Primary Jejunal Adenocarcinoma Presenting as Bilateral Ovarian Metastasis

Abstract

Small intestinal tumors are rare with adenocarcinoma of the small intestine accounting for less than 2% of all gastrointestinal cancers. Primary jejunal adenocarcinoma constitutes a minute portion of small intestine adenocarcinomas. Clinically, this cancer presents at latter stages of its progression, mainly due to vague and non-specific symptoms, and the difficulty encountered in accessing the jejunum on upper endoscopy. Diagnosis of jejunal adenocarcinoma is usually inconclusive with the use of computed tomography (CT) scan, small bowel series, or upper endoscopy. Laparoscopy followed by frozen section biopsy provides a definitive diagnosis. In the past decade, balloon-assisted enteroscopy (BAE) and capsule endoscopy have become popular as useful modalities for diagnosing small bowel diseases. Wide excisional jejunectomy is the only treatment option with an estimated 5-year survival of 40-65%. Physicians are advised to suspect jejunal adenocarcinoma as a differential diagnosis in patients who present with non-specific symptoms of abdominal pain, nausea, vomiting, weight loss, anemia, gastrointestinal bleeding or signs of small bowel obstruction. We present a rare case of a 37-year-old woman with suspected bilateral ovarian masses, which was immunohistochemically confirmed as primary jejunal adenocarcinoma with bilateral ovarian metastasis.

Keywords: Jejunal adenocarcinoma; Small bowel malignancy; Small bowel tumors; Upper endoscopy.

Figure 1

CT scan of abdomen shows dilated loop of small intestine in the left upper quadrant.

Figure 2

Near obstructing jejunal mass about 60 cm distally to the duodenal bulb.

Figure 3

Micrographic examination reveals benign jejunal glands (arrow) and metastatic adenocarcinoma (asterisks) in the lamina propria (a: × 40; b: × 100).