Intramucosal adenocarcinoma of the ileum originated 40 years after ileosigmoidostomy.
BACKGROUND
Small bowel adenocarcinomas (SBAs) are rare carcinomas. They are asymptomatic and usually neither endoscopy nor contrast studies are performed for screening


METHODS
A 72-year-old Japanese male had a positive fecal occult blood test at a regular check-up in 2006. He suffered appendicitis and received an ileosigmoidostomy in 1966. A colonoscopy revealed an irregular mucosal lesion with an unclear margin at the ileum side of the anastomosis. A mucosal biopsy specimen showed adenocarcinoma histopathologically. Excision of the anastomosis was performed for this patient. The resected specimen showed a flat mucosal lesion with a slight depression at the ileum adjacent to the anastomosis. Histological examination revealed a well differentiated intramucosal adenocarcinoma (adenocarcinoma in situ). Immunohistological staining demonstrated the overexpression of p53 protein in the adenocarcinoma.


CONCLUSIONS
Adenocarcinoma of the ileum at such an early stage is a very rare event. In this case, there is a possibility that the ileosigmoidostomy resulted in a back flow of colonic stool to the ileum that caused the carcinogenesis of the small intestine.
Sameshima
Shinichi
S
Department of Surgery, Hitachi Yokohama Hospital, 550 Totsuka-cho, Totsuka-ku, Yokohama, Kanagawa 244-0003, Japan. shinsame@me.com
Tomozawa
Shigeru
S
Koketsu
Shinichiro
S
Okada
Toshiyuki
T
Miyato
Hideyo
H
Iijima
Misa
M
Kojima
Masaru
M
Kaji
Toshio
T
D000230:Adenocarcinoma / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D000368:Aged; D001064:Appendicitis / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery*; D006801:Humans; D007078:Ileal Neoplasms / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*