Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
Ann Diagn Pathol. 2009 Dec;13(6):390-3. doi: 10.1016/j.anndiagpath.2009.06.011. Epub 2009 Sep 18.
Small intestinal neoplasia is a rare condition that frequently presents a diagnostic challenge. We describe the case of a 70-year-old patient who presented with several years of chronic, intermittent abdominal pain, previously diagnosed as irritable bowel syndrome. Radiographic evaluation, including upper gastrointestinal series with small bowel follow-through and computed tomography, demonstrated dilated small bowel with possible strictures. Colonoscopy and upper endoscopy were unrevealing. Attempted capsule endoscopy resulted in capsule retention. Subsequent laparoscopy led to the identification of severe, active Crohn disease with strictures, ulcers, crypt abscesses, pyloric metaplasia, and transmural inflammation. Extensive flat and polypoid high- and low-grade dysplasia were present, as well as an area of well-differentiated adenocarcinoma invading into the muscularis propria. We discuss the epidemiology, pathogenesis, and diagnosis of small bowel malignancy.
小肠肿瘤是一种罕见的疾病，常给诊断带来挑战。我们描述了一位 70 岁患者的病例，他有几年的慢性间歇性腹痛病史，此前被诊断为肠易激综合征。放射学评估，包括上消化道系列和小肠随诊 CT，显示小肠扩张并可能存在狭窄。结肠镜和上消化道内镜检查无明显异常。胶囊内镜检查尝试失败，胶囊滞留。随后的腹腔镜检查确定了严重的活动性克罗恩病，伴有狭窄、溃疡、隐窝脓肿、幽门化生和壁层炎症。广泛存在平坦和息肉状的高中低级别异型增生，以及一处分化良好的腺癌浸润固有肌层。我们讨论了小肠恶性肿瘤的流行病学、发病机制和诊断。
