Small bowel adenocarcinoma of the jejunum: a case report and literature review

Unusual Location of a Rare Complication of Celiac Disease

Introduction: Celiac disease has been associated with gastrointestinal malignancies, most commonly gastrointestinal lymphoma. Nevertheless, rarer malignancies have also been reported, such as small bowel adenocarcinoma, mainly located in the duodenum or jejunum. Case Presentation: We report a case of a female patient with celiac disease with poor adherence to a gluten-free diet who presented with small bowel obstruction due to a primary ileal adenocarcinoma. The patient remains asymptomatic, adherent to the gluten-free diet, and without clinical, biochemical, or imaging evidence of cancer recurrence. Discussion/Conclusion: This case should raise awareness about the importance of the gluten-free diet and the early diagnosis and appropriate management of rare small bowel malignant complications of celiac disease, namely, adenocarcinoma.

Adenocarcinoma in the Jejunum Presenting as Acute Abdomen and Melena in an Otherwise Healthy Patient: A Case Report

A jejunal adenocarcinoma is a rare form of cancer that is difficult to diagnose due to its vague and non-specific symptoms, often leading to delayed treatment and poor outcomes. In this case, we report a 43-year-old male who presented with acute abdominal pain, weight loss, and melena. A CT scan revealed a mass in the small intestine, and subsequent exploratory laparotomy confirmed the presence of a tumor, which was surgically excised. Histopathological analysis confirmed jejunal adenocarcinoma with positive CDX2 staining, ruling out other adenocarcinoma subtypes. This case underscores the importance of including jejunal adenocarcinoma in differential diagnoses of acute abdomen and highlights the critical role of early surgical intervention in improving patient outcomes.

Small bowel adenocarcinoma of the jejunum detected by double contrast enhanced ultrasound: a case report of a novel ultrasound modality

Background

Small Bowel Adenocarcinoma (SBA) is rare, occult and life-threatening malignancy in digestive system. Given low incidence and nonspecific symptoms, SBA is frequently detected in later stages. Double contrast enhanced ultrasound (DCEUS) is an innovative imaging technique applied to visualize the gastrointestinal tract, merging intravenous contrast-enhanced ultrasound with oral contrast-enhanced ultrasound. In this case, DCEUS was utilized and successfully detected an SBA of the jejunum.

Case presentation

A Chinese woman, aged 64, sought consultation in the gastroenterology department at our hospital, reporting symptoms of abdominal pain. Three months before entering the hospital, she underwent gastroscopy and colonoscopy which suggested chronic gastritis, and she was treated with oral drugs. However, her symptoms were not relieved, and even worsened. To further investigate, DCEUS was performed. The oral contrast agent dilated the luminal space of the upper gastrointestinal tract, resolving the hindrance caused by gas in the gastrointestinal tract and creating an acoustic window for scanning. Through this acoustic window, oral agent contrast-enhanced ultrasound (OA-CEUS) revealed a localized thickening of jejunal intestinal wall measuring 4x3 cm. Following intravenous injection of ultrasound contrast agent, the jejunal lesion exhibited faster enhancement and heterogeneous hyper-enhancement. Finally, the patient underwent jejunal tumor resection. Pathological examination revealed a jejunal adenocarcinoma.

Conclusion

The timely diagnosis of SBA can be challenging. DCEUS may have the potential to contribute to diagnosis and detailed evaluation of SBA, particularly in cases involving jejunum. Further researches are needed to fully explore the benefits of DCEUS in the standard diagnostic approach for small bowel diseases.

An Unexpected Challenge: Marked Small Bowel Obstruction Arising From a Poorly Differentiated Metastatic Mucinous Adenocarcinoma of the Distal Ileum in a Risk-Free Healthy Patient

Adenocarcinoma, while constituting the predominant variant among small bowel cancers, is a component of the broader category of primary small bowel malignancies, which are notably infrequent in occurrence. The diagnosis of such malignancies is often markedly delayed, a consequence of their insidious onset and the nonspecific nature of the abdominal symptoms presented. A 69-year-old Caucasian male presented to the emergency department manifesting acute, sharp, and colicky abdominal pain accompanied by a single episode of vomiting, all developing over one day. His medical history was notable for gastroesophageal reflux disease (GERD) and regionally confined prostate adenocarcinoma, which was under meticulous surveillance by the urological team. The patient's lifestyle was characterized by abstention from alcohol and tobacco, adherence to a nutritious diet, and a commitment to regular physical activity. Subsequent examination and surgical excision of an abnormal mass, as delineated on computed tomography (CT), culminated in the diagnosis of a stage IV, poorly differentiated adenocarcinoma. We have reported this case to spark research regarding early diagnostic techniques for small bowel adenocarcinoma (SBA). In this case, a healthy individual presented with vague abdominal pain and a single episode of vomiting. Diagnosis required the surgical resection of the tumor, where metastasis was also visualized. Due to the rare nature of SBA, we believe different diagnostic measures and adjuvant therapy should be researched for earlier diagnosis and subsequently better patient outcomes.

Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review

Small bowel tumors are relatively rare, representing only around 5% of all gastrointestinal neoplasms, with a progressively increasing incidence. Currently, there are no established guidelines for diagnostic approaches, screening procedures, or management strategies for small bowel tumors. We present here the case of a patient with a rare type of metastatic tumor of the small bowel originating from primary lung adenocarcinoma who presented with abdominal pain, severe iron-deficiency anemia, and melena. The initial investigations, gastroscopy and colonoscopy, failed to identify the bleeding source. The obscure bleeding source and diagnosis were achieved through power motorized spiral enteroscopy (MSE), which allowed the visualization and biopsy of the tumor. Histopathological examination established the presence of a poorly differentiated non-mucinous adenocarcinoma originating from the lung. This case is reported to provide evidence of the efficiency of MSE in the diagnosis of small bowel tumors, with the method providing higher insertion depth in a reduced amount of time.

Small Intestinal Adenocarcinoma Arising at the Anastomotic Site after Kasai Operation for Biliary Atresia: A Case Report and Literature Review

Biliary atresia is an obliterative cholangiopathy of unknown etiology. Hepatic portoenterostomy, in which obliterated extrahepatic bile ducts are resected and bile flow is restored, known as Kasai operation, is performed within 3 months after birth. While this operation enhances long-term survival of patients, the occurrence of primary malignant hepatic tumors has been increasing. We report a case of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation. A 49-year-old man, who underwent Kasai operation for biliary atresia when he was 2 months old, experienced rapidly progressive jaundice and liver dysfunction. Deceased-donor liver transplantation was performed for liver failure. Macroscopically, there was a white-yellow tumor located at the anastomotic site of hepatic portoenterostomy of the resected liver. Pathological examination revealed a well-differentiated adenocarcinoma with some Paneth cells in the neoplastic lesion. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) but positive for cytokeratin 20 (CK20) and a homeobox domain-containing transcription factor (CDX2). Mucin expression in tumor cells was negative for mucin 1 (MUC1) and mucin 6 (MUC6) and positive for mucin 2 (MUC2) and mucin 5AC (MUC5AC). The pathological diagnosis was small intestinal adenocarcinoma originating from the jejunum. The patient was discharged 48 days after the operation. The patient had not experienced recurrence at 10 months after the operation. This is the first report of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation for biliary atresia. Special care should be taken for the patients after Kasai operation with acute progressive jaundice and liver dysfunction because there is a possibility of malignancy in their native liver.

Small bowel adenocarcinoma in neoterminal ileum in setting of stricturing Crohn’s disease: A case report and review of literature

BACKGROUND

Small bowel adenocarcinomas (SBA) are rare malignancies with exceedingly low survival rates, with different presentation in Crohn’s disease (CD). CD-induced SBA poses diagnostic challenges given overlapping presentation with stricturing CD and lack of diagnostics for early detection. Moreover, guidance is lacking on the impact of recently approved therapeutics in CD on SBA management. Here, we aim to highlight the future of CD-induced SBA management and discuss the potential merit of balloon enteroscopy and genetic testing for earlier detection.

CASE SUMMARY

We report the case of a 60-year-old female with longstanding Crohn’s ileitis, presenting with acute obstructive symptoms attributed to stricturing phenotype. Her obstructive symptoms were refractory to intravenous (IV) steroids, with further investigation via computed tomography enterography not providing additional diagnostic yield. Ultimately, surgical resection revealed SBA in the neoterminal ileum, with oncologic therapy plan created. However, this therapy plan could not be initiated due to continued obstructive symptoms attributed to active CD. Ultimately, infused biologic therapy was initiated, but her obstructive symptoms continued to remain dependent on IV corticosteroids. Review of diagnostics by a multidisciplinary care team suggested metastatic disease in the peritoneum, lending to a shift in the goals of care to comfort.

CONCLUSION

With the diagnostic and therapeutic challenges of concurrent SBA and CD, multidisciplinary care and algorithmic management can optimize outcomes.

Primary Adenocarcinoma of the Jejunum: Case Report of Rare Small Bowel Neoplasm

Small bowel adenocarcinoma (SBA) is rare cancer that accounts for less than 2% of all gastrointestinal tract cancers. Usually, the clinical presentation is unspecific, and a patient might complain of nausea, vomiting, abdominal pain, small bowel obstruction, and small bowel bleeding. Because of these unspecific symptoms, the patient might be diagnosed late, from six to ten months, which affects the prognosis. This study contains a case report of a 38-year female with SBA in the jejunum, with unspecific symptoms. She had a history of recurrent admissions due to acute pancreatitis, acute kidney injury, and hyponatremia caused by dehydration. The patient was diagnosed six months after the first symptoms of nausea and vomiting started. The patient underwent exploratory laparotomy for a jejunal stricture mass, and a lymph node was resected. The course after surgery was smooth, and the patient was discharged home on the fourth-day post-surgery. In conclusion, the symptoms of SBA are unspecific and cannot be diagnosed without complete medical histories and lab examinations, making diagnosing SBA challenging.

Jejunal Adenocarcinoma: A Rare Cause of Small Bowel Obstruction

Jejunal adenocarcinoma (JA) is both a rare type of gastrointestinal malignancy and an uncommon cause of small bowel obstruction (SBO). It typically presents with vague symptoms, such as abdominal pain, nausea, vomiting, and, in some cases, weight loss. Due to this vague presentation as well as lack of definitive imaging techniques, diagnosis tends to be delayed and patients typically present at later stages. We present a case of a patient who presented with acute onset abdominal pain. Imaging revealed the presence of an SBO with the presence of a suspicious small bowel stricture. He eventually underwent upper endoscopy to find the mass, with subsequent biopsy indicating JA. We hope to bring greater awareness to jejunal carcinoma as a potent cause of SBO in adults.

Small bowel adenocarcinoma a rare cause of upper gastrointestinal obstruction (a case report and literature review)

INTRODUCTION

Small bowel adenocarcinoma is a rare but increasing disease. It poses both a diagnostic and therapeutic challange. Small bowel adenocarcinoma is a rare cause of small bowel obstruction. We present the case of a patient admitted to our emergency department for a bowel obstruction due to a mass of the jejunum and whose anatomopathological diagnosis was adenocarcinoma.

PATIENT AND METHOD

It is a 62-year-old woman with unparticular history, admitted to the emergency of visceral surgery of Ibn Rochd University Hospital for subocclusive syndrome evolving for one year, with early postprandial vomiting becoming stenosing two months ago. The abdominal CT scan showed thickening jejunal wall of 46 mm with upstream distension. She underwent a segmental bowel resection of 50 cm of small bowel with 3 cm stenotic mass located at 40 cm from the duodenojejunal angle. The pathophysiology revealed an invasive liberkhunian adenocarcinoma. The postoperative follow-up was simple, feeding allowed at D4 with discharge allowed at D6 and functional improvement at the time of the control performed three months after the intervention.

DISCUSSION

Small bowel adenocarcinoma is rare and represents only 1-3% of all gastrointestinal cancers. The incidence of SBA is 24 to 66 times lower than that of colorectal cancer (CRC). Due to its non-specific clinical manifestation and less accessible location, SBA is diagnosed at an advanced stage, and often at specimen analysis. The treatment is resection and the overall survival is increased when diagnostic is early made.

CONCLUSION

Small bowel adenocarcinoma is a rare but increasing cause of gastrointestinal malignancy, being both a diagnostic and therapeutic challenge. In front of the occlusive syndrome of small bowel appearance, adenocarcinoma must be ruled out.

Sister Mary Joseph's nodule revealing a jejunal adenocarcinoma: A case report

INTRODUCTION AND IMPORTANCE

Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule.

CASE PRESENTATION

A 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive.

CLINICAL DISCUSSION

The presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites.

CONCLUSION

Practicians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival.

Adenocarcinoma of the jejunum: management of a rare small bowel neoplasm

Small bowel adenocarcinomas are rare malignant tumors that account for less than 2% of gastrointestinal tumors. Despite a thorough history, physical examination and complete diagnostic workup, the correct diagnosis of small intestinal neoplasm has been established preoperatively in only 50% of cases. Due to the rarity of this disease, there are very few established guidelines for its management and it has been primarily treated the same way as colorectal cancer, even though patient’s prognostic outcome is worse. With new guidelines in 2020, we review a clinical case of a 64-year-old male patient with adenocarcinoma of the jejunum treated in our institution.

Beyond bevacizumab: a review of targeted agents in metastatic small bowel adenocarcinoma

Small bowel cancers are rare tumors with an incidence 50-100-fold less than colorectal cancer. These tumors carry a poor prognosis. Owing to its rarity, treatment of this disease, particularly in its advanced stages, has not been optimized and is derived mainly from treatment regimens for colorectal cancer. Based on recent studies bevacizumab, an antibody directed against vascular endothelial growth factor and used in the management of metastatic CRC, has been added to treatment guidelines for metastatic small bowel adenocarcinoma. We investigate in this review the evidence behind other targeted treatments that may be beneficial in the treatment of metastatic small bowel adenocarcinoma. These are agents against EGFR, VEGFR-2, HER2, and NTRK as well as immune checkpoint inhibitors. The last class of drugs appears to hold the greatest promise based on the preponderance of evidence supporting its use. However, overall data remains sparse. Results of studies currently underway will be valuable in shedding more light on the management of this aggressive cancer.

Rare presentation of small bowel adenocarcinoma with neuroendocrine differentiation in the jejunum: A case report and summary of diagnostic and management options

Cancer of the small bowel (SB) is rare. The most common SB malignancy is neuroendocrine, followed by adenocarcinoma. SB adenocarcinoma with overlapping neuroendocrine differentiation (NED) is very uncommon. The present case report discusses the case of a young African American female who presented with high-grade SB perforation and underwent urgent surgical repair. Histology of the tumor revealed jejunal adenocarcinoma with NED. To the best of our knowledge, this type of tumor has not yet been reported in the jejunum. Referring patients that present with insidious and nonspecific abdominal discomfort for imaging studies that are more sensitive to the SB could potentially identify tumors earlier, prevent the development of emergent gastrointestinal complications and offer a chance for cure. An overview of diagnostic tools for SB evaluation was provided.

A viral map of gastrointestinal cancers

Cancers of the gastrointestinal tract (GIT) are expected to account for approximately 20% of all cancers in 2017. Apart from their high incidence, GIT cancers show high mortality rates, placing these malignancies among the most prominent public health issues of our time. Cancers of the GIT are the result of a complex interplay between host genetic factors and environmental factors and frequently arise in the context of a continued active inflammatory response. Several tumor viruses are able to elicit such chronic inflammatory responses. In fact, several viruses have an impact on GIT tumor initiation and progression, as well as on patients' response to therapy and prognosis, through direct and indirect mechanisms. In this review, we have gathered information on different viruses' rates of infection, viral-driven specific carcinogenesis mechanisms and viral-related impact on the prognosis of cancers of the GIT (specifically in organs that have an interface with the environment - esophagus, stomach, intestines and anus). Overall, while some viral infections show a strong causal relation with specific gastrointestinal cancers, these represent a relatively small fraction of GIT malignancies. Other types of cancer, like Esophageal Squamous Cell Carcinoma, require further studies to confirm the carcinogenic role of some viral agents.

The burden of rare cancers in the United States

There are limited published data on the burden of rare cancers in the United States. By using data from the North American Association of Central Cancer Registries and the Surveillance, Epidemiology, and End Results program, the authors provide information on incidence rates, stage at diagnosis, and survival for more than 100 rare cancers (defined as an incidence of fewer than 6 cases per 100,000 individuals per year) in the United States. Overall, approximately 20% of patients with cancer in the United States are diagnosed with a rare cancer. Rare cancers make up a larger proportion of cancers diagnosed in Hispanic (24%) and Asian/Pacific Islander (22%) patients compared with non-Hispanic blacks (20%) and non-Hispanic whites (19%). More than two-thirds (71%) of cancers occurring in children and adolescents are rare cancers compared with less than 20% of cancers diagnosed in patients aged 65 years and older. Among solid tumors, 59% of rare cancers are diagnosed at regional or distant stages compared with 45% of common cancers. In part because of this stage distribution, 5-year relative survival is poorer for patients with a rare cancer compared with those diagnosed with a common cancer among both males (55% vs 75%) and females (60% vs 74%). However, 5-year relative survival is substantially higher for children and adolescents diagnosed with a rare cancer (82%) than for adults (46% for ages 65-79 years). Continued efforts are needed to develop interventions for prevention, early detection, and treatment to reduce the burden of rare cancers. Such discoveries can often advance knowledge for all cancers. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:261-272. © 2017 American Cancer Society.