Intest Res.  2015 Oct;13(4):350-354. 10.5217/ir.2015.13.4.350.

Small Bowel Metastatic Cancer Observed With Double Balloon Enteroscopy in a Patient With a Past History of Multiple Cancers

• Song JY
• Lee BJ
• Yu ES
• Na YJ
• Park JJ
• Kim JS
• Bak YT

• KMID: 2070752
• DOI: http://doi.org/10.5217/ir.2015.13.4.350

Abstract

Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE.

Keyword

Small bowel; Metastatic cancer; Double-balloon enteroscopy

MeSH Terms

Aged
Biopsy
Breast Neoplasms
Diagnosis
Double-Balloon Enteroscopy*
Female
Humans
Ovarian Neoplasms
Urinary Bladder Neoplasms

Figure

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  Fig. 1 Diagnostic studies. (A) Abdominal CT showing a circumferential wall-thickening lesion in the proximal to mid jejunum, which was suspected to be malignant (axial view; arrow). (B) Abdominal CT (sagittal view). (C) Small bowel follow-through showing a 2-cm circumferential wall thickening, illustrating the "apple core sign" in the mid jejunum.

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  Fig. 2 Endoscopic findings. (A) Antegrade double balloon enteroscopy (DBE) showing a 2-cm long encircling the ulceroinfiltrative lesion in the mid jejunum. (B) Fluoroscopy during DBE.

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  Fig. 3 Histopathologic analysis by endoscopic biopsy. (A) Many atypical epithelial nests, with nuclear pleomorphism and frequent mitosis, suggesting metastatic carcinoma from the breast (H&E, ×40). (B) Metastatic carcinoma from the breast (H&E, ×100). (C) Positive immunohistochemical staining for CD44. (D) Positive immunohistochemical staining for CD7.

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  Fig. 4 Gross photography of the resected specimen of small bowel.

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