Endoscopic characteristics of small intestinal malignant tumors observed by balloon-assisted enteroscopy

Meckel's diverticulum: A rare and missed cause of adult gastrointestinal bleed

Our report details a rare case of gastrointestinal bleeding in an adult male from Meckel's diverticulum. Diagnostic tests were negative except for technetium-99m pertechnetate scintigraphy with SPECT/CT, highlighting importance of diverse modalities.

Small intestinal mucosa-associated lymphoid tissue lymphoma with deep ulcer and severe stenosis: A case report

INTRODUCTION

Although eosinophils are commonly present on the mucosa of the gastrointestinal tract, various pathological conditions may cause a secondary increase in eosinophil quantity.

PRESENTATION OF CASE

A 78-year-old man was referred to our hospital due to abdominal pain. Examinations revealed an ulcerative lesion with white moss in the terminal ileum and severe stenosis on the oral and anal sides. Tissue biopsies obtained from the ulcer margins showed a predominance of chronic inflammatory cells and abundant eosinophils in addition to lymphocytes/plasma cells. Secondary causes of tissue eosinophilia were suspected; however, the diagnosis could not be confirmed because of atypical endoscopic findings. Partial resection of the ileum was performed for therapeutic and diagnostic purposes. Histopathology of the resected specimen identified a lymphoepithelial lesion with an invasive tendency. While CD20 staining was positive, MUM-1 and Bcl-6 staining were negative. Based on these findings, the lesion was diagnosed as a small intestinal mucosa-associated lymphoid tissue lymphoma (Lugano staging, stage II₁).

DISCUSSION

Hypereosinophilia in this lesion was suggested to be secondary to chronic inflammation due to tumor growth or impaired transit.

CONCLUSION

There is a type of gastrointestinal MALT lymphoma showing an invasive tendency. In such cases, it may demonstrate atypical findings and hypereosinophilia in gastrointestinal tissues.

Adenocarcinoma of the Jejunum: A Case Report and Literature Review

Small intestine cancers account for 1-3% of all gastrointestinal tumors, with only 11-25% of these tumors located in the jejunum. We report the case of a woman who has been experiencing abdominal pain for the last six months, accompanied by nausea, vomiting and appearance of dark-colored stools, who has lost 20 kg in weight during the last few months. Laboratory findings indicated anemia and no significant changes were identified in the abdominal ultrasound. By endoscopic examination of the stomach and duodenum and by colonoscopy, no infiltrations were found. Serum markers were elevated and CT scan of the abdomen showed thickening of a part of the jejunum wall with swollen lymph nodes in the mesentery, along the inferior vena cava and abdominal aorta, in the retroperitoneal space. By opening the abdominal cavity, we observed an infiltration in the initial part of the jejunum with an infiltration of the entire wall. Resection of the jejunum with related mesenthery, vessels and lymph nodes therein was performed. Histopathology revealed an invasive adenocarcinoma of the small intestine, with an invasion of all layers of the wall and mesentery. Adjuvant FOLFOX chemotherapy was introduced, 6 cycles in total, and following each cycle, tumor markers have been constantly decreasing. No relapse has been identified after nine months. Due to often deep position in the small intestine, atypical symptomatology and lack of screening, an early diagnosis is difficult. Surgical resection of the affected small intestine followed by an additional chemotherapy is the optimal treatment strategy.

Recurrent Enteritis Associated with Epstein-Barr Virus-positive CD4+ T-cell Lymphoproliferative Disorder after Autologous Stem Cell Transplantation

We encountered a patient with multiple myeloma treated with autologous hematopoietic stem cell transplantation (HSCT) who developed repeated episodes of enteritis but regressed spontaneously. An endoscopic examination revealed no abnormalities, but biopsy specimens showed massive infiltration of CD4⁺ and Epstein-Barr encoding region (EBER⁺) abnormal lymphocytes in which a high copy number of Epstein Barr virus (EBV) genomes was detected by quantitative polymerase chain reaction (qPCR). EBV infection was exclusively detected in CD4⁺ T-cells, leading to a diagnosis of EBV-positive CD4⁺ T-cell lymphoproliferative disorder (LPD). This case suggests that an immediate biopsy and examinations, including qPCR for EBV DNA, should be considered for patients with recurrent enteritis after autologous HSCT, regardless of endoscopic findings.

Clinicopathological Features of Small Bowel Tumors Diagnosed by Video Capsule Endoscopy and Balloon-Assisted Enteroscopy: A Single Center Experience

Background/Aims

Small bowel malignancies often present a diagnostic challenge due to their relative rarity and nonspecific clinical symptoms. However, technical developments in endoscopic instruments, including video capsule endoscopy (VCE) and enteroscopy, have allowed for the visualization of the entire small bowel. This study aimed to investigate the clinicopathological features of small bowel malignant tumors diagnosed by VCE and double-balloon enteroscopy (DBE) in a single tertiary center.

Methods

We retrospectively analyzed VCE and DBE findings from Korea University Guro Hospital from January 2010 through September 2018.

Results

A total of 510 VCE and 126 DBE examinations were performed in 438 patients. Small bowel malignancies were diagnosed in 28 patients (15 males; mean age, 61.0 years; range, 42 to 81 years). Among them, 8 had lymphoma, 8 had primary adenocarcinoma, 7 had gastrointestinal stromal tumor (GIST) and 5 had metastatic cancer. Abdominal pain and obstructive symptoms were the most common findings in metastatic cancers (4/5, 80%). On the other hand, obscure gastrointestinal bleeding was the most common symptom of GIST (6/7, 85.7%) and adenocarcinoma (3/8, 37.5%).

Conclusions

Approximately 6% of the patients who underwent either VCE or DBE were diagnosed with small bowel malignancy. These findings demonstrated the different clinical characteristics among small bowel malignancies and merit further study.