Small bowel adenocarcinoma complicating coeliac disease: a report of three cases and the literature review

Abstract

Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

Figure 1

Abdominal computed tomography showing gastric and duodenal distension related to an irregular thickening with stenosis localized to genus inferius duodenal portion.

Figure 2

Upper gastrointestinal endoscopy revealing (a) duodenal stenosis with proximal dilatation, (b) mosaic mucosal pattern with scalloped configuration of duodenal folds.

Figure 3

Histology of surgical specimen revealing (a) moderately differentiated adenocarcinoma of duodenum, (b) total villous atrophy, crypt hyperplasia, and inflammatory cells in adjacent mucosa—Marsch IV.