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Elusive Tumors: Metachronous And Synchronous Ileal And Colonic Adenocarcinomas

Associated With Jejunal Adenocarcinoma


INTRODUCTION
Nay Min Tun, MD; Zaw Min Bo, MD; Meena Ahluwalia, MD; Kenneth Ong, MD
The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, New York 11201
CASE PRESENTATION
Adenocarcinoma of the small bowel is among the
rarest types of cancer, accounting for less than 1% of
primary gastrointestinal malignancies. Small-bowel and
large-bowel adenocarcinomas tend to occur
concomitantly in the same individuals, with an
increased risk of colorectal adenocarcinoma in
survivors of small-bowel adenocarcinoma and vice
versa.

In our case, the initial small bowel adenocarcinoma
was diagnosed in an early stage of the disease in
contrast to the usual majority that are diagnosed in late
stages. In addition, it is a rarity where one primary large
bowel adenocarcinoma developed synchronously with
another primary small bowel adenocarcinoma, both
cancers occurring metachronously after previously
resected small bowel adenocarcinoma. Due to its
rareness, there is no standardized guideline on follow-
up of patients status post resection of localized small
bowel adenocarcinoma although the general
consensus is to monitor closely. Physicians should be
alert to even the vaguest gastrointestinal symptoms in
view of aggressiveness of the tumor. In case of
unexplained symptoms with a normal
esophagogastroduodenoscopy and colonoscopy, small
bowel contrast study or capsule endoscopy is
warranted to rule out recurrent small intestinal cancer.

DISCUSSION
A 70-year-old African American female, with
noncontributory past medical and family history, initially
presented with features of intestinal obstruction and
recent weight loss. She underwent exploratory
laparotomy and was diagnosed to have localized
jejunal adenocarcinoma. Post-operative PET scan
revealed no evidence of cancer. She was then closely
monitored clinically as well as with surveillance
abdominal CT scan and esophagogastroduodenoscopy
every six months that showed no evidence of small
bowel tumor recurrence or metastasis. Sixteen months
after initial diagnosis, she presented again with lower
abdominal pain, constipation and blood in stool.
Colonoscopy revealed friable mass at sigmoid-distal
colon junction. The last colonoscopy that was done two
years ago disclosed only tubular adenoma, which was
Take-Home Message
resected. Surprisingly, at laparotomy, apart from the
expected lesion in sigmoid colon, another mass in the
ileum was discovered. Histopathology was consistent
with two primary tumors: moderately differentiated
adenocarcinoma of the small bowel and moderately
differentiated adenocarcinoma of sigmoid colon.

Small bowel cancer is aggressive.
Close follow-up with EGD,
colonoscopy and, in case of
unexplained symptoms, small
bowel contrast study or capsule
endoscopy are recommended.
Annular lesion in small bowel at
enteroclysis.
Jejunal Cancer
Ileal Cancer Colon Cancer
SYNCHRONOUS
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