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

Li J, Wang Z, Liu N, Hao J, Xu X - World J Surg Oncol (2016)

Bottom Line: This case is reported to arouse a clinical suspicion of SBA in patients with abdominal pain of unknown cause.We also provided evidence in this case of a response to palliative chemotherapy with FOLFOX.Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710004, China.

ABSTRACT

Background: In practice, small bowel cancer is a rare entity. The most common histologic subtype is adenocarcinoma. Adenocarcinoma of the small bowel (SBA) is challenging to diagnose, often presents at a late stage and has a poor prognosis. The treatment of early-stage SBA is surgical resection. No standard protocol has been established for unresectable or metastatic disease.

Case presentation: We report here on a 26-year-old man with SBA in the jejunum, lacking specific symptoms and with a delay of 6 months in diagnosis. The diagnosis was finally achieved with a combination of balloon-assisted enteroscopy, computed tomography scans, positron emission computed tomography scans and the values of carcino-embryonic antigen and carbohydrate antigen 19-9. The patient underwent segmental intestine with lymph node resection, followed by eight cycles of FOLFOX palliative chemotherapy with good tolerance. As of the 11-month postoperative follow-up, there has been no evidence of recurrent disease.

Conclusions: This case is reported to arouse a clinical suspicion of SBA in patients with abdominal pain of unknown cause. We also provided evidence in this case of a response to palliative chemotherapy with FOLFOX. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

No MeSH data available.


Related in: MedlinePlus

a Values of CEA (left Y-axis) and CA 19-9 (right Y-axis) decreased gradually as the eight cycles of FOLFOX palliative chemotherapy progressed. b CT scan image (axial view) showing swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space lessened after chemotherapy
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Fig5: a Values of CEA (left Y-axis) and CA 19-9 (right Y-axis) decreased gradually as the eight cycles of FOLFOX palliative chemotherapy progressed. b CT scan image (axial view) showing swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space lessened after chemotherapy

Mentions: Because of the symptoms of intestinal obstructions and a high possibility of advanced stage, the patient underwent segmental resection of the jejunum. At laparotomy, a 5 × 5 cm round mass with no distinct boundary was present at the jejunum (25 cm from the ligament of Treitz). The mass involved the entire wall of the small intestine and directly invaded the neighbouring mesentery. There were many enlarged lymph nodes around the superior mesenteric vein and the first and second jejunal arteries in the involved mesentery. There was no evidence of metastatic lesions in the peritoneum or liver during intraoperative inspection of all quadrants of the abdominal cavity. We performed a radical resection with 40 cm of the jejunum and the involved mesentery, vessels and lymph nodes (Fig. 3b, c). Pathologic examination revealed a moderately differentiated adenocarcinoma with metastasis to seven out of 14 resected lymph nodes (Fig. 4); free surgical margins were achieved. The tumour was staged as T4N2M0, stage IIIB disease [7]. Genetic studies of the specimen revealed that it had low expression of thymidylate synthase (TS) and excision repair cross-complementing gene 1 (ERCC1), sensitive to fluoropyrimidine and platinum [8]. He was started on palliative chemotherapy with FOLFOX for a total of eight cycles. He tolerated chemotherapy well, and the values of CEA and CA 19-9 decreased gradually as the chemotherapy progressed (Fig. 5a). CT scans also showed that the swollen lymph nodes adjacent to the abdominal aorta were significantly lessened (Fig. 5b). As of the 11-month postoperative follow-up, there has been no evidence of recurrent disease.Fig. 4


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

Li J, Wang Z, Liu N, Hao J, Xu X - World J Surg Oncol (2016)

a Values of CEA (left Y-axis) and CA 19-9 (right Y-axis) decreased gradually as the eight cycles of FOLFOX palliative chemotherapy progressed. b CT scan image (axial view) showing swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space lessened after chemotherapy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940967&req=5

Fig5: a Values of CEA (left Y-axis) and CA 19-9 (right Y-axis) decreased gradually as the eight cycles of FOLFOX palliative chemotherapy progressed. b CT scan image (axial view) showing swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space lessened after chemotherapy
Mentions: Because of the symptoms of intestinal obstructions and a high possibility of advanced stage, the patient underwent segmental resection of the jejunum. At laparotomy, a 5 × 5 cm round mass with no distinct boundary was present at the jejunum (25 cm from the ligament of Treitz). The mass involved the entire wall of the small intestine and directly invaded the neighbouring mesentery. There were many enlarged lymph nodes around the superior mesenteric vein and the first and second jejunal arteries in the involved mesentery. There was no evidence of metastatic lesions in the peritoneum or liver during intraoperative inspection of all quadrants of the abdominal cavity. We performed a radical resection with 40 cm of the jejunum and the involved mesentery, vessels and lymph nodes (Fig. 3b, c). Pathologic examination revealed a moderately differentiated adenocarcinoma with metastasis to seven out of 14 resected lymph nodes (Fig. 4); free surgical margins were achieved. The tumour was staged as T4N2M0, stage IIIB disease [7]. Genetic studies of the specimen revealed that it had low expression of thymidylate synthase (TS) and excision repair cross-complementing gene 1 (ERCC1), sensitive to fluoropyrimidine and platinum [8]. He was started on palliative chemotherapy with FOLFOX for a total of eight cycles. He tolerated chemotherapy well, and the values of CEA and CA 19-9 decreased gradually as the chemotherapy progressed (Fig. 5a). CT scans also showed that the swollen lymph nodes adjacent to the abdominal aorta were significantly lessened (Fig. 5b). As of the 11-month postoperative follow-up, there has been no evidence of recurrent disease.Fig. 4

Bottom Line: This case is reported to arouse a clinical suspicion of SBA in patients with abdominal pain of unknown cause.We also provided evidence in this case of a response to palliative chemotherapy with FOLFOX.Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, The Second Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710004, China.

ABSTRACT

Background: In practice, small bowel cancer is a rare entity. The most common histologic subtype is adenocarcinoma. Adenocarcinoma of the small bowel (SBA) is challenging to diagnose, often presents at a late stage and has a poor prognosis. The treatment of early-stage SBA is surgical resection. No standard protocol has been established for unresectable or metastatic disease.

Case presentation: We report here on a 26-year-old man with SBA in the jejunum, lacking specific symptoms and with a delay of 6 months in diagnosis. The diagnosis was finally achieved with a combination of balloon-assisted enteroscopy, computed tomography scans, positron emission computed tomography scans and the values of carcino-embryonic antigen and carbohydrate antigen 19-9. The patient underwent segmental intestine with lymph node resection, followed by eight cycles of FOLFOX palliative chemotherapy with good tolerance. As of the 11-month postoperative follow-up, there has been no evidence of recurrent disease.

Conclusions: This case is reported to arouse a clinical suspicion of SBA in patients with abdominal pain of unknown cause. We also provided evidence in this case of a response to palliative chemotherapy with FOLFOX. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.

No MeSH data available.


Related in: MedlinePlus