title: Adenocarcinoma of the ileum with an enterotubal fistula presenting as an adnexal mass.
abstract: Small bowel adenocarcinomas account for 3% of gastrointestinal malignancies, and 20 to 25% of these arise in the ileum. Clinical presentation is variable, and early diagnosis is difficult. A 56-year-old postmenopausal woman presented with crampy abdominal pain, anorexia, and weight loss. Pelvic examination and ultrasound revealed a 6 x 8-cm complex right adnexal mass. At laparotomy, en bloc resection of the right adnexa and the densely adherent ileal segment was performed along with a hysterectomy and a left salpingo-oophorectomy. The final pathology showed a moderately differentiated invasive adenocarcinoma of the ileum with a malignant enterotubal fistula. This is the first case reported in the literature of an ileal adenocarcinoma with a tubal fistula masquerading as an adnexal mass.
authors.affiliation: Department of Gynecology, Boston Medical Center, Boston University School of Medicine, Massachusetts 02118, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Hamid
authors.forename: S A
authors.initials: SA
authors.lastname: Ghamande
authors.forename: J
authors.initials: J
authors.lastname: Kasznica
mesh_terms: D000230:Adenocarcinoma / Q000150:complications*; D000291:Adnexal Diseases / Q000473:pathology; D003937:Diagnosis, Differential; D005184:Fallopian Tube Diseases / Q000209:etiology* / Q000473:pathology; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology* / Q000473:pathology; D007078:Ileal Neoplasms / Q000150:complications*; D007412:Intestinal Fistula / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged