Small bowel (small intestine)

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Small bowel (small intestine)

Carcinoma

Adenocarcinoma

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 13 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

See also Ampullary adenocarcinoma

General
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● Much less common in small intestine than in colon
● Men or women, ages 40-70, any site in small bowel
● Also associated with Lynch syndrome (hereditary nonpolyposis colorectal cancer), Crohn’s disease, Peutz-Jegher’s syndrome, von Recklinghausen’s disease, cholecystectomy, cystic fibrosis, Meckel’s diverticulum (Hum Pathol 2010;41:1087)
● May cause obstruction
● Usually advanced stage at diagnosis with deep wall penetration, nodal metastases
● Nodal metastases and distal location (jejunum and ileum) of tumor are most important independent prognostic factors (Hum Pathol 2010;41:1087)
● Presence of adenomatous component may be favorable prognostic factor

Case reports
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● 36 year old woman, also with intestinal duplication of ileum (Rev Med Chil 2009;137:1341)
● 48 year old man, also with Crohn’s disease (World J Gastroenterol 2009;15:1774)
● 64 year old woman with synchronous adenocarcinoma and carcinoid tumor of the terminal ileum (BMC Cancer 2005;5:157)
● 68 year old woman with ileal adenocarcinoma arising from multifocal gastric heterotopias (Med Oncol 2011;28:1023)
● 72 year old Japanese man with intramucosal adenocarcinoma of the ileum after ileosigmoidostomy (World J Surg Oncol 2009;7:41)
● Small bowel carcinoma mimicking relapse of Crohn’s disease (J Crohns Colitis 2011;5:152)

Gross description
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● Papillary or polypoid, may have napkin ring appearance (encircles lumen), proximal bowel dilation

Gross images
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Various images

Micro description
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● Often moderately well differentiated, mucin producing
● Scattered endocrine cells

Micro images
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Various images

Positive stains
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● Mucin staining varies based on site of lesion (Mod Pathol 2003;16:403)
● Mucin, CEA, lysozyme
● Duodenum: positive for MUC1
● Jejunum/ileum: positive for CK20

Negative stains
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● Duodenum: negative for CK20
● Jejunum/ileum: negative for MUC1

Electron microscopy description
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● Prominent microvilli

Additional references
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● Int J Clin Exp Pathol 2012;5:203, Nihon Shokakibyo Gakkai Zasshi 2011;108:429, World J Gastroenterol 2010;16:1527

End of Small bowel (small intestine) > Carcinoma > Adenocarcinoma

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