Abstract
BackgroundSmall bowel adenocarcinomas (SBAs) are rare carcinomas. They are asymptomatic and usually neither endoscopy nor contrast studies are performed for screeningCase presentationA 72-year-old Japanese male had a positive fecal occult blood test at a regular check-up in 2006. He suffered appendicitis and received an ileosigmoidostomy in 1966. A colonoscopy revealed an irregular mucosal lesion with an unclear margin at the ileum side of the anastomosis. A mucosal biopsy specimen showed adenocarcinoma histopathologically. Excision of the anastomosis was performed for this patient. The resected specimen showed a flat mucosal lesion with a slight depression at the ileum adjacent to the anastomosis. Histological examination revealed a well differentiated intramucosal adenocarcinoma (adenocarcinoma in situ). Immunohistological staining demonstrated the overexpression of p53 protein in the adenocarcinoma.ConclusionAdenocarcinoma of the ileum at such an early stage is a very rare event. In this case, there is a possibility that the ileosigmoidostomy resulted in a back flow of colonic stool to the ileum that caused the carcinogenesis of the small intestine.
Highlights
Small bowel adenocarcinomas (SBAs) are rare carcinomas
We report a case of an intramucosal adenocarcinoma of the ileum mucosa an ileosigmoidostomy
Most SBAs are diagnosed at advanced stages and adenocarcinomas at the early stage are rarely-detected entities
Summary
Small bowel adenocarcinomas (SBAs) are rare carcinomas. They are asymptomatic and usually neither endoscopy nor contrast studies are performed for screening. Histological examination of a mucosal biopsy revealed a well differentiated adenocarcinoma. He was referred to our hospital in October 2006. We conducted another colonoscopy and identified an ileocolonic anastomosis 28 cm from the anal verge It showed an irregular mucosal surface with a diameter of 4 cm at the ileum (Fig. 1). Histological analysis of the mucosal biopsy showed a well differentiated adenocarcinoma of the ileum. The resected specimen showed a flat mucosal lesion with a slight depression at the ileum adjacent to the anastomosis (Fig. 2). Histological examination of the specimen revealed intramucosal adenocarcinoma (Tis) It was detected in the ileum mucosa and not at the sigmoid colon side (Fig. 3A, B). W Figeullrdeiff3erentiated adenocarcinoma in the mucosal layer (A: hematoxylin and eosin, ×10, B: hematoxylin and eosin, ×100) Well differentiated adenocarcinoma in the mucosal layer (A: hematoxylin and eosin, ×10, B: hematoxylin and eosin, ×100)
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