J Korean Soc Radiol.  2019 Jul;80(4):793-797. 10.3348/jksr.2019.80.4.793.

Mixed Adenoneuroendocrine Carcinoma of the Small Bowel in a Patient with Crohn's Disease: A Case Report

• Kim KM
• Bae KE
• Kim JH
• Jeong MJ
• Kim SH
• Kim JY
• Kim SH
• Lee J
• Kang MJ
• Kim TG

• KMID: 2457460
• DOI: http://doi.org/10.3348/jksr.2019.80.4.793

Abstract

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract that has both exocrine and neuroendocrine components. There are only 5 case reports about this combined tumor in the small bowel, arose in a background of long-standing Crohn's disease. Here, we report a case of small bowel MANEC in a 54-year-old male with Crohn's disease, who presented a heterogeneous enhancing, asymmetric small bowel wall thickening with small bowel obstruction and had a difficulty in differential diagnosis before surgery.

MeSH Terms

Crohn Disease*
Diagnosis, Differential
Gastrointestinal Tract
Humans
Intestinal Neoplasms
Male
Middle Aged
Neuroendocrine Tumors

Figure

• 

  Fig. 1 A 54-year-old man with mixed adenoneuroendocrine carcinoma of the small bowel. A. Simple radiograph, erect position. The radiograph shows multiple dilated small bowel loops with air-fluid levels (arrows). B, C. Axial (B) and coronal (C) images in abdominopelvic CT. Asymmetric segmental wall thickening of small bowel is revealed in the mid-abdomen (white arrows). The thickened bowel shows heterogeneous enhancement and mesenteric fat stranding. The image also shows enlarged mesenteric lymph nodes with central low density (curved arrows) and ill-defined, low-density hepatic nodules (black arrows), suggesting metastasis. D. PET/CT image shows increased FDG uptake in the thickened small bowel (white arrow) and hepatic nodules (black arrow) that appear on the CT scan. E, F. Immunohistochemical staining of the tumor; H&E stain, × 40 (E) and synaptophysin, × 40 (F). On H&E staining, the tumor shows an adenocarcinoma component with a glandular growth pattern and a neuroendocrine component. The neuroendocrine component also shows a positive and diffuse reaction for synaptophysin (arrows). The tumor is consistent with a mixed adenoneuroendocrine carcinoma. FDG = 18F-fluorodeoxyglucose, H&E = hematoxylin and eosin

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