RESUMO
An 86 years old man was diagnosed with jejunum tumor by detail examination of anemia. Eight days after endoscopy he developed abdominal pain, an emergency surgery was performed by a diagnosis of gastrointestinal perforation. They detected perforation in jejunum and performed jejunum resection, small intestinal lymphoma was diagnosed by histopathological examination. We were talked about chemotherapy against lymphoma, he was transferred at our hospital. The first chemotherapy was provided, abdominal pain appeared at 2 days after chemotherapy. Computed tomography revealed air bubbles out of intestinal tract, we performed emergency operation. A perforation of jejunum in the part where is different from the last time was existed, we performed jejunum resection. Chemotherapy was performed postoperatively, resulted in successful progress. Lymphoma of gastrointestinal tract often causes intestinal perforations, but reports that perforations heterochrony in separate parts multiple tumors of intestine is rare. We report a case of intestinal lymphoma with 2 perforations in a short period time.
Assuntos
Perfuração Intestinal , Humanos , Masculino , Perfuração Intestinal/cirurgia , Perfuração Intestinal/etiologia , Idoso de 80 Anos ou mais , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/patologia , Fatores de Tempo , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoAssuntos
Hemorragia Gastrointestinal , Hemangioma Cavernoso , Neoplasias do Jejuno , Humanos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgia , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/cirurgia , Recidiva , Masculino , Hemostase Endoscópica/métodos , Idoso , FemininoRESUMO
Dermatofibrosarcoma protuberans (DFSP) is an aggressive tumour with multiple local recurrences and rare metastatic potential. Fibrosarcomatous transformation occurs in a few cases of DFSP which makes them more aggressive in terms of recurrence and metastasis. Here we report the case of a woman in her late 30s who presented with massive lower gastrointestinal (GI) bleeding with a history of multiple surgeries for DFSP on her anterior abdominal wall. The bleeding source was identified to be a mass lesion in the jejunum, which was excised. The patient recovered well and the histopathology revealed fibrosarcoma of the jejunum. Follow-up investigations showed multiple lung nodules, ascites and abdominal lymph nodes suggesting progressive disease. She is currently receiving chemotherapy and progressing well 3 months postoperatively. Patients with fibrosarcomatous changes within DFSP must be followed up closely as it is associated with increased metastatic potential.
Assuntos
Dermatofibrossarcoma , Hemorragia Gastrointestinal , Neoplasias do Jejuno , Neoplasias Cutâneas , Humanos , Dermatofibrossarcoma/complicações , Dermatofibrossarcoma/patologia , Dermatofibrossarcoma/diagnóstico , Dermatofibrossarcoma/secundário , Feminino , Hemorragia Gastrointestinal/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/secundário , Adulto , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgiaAssuntos
Anastomose Cirúrgica , Laparoscopia , Stents , Humanos , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Stents/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Masculino , Neoplasias Gástricas/cirurgia , Neoplasias do Jejuno/cirurgia , Jejuno/cirurgia , Idoso , Pessoa de Meia-Idade , Feminino , Endoscopia Gastrointestinal/métodos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgiaRESUMO
A case describes a 49-year-old male patient who underwent emergency exploratory laparotomy for small intestinal perforation. Peritonitis was present due to perforation of the jejunal tumor. Resection of the jejunal tumor with perforation was performed followed by end-to-end anastomosis of the jejunum. The resected jejunal tumor was identified in the histopathological examination as metastatic from a clear cell variant of squamous cell/large cell carcinoma of the lung. It was associated with metastatic lesions in the brain. Metastasis from the lung carcinoma in the jejunum is a very rare condition predisposing to small intestinal perforation which is also associated with brain metastasis.
Assuntos
Neoplasias Encefálicas , Perfuração Intestinal , Neoplasias do Jejuno , Neoplasias Pulmonares , Humanos , Masculino , Pessoa de Meia-Idade , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Perfuração Intestinal/diagnóstico , Neoplasias do Jejuno/secundário , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/diagnóstico , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Encefálicas/secundário , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Grandes/secundário , Carcinoma de Células Grandes/cirurgia , Carcinoma de Células Grandes/diagnósticoRESUMO
BACKGROUND Schwannomas are tumors that arise from Schwann cells that surround and support nerve cells. Most common sites for presentations are head, neck, and extremities. Schwannomas of gastrointestinal tract are rare, slow-growing tumors, usually benign, arising from gastrointestinal tract's neural plexus. They are histologically distinguishable from conventional schwannomas that arise in soft tissue or the central nervous system. Preoperative diagnosis of gastrointestinal schwannoma is challenging, requiring immunohistological confirmation of the nature of the tumor. Here, we report a case of 57-year-old woman with an incidental finding of an asymptomatic submucosal jejunal schwannoma. CASE REPORT A 57-year-old woman with a medical history of hematological disorder underwent a contrast abdominal computed tomography as part of medical follow-up. The imaging revealed the presence of a jejunal mass. The patient underwent laparoscopic surgical resection of the lesion, followed by side-to-side jejuno-jejunal anastomosis with 4-cm clear surgical margins. The final pathologic study revealed the presence of jejunal schwannoma, as tested positive for S-100 protein. The patient was discharged home on the fourth postoperative day, having an uneventful recovery. CONCLUSIONS Jejunal schwannoma are usually benign and asymptomatic, and they are often discovered incidentally during diagnostic tests for other conditions; therefore, it should be included in the differential diagnosis of gastrointestinal tumors. Surgical treatment appears to be necessary to achieve a definitive diagnosis through a biopsy of the tumor tissue. Benign jejunal schwannomas have a good prognosis.
Assuntos
Achados Incidentais , Neoplasias do Jejuno , Neurilemoma , Humanos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neurilemoma/patologia , Feminino , Pessoa de Meia-Idade , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/patologia , Doenças Assintomáticas , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan. METHODS: We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum. RESULTS: The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA. CONCLUSIONS: Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.
Assuntos
Adenocarcinoma , Endoscopia por Cápsula , Neoplasias Duodenais , Neoplasias do Íleo , Neoplasias Intestinais , Neoplasias do Jejuno , Idoso , Humanos , Masculino , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/patologia , Neoplasias do Íleo/diagnóstico , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/terapia , Japão/epidemiologia , Neoplasias do Jejuno/diagnóstico , PrognósticoAssuntos
Neoplasias do Jejuno , Recidiva Local de Neoplasia , Humanos , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/patologia , Recidiva Local de Neoplasia/cirurgia , Masculino , Carcinossarcoma/cirurgia , Carcinossarcoma/patologia , Pessoa de Meia-Idade , Idoso , Jejuno/cirurgia , Jejuno/patologia , FemininoRESUMO
BACKGROUND: Small intestinal adenocarcinomas (SIAs) are rare. Hence, randomized controlled trials are lacking and understanding of the disease features is limited. This nationwide cohort investigates incidence, treatment and prognosis of SIA patients, to improve disease outcome. PATIENTS AND METHODS: Data of 2697 SIA patients diagnosed from January 1999 through December 2019 were retrieved from the Netherlands Cancer Registry and Pathology Archive. Incidence was calculated using the revised European Standardized Rate. The influence of patient and tumor characteristics on overall survival (OS) was studied using survival analyses. RESULTS: The age-standardized incidence rate almost doubled from 0.58 to 1.06 per 100,000 person-years, exclusively caused by an increase in duodenal adenocarcinomas. OS did not improve over time. Independent factors for a better OS were a younger age, jejunal tumors, Lynch syndrome and systemic therapy. Only 13.8% of resected patients was treated with adjuvant chemotherapy, which improved OS compared to surgery alone in stage III disease (HR 0.47 (0.35-0.61)), but not in the limited group of deficient mismatch repair (MMR) patients (n = 53, HR 0.93 (0.25-3.47)). In the first-line setting, CAPOX was associated with improved OS compared to FOLFOX (HR 0.51 (0.36-0.72)). For oligometastatic patients, a metastasectomy significantly improved OS (HR 0.54 (0.36-0.80)). CONCLUSIONS: The incidence of SIAs almost doubled in the past 20 years, with no improvement in OS. This retrospective non-randomized study suggests the use of adjuvant chemotherapy for stage III disease and first-line CAPOX for metastatic patients. For selected oligometastatic patients, a metastasectomy may be considered. MMR-status testing could aid in clinical decision-making.
Assuntos
Adenocarcinoma , Neoplasias do Jejuno , Humanos , Adenocarcinoma/terapia , Adenocarcinoma/tratamento farmacológico , Estudos de Coortes , Incidência , Neoplasias do Jejuno/terapia , Neoplasias do Jejuno/tratamento farmacológico , Prognóstico , Estudos RetrospectivosRESUMO
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
Assuntos
Adenocarcinoma , Neoplasias Duodenais , Neoplasias do Íleo , Neoplasias do Jejuno , Humanos , Intestino Delgado/patologia , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/patologia , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/patologia , Neoplasias Duodenais/patologia , Neoplasias Duodenais/terapia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , ImunoterapiaRESUMO
It is rare to find a small bowel tumour presenting as intestinal obstruction. This type of cancer is an extremely unusual condition often misdiagnosed until late stages. We report the case of a patient with persistent vomiting secondary to an obstructing jejunal adenocarcinoma not related to intestinal bowel disease. After resection and chemotherapy treatment a huge mass was detected in the left ovary. The anatomopathological findings confirmed a metastatic cancer consequent to the jejunal adenocarcinoma previously resected. This case illustrates a successful outcome of a jejunal adenocarcinoma with very poor prognosis after a extremely unusual ovarian metastasis. It is highly important to suspect other causes than intestinal bowel disease when doing a differential diagnosis in a young patient presenting with clinical symptoms of intestinal obstruction.
Assuntos
Adenocarcinoma , Neoplasias Duodenais , Obstrução Intestinal , Neoplasias do Jejuno , Neoplasias Ovarianas , Feminino , Humanos , Adenocarcinoma/cirurgia , Neoplasias Duodenais/complicações , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , AdultoRESUMO
ABSTRACT: Follicular dendritic cell sarcoma of the gastrointestinal tract is a rare malignancy. We describe contrast-enhanced CT and FDG PET/CT findings in a case of jejunal follicular dendritic cell sarcoma with hepatic metastasis. The primary jejunal tumor showed inhomogeneous enhancement on contrast-enhanced CT and intense FDG uptake on PET/CT mimicking adenocarcinoma or gastrointestinal stromal tumor. The hepatic metastatic tumor showed hypovascularity on contrast-enhanced CT and mild FDG uptake on PET/CT. This case indicates that follicular dendritic cell sarcoma should be included in the differential diagnosis of the hypermetabolic intestinal lesions.
Assuntos
Sarcoma de Células Dendríticas Foliculares , Neoplasias do Jejuno , Neoplasias Hepáticas , Sarcoma de Células Dendríticas Foliculares/diagnóstico por imagem , Sarcoma de Células Dendríticas Foliculares/patologia , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Neoplasias Hepáticas/secundário , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In this report, we described a case of jejunum cancer that presented with abdominal pain and vomiting as chief complaints, which mimicked superior mesenteric artery syndrome. An elderly woman in her 70s was referred to our department for prolonged abdominal discomfort. Findings from CT and abdominal echo indicated that superior mesenteric artery syndrome may be responsible for jejunum cancer. Upper gastrointestinal endoscopy revealed a peripheral type 2 lesion in the upper jejunum. Upon biopsy, the patient was diagnosed with adenocarcinoma(papillary type). Surgical resection of the small intestine was performed. Although small intestinal cancer is a fairly rare disease, it should be considered a differential diagnosis. Comprehensive evaluations including medical history and imaging should be considered.
Assuntos
Neoplasias Duodenais , Neoplasias do Jejuno , Síndrome da Artéria Mesentérica Superior , Humanos , Feminino , Idoso , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/cirurgia , Neoplasias do Jejuno/cirurgia , Intestino Delgado/cirurgia , Jejuno/cirurgia , Artéria Mesentérica SuperiorRESUMO
BACKGROUND: Angiosarcoma is a highly malignant soft-tissue sarcoma derived from vascular endothelial cells that mainly occurs in the skin and subcutaneous tissues. Small-intestinal angiosarcomas are rare, and the prognosis is poor. CASE SUMMARY: We reported a case of primary multifocal ileal angiosarcoma and analyze previously reported cases to improve our understanding of small intestinal angiosarcoma. Small intestinal angiosarcoma is more common in elderly and male patients. Gastrointestinal bleeding, anemia, abdominal pain, weakness, and weight loss were the common symptoms. CD31, CD34, factor VIII-related antigen, ETS-related gene, friend leukemia integration 1, and von Willebrand factor are valuable immunohistochemical markers for the diagnosis of small-intestinal angiosarcoma. Small-intestinal angiosarcoma most commonly occurs in the jejunum, followed by the ileum and duodenum. Radiation and toxicant exposure are risk factors for angiosarcoma. After a definite diagnosis, the mean and median survival time was 8 mo and 3 mo, respectively. Kaplan-Meier survival analysis showed that age, infiltration depth, chemotherapy, and the number of small intestinal segments invaded by tumor lesions were prognostic factors for small intestinal angiosarcoma. Multivariate Cox regression analysis showed that chemotherapy and surgery significantly improved patient prognosis. CONCLUSION: Angiosarcoma should be considered for unexplained melena and abdominal pain, especially in older men and patients with a history of radiation exposure. Prompt treatment, including surgery and adjuvant chemotherapy, is essential to prolonging patient survival.
Assuntos
Hemangiossarcoma , Neoplasias do Jejuno , Humanos , Masculino , Idoso , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/terapia , Hemangiossarcoma/patologia , Células Endoteliais/patologia , Intestino Delgado/patologia , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/terapia , Neoplasias do Jejuno/patologia , Prognóstico , Fator de von WillebrandAssuntos
Anemia , Neoplasias Duodenais , Hemangiossarcoma , Neoplasias do Íleo , Neoplasias do Jejuno , Humanos , Hemangiossarcoma/complicações , Hemangiossarcoma/cirurgia , Intestino Delgado , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgia , Neoplasias Duodenais/complicações , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Anemia/etiologiaAssuntos
Intussuscepção , Neoplasias do Jejuno , Leiomiossarcoma , Segunda Neoplasia Primária , Humanos , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgia , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Intestino Delgado/patologia , Segunda Neoplasia Primária/patologiaRESUMO
BACKGROUND: Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS: To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS: We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION: SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
Assuntos
Adenocarcinoma , Neoplasias do Colo , Neoplasias Duodenais , Neoplasias do Íleo , Neoplasias Intestinais , Neoplasias do Jejuno , Humanos , Neoplasias Intestinais/epidemiologia , Neoplasias Intestinais/terapia , Intestino Delgado/patologia , Neoplasias do Íleo/patologia , Neoplasias do Íleo/terapia , Neoplasias Duodenais/epidemiologia , Neoplasias Duodenais/terapia , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/terapia , Adenocarcinoma/epidemiologia , Adenocarcinoma/terapia , Adenocarcinoma/diagnóstico , Neoplasias do Colo/patologiaRESUMO
Small intestinal lipomas are rare, but may cause obscure gastrointestinal bleeding. The endoscopic unroofing technique excises only the upper third of the lipoma and allows both histological confirmation and complete treatment with minimal risk of perforation. We present a rare case of obscure gastrointestinal bleeding caused by a jejunal lipoma. A 75-year-old man on antiplatelet therapy presented to our department with melena and anemia. Computed tomography revealed he had a 45-mm jejunal submucosal tumor with fat attenuation. Endoscopic resection using an endoscopic unroofing technique with double balloon enteroscopy was successfully performed. The tumor was confirmed to be a lipoma.
Assuntos
Neoplasias do Jejuno , Lipoma , Masculino , Humanos , Idoso , Enteroscopia de Duplo Balão/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Jejuno/cirurgia , Jejuno/patologia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Lipoma/complicações , Lipoma/diagnóstico por imagem , Lipoma/cirurgiaRESUMO
PURPOSE: Small intestinal cancers have a non-specific clinical presentation and hence a delayed diagnosis. The prevalence of small intestinal cancers is low, and there are no cost-effective methods of screening. This study aimed to identify clinical characteristics of duodenal and jejunal adenocarcinomas that can assist in the early detection and diagnosis of disease. METHODS: Duodenal adenocarcinoma and jejunal adenocarcinoma in Explorys database (1999-2019) were compared using odds ratio (OR) with 95% confidence intervals. Data on demographic characteristics, risk factors, clinical features, and treatment were collected. RESULTS: Out of a total of 8100 patients with a diagnosis of primary adenocarcinoma of the small intestine, 5110 are primary adenocarcinoma of duodenum (63%), and 600 are primary adenocarcinoma of jejunum (7.4%). Patients with jejunal adenocarcinoma when compared with patients with duodenal adenocarcinoma are more obese (OR, 1.36) and have a significantly higher prevalence of malignant neoplasm of colon (OR, 3.07), Crohn's disease (OR, 4.42), and celiac disease (OR, 2.48). Jejunal adenocarcinoma patients presented more frequently with intestinal obstruction (OR, 1.99), whereas duodenal adenocarcinoma patients more commonly presented with iron deficiency anemia (OR, 0.16). Patients with jejunal adenocarcinoma are less likely to undergo therapy with anti-neoplastic agents when compared with duodenal adenocarcinoma (OR, 0.81). There are no differences in patients undergoing surgical intervention or a combination of surgical intervention and antineoplastic therapy. CONCLUSIONS: Jejunal adenocarcinoma is more commonly associated with colorectal cancer, celiac disease, and Crohn's disease. They also had lower odds of requiring chemotherapeutic agents.