Kodaira C, Osawa S, Mochizuki C, Sato Y, Nishino M, Yamada T, Takayanagi Y, Takagaki K, Sugimoto K, Kanaoka S, Furuta T, Ikuma M. A case of small bowel adenocarcinoma in a patient with Crohn’s disease detected by PET/CT and double-balloon enteroscopy. World J Gastroenterol 2009; 15(14): 1774-1778 [PMID: 19360924 DOI: 10.3748/wjg.15.1774]
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Satoshi Osawa, MD, PhD, First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. email@example.com
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Chise Kodaira, Satoshi Osawa, Masafumi Nishino, Takanori Yamada, Yasuhiro Takayanagi, Kosuke Takagaki, Ken Sugimoto, Mutsuhiro Ikuma, First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Chihiro Mochizuki, Yoshihiko Sato, Department of Gastroenterology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu 431-3192, Japan
Shigeru Kanaoka, Molecular Diagnosis, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Takahisa Furuta, Center for Clinical Research, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Author contributions: Kodaira C and Osawa S wrote the paper; Mochizuki C and Sato Y contributed to the PET/CT and imaging diagnosis; Nishino M, Yamada T, Takayanagi Y, and Takagaki K performed the double-balloon enteroscopy; Sugimoto K, Kanaoka S, Furuta T, and Ikuma M designed the paper.
Correspondence to: Satoshi Osawa, MD, PhD, First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan. firstname.lastname@example.org
Received: September 23, 2008 Revised: March 12, 2009 Accepted: March 19, 2009 Published online: April 14, 2009
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.