Rare presentation of small bowel adenocarcinoma with neuroendocrine differentiation in the jejunum: A case report and summary of diagnostic and management options

Abstract

Cancer of the small bowel (SB) is rare. The most common SB malignancy is neuroendocrine, followed by adenocarcinoma. SB adenocarcinoma with overlapping neuroendocrine differentiation (NED) is very uncommon. The present case report discusses the case of a young African American female who presented with high-grade SB perforation and underwent urgent surgical repair. Histology of the tumor revealed jejunal adenocarcinoma with NED. To the best of our knowledge, this type of tumor has not yet been reported in the jejunum. Referring patients that present with insidious and nonspecific abdominal discomfort for imaging studies that are more sensitive to the SB could potentially identify tumors earlier, prevent the development of emergent gastrointestinal complications and offer a chance for cure. An overview of diagnostic tools for SB evaluation was provided.

Perforated Jejunal Adenocarcinoma in a COVID-19-Positive Patient

“…Due to this, the diagnosis is usually delayed and takes place during surgical intervention or at advanced stages of the disease, worsening the prognosis for the patient. 8,10 Finding and locating tumors in the small intestine, particularly in the jejunum and in the ileum, is a current challenge. The barium series technique has a sensitivity of $ 60%, while computed tomography (CT) and magnetic resonance imaging (MRI) have reported different degrees of sensitivity according to tumor location and disease stage, ranging from 47 to 80%.…”

“…Nonmodifiable risk factors include familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome, Crohn´s disease, and both hereditary colorectal nonpolyposis as well as the antecedent of non-hereditary colorectal cancer. 6,10 Another similarity with colorectal cancer is that most small intestine adenocarcinomas also seem to arise from adenomas through a sequence of specific genetic changes. Some of these changes include mutations in the p53 tumor suppressor gene and in the Kirsten rat sarcoma (KRAS) oncogene, which have been implicated in up to 50% of cases, as well as mutations in the adenomatous polyposis coli tumor suppressor gene, present in $ 10% of cases.…”

“…As previously mentioned, the operating room plays a key role in the diagnosis in up to 85% of cases. 3,8,10,12 After the diagnosis, French guidelines recommend performing a thoraco-abdomino-pelvic tomographic scan to detect possible distant metastases, as well as both upper and lower endoscopy to look for other tumors that may suggest a predisposing genetic syndrome. Carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9) should be measured at baseline, as these tumor markers may have a prognostic value, particularly in advanced disease.…”

“…12 Capecitabine and oxaliplatin (CAPOX), folinic acid/5-FU/oxaliplatin (FOLFOX), and folinic acid/5-FU/irinotecan (FOLFIRI) are promising therapeutic options, but more randomized clinical trials are needed to evaluate the efficacy of these treatment methods, as well as that of chemotherapy itself for this rare type of malignancy. 10 The currently accepted staging system for small bowel adenocarcinomas is the tumor, node, metastasis (TNM) system of the combined American Joint Committee on Cancer/Union for International Cancer Control. Its most recent edition revised the definitions of the T stage, with T1, T2, T3, and T4 representing a tumor that invades up to the submucosa (T1), the muscularis propia (T2), the subserosa or mesentery (T3), and that perforates the visceral peritoneum or invades neighboring structures (T4), respectively.…”

Adenocarcinoma de yeyuno proximal: a propósito de un caso

“…Debido a la recurrencia de lesiones aun después de la cirugía, se recomiendan ciclos de quimioterapia como tratamiento coadyuvante (21) . El 5-fluorouracilo es el agente farmacológico más utilizado en la quimioterapia de pacientes que ya han sido intervenidos quirúrgicamente y presentaban enfermedad extensa (10,22) .…”