In such situations, the surgeon may have to decide the extent of resection and the need for lymphadenectomy without a histological diagnosis, even though the optimal strategy differs substantially among adenocarcinoma, gastrointestinal stromal tumor (GIST), small-bowel neuroendocrine tumor (SBNET), lymphoma, and desmoid-type fibromatosis. This narrative review integrates clinical presentation, preoperative computed tomography (CT) features, and intraoperative macroscopic findings to support a presumptive diagnosis and guide surgical decision-making when histology is unavailable. The evidence was synthesized along the decision pathway preoperative imaging \u2192 diagnostic suspicion \u2192 intraoperative appearance \u2192 surgical decision \u2192 definitive histopathology. Histology-specific CT associations are relatively well documented, whereas the independent ability of intraoperative macroscopic impression to predict histology remains limited. We propose a pragmatic, histology-oriented decision framework that prioritizes clinical urgency, disease extent and resectability, the feasibility of preoperative tissue sampling, and the potential impact of histology on the surgical procedure. The framework is conceptual and requires prospective validation; its aim is not to replace histopathological examination but to reduce the risk of both oncologically inadequate and unnecessarily extensive resections.<\/jats:p>","DOI":"10.3390\/jcm15187106","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"7106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Histology Is Unknown: Surgical Decision-Making in Small Bowel Tumors\u2014From Preoperative Imaging to Intraoperative Findings: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Cosmin Vasile","family":"Obleaga","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-7683","authenticated-orcid":false,"given":"Sergiu Marian","family":"Cazacu","sequence":"additional","affiliation":[{"name":"Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecil Sorin","family":"Mirea","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu","family":"Mesina","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Marin","family":"Pascu","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgica Costinel","family":"T\u00e2rtea","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela-Marinela","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0673-4120","authenticated-orcid":false,"given":"Dragos-Florin","family":"Vasile","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian Mihai","family":"Florescu","sequence":"additional","affiliation":[{"name":"Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion","family":"Vasile","sequence":"additional","affiliation":[{"name":"Dolj Section, Romanian Academy of Medical Sciences, Craiova Branch, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristin Constantin","family":"Vere","sequence":"additional","affiliation":[{"name":"Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cazacu, S.M., C\u00e2r\u021bu, D., Popescu, M., Streba, L., Ungureanu, B.S., Iov\u0103nescu, V.F., Cimpoeru, M., Mirea, C.S., Surlin, V.M., and Mogoant\u0103, S. 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