A case of small bowel adenocarcinoma in a patient with Crohn's disease detected by PET/CT and double-balloon enteroscopy.
Small bowel adenocarcinoma (SBA) in patients with Crohn's disease (CD) is quite rare, difficult to diagnose without surgery, and has a poor prognosis. Here, we report a 48-year-old man with SBA and a 21-year history of CD who was diagnosed by a combination of positron emission tomography/computed tomography (PET/CT) and double-balloon enteroscopy (DBE). Since the age of 27 years, the patient had been treated for ileal CD and was referred to our hospital with persistent melena. Multiple hepatic tumors were found by CT. PET/CT detected an accumulation spot in the small bowel. DBE revealed an ulcerative tumor in the ileum about 100 cm from the ileocecal valve. An endoscopic forceps biopsy specimen showed poorly differentiated adenocarcinoma. There were some longitudinal ulcer scars near the tumor, and the chronic inflammation in the small bowel appeared to be associated with the cancer development. Previous reports suggest the risk of SBA in patients with CD is higher than in the overall population. Since early diagnosis is extremely difficult in these cases, novel techniques, such as PET/CT and DBE, may be expected to help in making a preoperative diagnosis of the development of SBA in CD.
Kodaira
Chise
C
First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Japan.
Osawa
Satoshi
S
Mochizuki
Chihiro
C
Sato
Yoshihiko
Y
Nishino
Masafumi
M
Yamada
Takanori
T
Takayanagi
Yasuhiro
Y
Takagaki
Kosuke
K
Sugimoto
Ken
K
Kanaoka
Shigeru
S
Furuta
Takahisa
T
Ikuma
Mutsuhiro
M
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D003424:Crohn Disease / Q000150:complications*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D017809:Fatal Outcome; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods