Guadagni S, Catarci M, Ventura T, Leocata P, Carboni M
Department of Surgery, L'Aquila University Medical School, Italy.
Jpn J Clin Oncol. 1993 Feb;23(1):59-63.
Adenocarcinoma of the small bowel is uncommon. Due to the paucity and lack of specificity of symptoms, patients are usually seen late in the course of their illness when curative therapy, mainly represented by wide surgical resection, is unlikely. The authors report a case of primary adenocarcinoma arising in the jejunal limb transposed for a Roux-en-Y esophagojejunostomy reconstruction eight years after a total gastrectomy performed for an advanced gastric cancer (pT2N1M0), with mixed histological pattern (tubular-mucinous) and negative CEA staining of cancer cells. Evidence for excluding the possibility of a recurrence of the primitive gastric cancer was based on the different histologic pattern, positive CEA staining of cancer cells and other features of the second neoplasm. Early diagnosis of the neoplasm was made possible by its favorable anatomic location and the early onset of symptoms, which prompted effective surgical therapy (wide resection). The authors, furthermore, analyze and discuss the possible pathogenesis of the neoplasm, based on the evidence of slow jejunal limb emptying, elevated concentration of N-Nitroso compounds and contamination by N-nitrosating bacteria in the jejunal limb juice, suggesting that each of these factors could have had a role to play in the development of the jejunal malignancy.
小肠腺癌并不常见。由于症状稀少且缺乏特异性，患者通常在疾病晚期才被发现，此时以广泛手术切除为主的根治性治疗不太可能实现。作者报告了一例原发性腺癌病例，该腺癌发生在因进展期胃癌（pT2N1M0）行全胃切除术后八年进行的Roux-en-Y食管空肠吻合术重建的空肠袢中，具有混合组织学模式（管状-黏液性）且癌细胞CEA染色阴性。排除原发性胃癌复发可能性的证据基于不同的组织学模式、癌细胞CEA染色阳性以及第二种肿瘤的其他特征。肿瘤的早期诊断得益于其有利的解剖位置和症状的早期出现，这促使了有效的手术治疗（广泛切除）。此外，作者基于空肠袢排空缓慢、空肠袢液中N-亚硝基化合物浓度升高以及被N-亚硝化细菌污染的证据，分析并讨论了肿瘤可能的发病机制，表明这些因素中的每一个都可能在空肠恶性肿瘤的发生发展中起作用。
