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

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.

Keywords: Diagnosis; FOLFOX; Rarity; Small bowel adenocarcinoma; Surgery.

Fig. 1

CT scan image (axial view) showing many swollen lymph nodes adjacent to the abdominal aorta in the retroperitoneal space but no discernible mass

Fig. 2

PET/CT scan image showing abnormal accumulations of ¹⁸F-FDP in many intestinal segments and also in many retroperitoneal swollen lymph nodes, indicating hypermetabolism disease, with a high possibility of a malignant disease

Fig. 3

a DBE examination showing at the upper jejunum; lumen was narrowed by an irregular protrusive tumour. b About 40 cm of the involved jejunum, mesentery and vessels were resected. c Tumour involved the entire wall of the small intestine

Fig. 4

Microscopic images of the tumour from the pathologic specimen; haematoxylin and eosin staining. a Low-power magnification (×100) showing a moderately differentiated adenocarcinoma of the jejunum with invasion into the lymph nodes. b High-power magnification (×400) showing adenocarcinoma

Fig. 5

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