Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease

Ji Min Choi; Changhyun Lee; Jong Pil Im

doi:10.4166/kjg.2014.63.4.258

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Choi, Lee, and Im: Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease

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Korean J Gastroenterol 2014;63(4):258-261.

Published online: 4 October 2014

DOI: https://doi.org/10.4166/kjg.2014.63.4.258

Metastatic Recurrence of Small Bowel Cancer in Crohn's Disease

Ji Min Choi, Changhyun Lee¹, Jong Pil Im

Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

¹Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea

Correspondence to: Jong Pil Im, Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-740-8112, Fax: +82-2-743-6701, E-mail: jpim0911@snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

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Fig. 1.

(A) Abdomen CT scan shows circumferential wall thickening (arrow-heads) of the small bowel with luminal narrowing and dilated bowel proximal to the obstruction. (B) This lesion was resected by surgery. (C) Microscopic findings show mucinous adeno-carcinoma invading the sub serosa containing signet ring cells (H&E, ×100) and (D) mesenteric lymph node metastases (H&E, ×40).

Fig. 2.

Endoscopic findings. Multiple nodular lesions with erosion are seen in the stomach (A) and duodenum (B). Colonoscopy shows hard nodular mucosa at the anastomotic site (C) and multiple variable sized ulcerations through the entire colon (D).

Fig. 3.

Staging workup results. (A) Abdomen CT scan shows multifocal enhancing wall thickening (arrowhead) and multiple lymph node enlargements in the retroperitoneum (arrows). (B) Chest CT showed enlarged lymph nodes in the left supraclavicular area (arrowheads), mediastinum (4B), and retrocrural area. (C) PET scan reveals hypermetabolic lymph nodes in the left supraclavicular area (maximal standardized uptake value [SUV] 5.0), mediastinum (4R: maximal SUV 5.1), retrocrural (maximal SUV 5.3), retroperitoneum (left para-aortic: maximal SUV 5.5), and both common iliac area. Additionally, irregular, partial focal hypermetabolism in marrow space is observed. (D) Bone scan shows diffuse increased uptake in whole axial and both proximal appendicular skeletons suggesting early bone marrow involvement.

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