A Case of Small Bowel Anaplastic Carcinoma with Multiple Intramural Metastases

Tasuku Matsuoka, Kei Katsuragi, Taro Matsuzaki, Sumio Takashima, Kenichi Wakasa* and Masahiro Okuno

Yukawa Gastrointestinal Hospital
Department of Diagnosed Pathology, Osaka City University Graduate School of Medicine*

A 56-year-old man reporting abdominal pain and showing palpation of a right lateral abdominal mass was found in laboratory tests to be severe anemia. A small-bowel contrast examination showed several tumors with stricture in the small intestine, and a computed tomography showed an intestinal tumor with thickened walls, suggesting that multiple small intestinal tumors. Emergency surgery was conducted under a diagnosis of peritonitis due to gastrointestinal tract perforation. Upon laparotomy, we found multiple tumors 40 cm from the anal side of Treiz' ligament to the terminal ileum, two of which had ruptured due to necrosis, necessitating small-intestinal resection and peritoneal lavage. Histopathologically, the tumor was identified as anaplastic carcinoma infiltrating the serosal membrane. Further immunohistochemical studies showed the tumor to be positive for EMA and CAM 5.2. No staining for vimentin, desmin, or CD31 was found. The patient recovered to where he began eating solid food, but died 37 days after surgery due to massive hemorrhaging from a residual bowel tumor. An autopsy showed no evidence of malignancy at other sites, excluding multiple mesenteric lymph node metastases, yielding a definitive diagnosis of anaplastic carcinoma arising in the small intestine. Anapastic carcinoma of the small bowel is rare. We report the present case in detail and discuss it in light of the literature.

Key words
small bowel tumor, anaplastic carcinoma, invagination

Reprint requests
Tasuku Matsuoka Department of Surgery, Senbon Hospital
1-1-31 Matsu, Nishinari-ku, Osaka, 557-0034 JAPAN

Accepted
June 27, 2007

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