RESUMO
A 53-year-old man with an abnormal routine physical examination was referred to our hospital. Colonoscopy showed a 5-mm submucosal tumor that was 7cm proximal to the ileocecal valve. It was identified as a neuroendocrine tumor (NET) on biopsy. Preoperatively, we conducted a double balloon endoscopy to examine the entire small intestine. Another 7-mm submucosal tumor was found on the ileocecal valve, which was missed during the first colonoscopy. A final diagnosis of multiple ileal NETs (<10mm in diameter) was made, and the patient underwent ileocecal resection with lymphadenectomy. Histopathological evaluation of the surgical specimen verified the diagnosis of NET Grade 1 with submucosal invasion. Metastasis to lymph node #202 was also detected. He remained relapse-free for 5 years and 5 months after the operation. In conclusion, this was a case of multiple ileal NETs (<10mm in diameter) with lymph node metastasis that could not be detected preoperatively on contrast-enhanced computed tomography. This case highlights the significance of detailed endoscopic observation of the terminal ileum.
Assuntos
Neoplasias do Íleo , Metástase Linfática , Tumores Neuroendócrinos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Íleo/patologia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/diagnóstico por imagem , Colonoscopia , Excisão de Linfonodo , Endoscopia GastrointestinalAssuntos
Neoplasias do Íleo , Linfoma Folicular , Humanos , Linfoma Folicular/diagnóstico , Linfoma Folicular/patologia , Neoplasias do Íleo/patologia , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Neoplasias do Íleo/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , IdosoRESUMO
ABSTRACT: A 71-year-old man with a newly discovered metastatic grade II neuroendocrine tumor of the terminal ileum was referred for a 68 Ga-DOTATATE PET/CT scan to stage the disease and assess suitability for PRRT (peptide receptor radionuclide therapy). The patient was known to have secondary nodal and bone/liver metastatic disease through prior morphological investigations. PET images revealed an atypical pattern of metastatic disease, showcasing secondary lesions in bilateral extraocular muscles, the myocardium, and both testes. The patient was pauci-symptomatic and only reported fatigue and diarrhea. Management involved lanreotide administration, and PRRT is being envisaged.
Assuntos
Neoplasias do Íleo , Tumores Neuroendócrinos , Compostos Organometálicos , Masculino , Humanos , Idoso , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Tomografia por Emissão de Pósitrons , Neoplasias do Íleo/diagnóstico por imagemRESUMO
AIM: Patients with Crohn's disease (CD) are at higher risk of small bowel adenocarcinoma (SBA). We aimed to identify radiological predictors of SBA in CD. METHODS: We conducted a retrospective case-control study at two tertiary inflammatory bowel disease centers and identified CD patients diagnosed with SBA between 2003 and 2019. Patients were matched with up to four controls. Pre-operative imaging (magnetic resonance imaging (MRI) or computed tomography (CT)) were reviewed by three gastrointestinal radiologists. RESULTS: Nineteen patients with CD-associated SBA with a mean age of 54.9 and 32 matched controls were included. Mean length of small bowel involvement was 216 (± 188) mm in the SBA group versus 156 (± 167) mm in the control group (p = 0.76). Only 11.8 % of cases had a diagnosis of SBA made preoperatively. In univariate analysis, focal loss of mural stratification (odds ratio [OR], 11; 95%CI, 2.43-49.5, p = 0.002), and wall thickening (OR, 1.32; 95%CI, 1.05-1.66, p = 0.02) were significantly associated with SBA. After adjustment, focal loss of mural stratification was the only independent risk factor (OR, 11; 95 % CI, 2.43-49.5, p = 0.002). CONCLUSIONS: Focal loss of mural stratification was identified as a predictor of CD-associated SBA, which should be described in imaging reports and further validated.
Assuntos
Adenocarcinoma , Doença de Crohn , Neoplasias Duodenais , Neoplasias do Íleo , Humanos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Estudos Retrospectivos , Estudos de Casos e Controles , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/etiologia , Neoplasias do Íleo/patologia , Neoplasias Duodenais/patologia , Imageamento por Ressonância Magnética , Adenocarcinoma/patologiaAssuntos
Neoplasias do Íleo , Tumores Neuroendócrinos , Humanos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/patologia , Íleo/cirurgia , Íleo/patologia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Neoplasias do Íleo/patologiaRESUMO
Neuroendocrine tumors (NETs) are heterogeneous, slow-growing tumors whose most common locations are lung, gastrointestinal tract, and pancreas.
Assuntos
Neoplasias do Íleo , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias Intestinais , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias GástricasAssuntos
Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/imunologia , Hospedeiro Imunocomprometido , Transplante de Rim , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/imunologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Tacrolimo/uso terapêutico , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Neoplasias do Íleo , Valva Ileocecal , Tumores Neuroendócrinos , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Valva Ileocecal/diagnóstico por imagem , Valva Ileocecal/patologia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgiaRESUMO
A 72-year-old man was diagnosed with tumors outside of the stomach and mesentery of the small intestine on abdominal computed tomography. Histopathological examination of an endoscopic ultrasound-guided fine-needle aspiration biopsy specimen confirmed the diagnosis of lymph node metastasis of a neuroendocrine tumor (NET). Gastroscopy, colonoscopy, small bowel capsule endoscopy, somatostatin receptor scintigraphy, and 18F-fluorodeoxyglucose positron emission tomography were performed. However, the primary lesion could not be diagnosed. The patient underwent surgery, and an ileal submucosal tumor, which was not identified preoperatively in addition to the aforementioned abdominal tumors, was detected. All tumors were diagnosed as NET, and the ileal tumor was considered the primary lesion. The patient has shown no recurrence postoperatively. The current study presents a case of an ileal NET with lymph node metastases in a patient in whom the primary lesion remained preoperatively undiagnosed.
Assuntos
Neoplasias do Íleo , Tumores Neuroendócrinos , Idoso , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgiaRESUMO
The patient was a 46-year-old woman with a history of Crohn's disease for several years. At 45 years of age, a colonoscopy was performed, and a protruding lesion in the terminal ileum was detected. Pathological analysis of a biopsy specimen noted high suspicion for a well differentiated adenocarcinoma. The patient underwent ileocecal resection, and histological examination of the specimen revealed that infiltration of the well differentiated adenocarcinoma was limited to the mucosa. To the best of our knowledge, this is the first known case of early small intestinal cancer associated with Crohn's disease in Japan. Both endoscopy and a biopsy of any protruding lesions may be useful for making a preoperative diagnosis of small intestinal cancer associated with Crohn's disease.
Assuntos
Doença de Crohn , Neoplasias Duodenais , Neoplasias do Íleo , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Feminino , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Intestino Delgado , Japão , Pessoa de Meia-IdadeRESUMO
The first case of small-bowel carcinoma (SBC) associated with Crohn's disease (CD) was described by Ginzburg in 1956. Since then, only 220 cases have been published in the literature.
Assuntos
Adenocarcinoma , Doença de Crohn , Neoplasias do Íleo , Adenocarcinoma/diagnóstico por imagem , Doença de Crohn/complicações , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagemAssuntos
Doença de Crohn/cirurgia , Neoplasias do Íleo/cirurgia , Tumores Neuroendócrinos/cirurgia , Idoso , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Masculino , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagemRESUMO
Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.
Assuntos
Adenocarcinoma/complicações , Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Valva Ileocecal , Intussuscepção/etiologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Valva Ileocecal/diagnóstico por imagem , Valva Ileocecal/patologia , Valva Ileocecal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Estadiamento de Neoplasias , Resultado do TratamentoAssuntos
Doença de Crohn , Neoplasias do Íleo , Obstrução Intestinal , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagemAssuntos
Linfoma de Burkitt/patologia , Neoplasias do Íleo/patologia , Intussuscepção/etiologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/diagnóstico por imagem , Criança , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
A 34-year-old woman presented with abdominal pain for 2 months. Abdominal CT revealed a large bezoar in the distal ileum with surrounding thickened ileal wall and enlarged mesentery lymph nodes. On FDG PET/CT, the thickened ileal wall and enlarged mesentery lymph nodes showed increased FDG uptake. Ileal malignancy with mesentery lymph node metastasis was suspected. The distal ileum and enlarged mesentery lymph nodes were removed. Benign ileal ulcer and mesentery reactive lymphoid hyperplasia were confirmed by histopathology.
Assuntos
Bezoares/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Bezoares/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/patologia , Metástase LinfáticaRESUMO
A 62-year-old man was referred to our department with suspected intussusception due to an ileal tumor. Tumor markers including soluble interleukin-2 receptor were not elevated. Contrast-enhanced computed tomography and color Doppler ultrasonography showed a distinct ileal tumor without intratumoral blood flow or surrounding lymphadenopathies. Retrograde single-balloon enteroscopy revealed a submucosal tumor in the ileum that was hard and ulcerated. Partial intestinal resection was performed, and the lesion was diagnosed as an inflammatory myofibroblastic tumor. The patient had no recurrence over 2 years without additional treatment after surgery. This rare tumor should be kept in mind as a cause of ileal intussusception in adult and a multidisciplinary approach is vital to characterize it.