A Case of Jejunal Carcinoid Tumor Detected by Huge Nodal Metastasis

Kazuma Yamakawa, Masahiro Fujikawa, Riichiro Nezu, Jun-ichi Hasegawa, Shoki Mikata, Yokoku Kim, Yoichiro Yoshida, Kiyoshi Yoshikawa, Kiyoshi Kawano¹⁾ and Yasuhiro Tanaka²⁾

Department of Surgery and Department of Pathology¹⁾, Osaka Rosai Hospital
Department of Surgery, Osaka General Medical Center²⁾

A73-year-old woman admitted for abdominal distention and a huge mass was found in abdominal computed tomography (CT) and magnetic resonance imaging (MRI) to have a heterogeneously enhanced tumor 9.0 cm in diameter at the back of the superior mesenteric vessels. Small bowel radiography showed a small type 2 lesion in the proximal jejunum. The preoperative diagnosis was gastrointestinal stromal tumor (GIST) of the jejunum. At surgery, we found a tumor 10 cm in diameter at the jejunal mesentery just distal from the Treitz ligament, necessitating segmental resection of the jejunum together with the mesenteric tumor. The resected specimen showed a type 2 tumor 19×19 mm in diameter of the proximal jejunum. The jejunal tumor was diagnosed histologically as a carcinoid tumor, depth sm, and the jejunal mesentery tumor was diagnosed as lymph node metastasis. The woman remains alive without recurrence in the over 22 months following resection. Jejunal carcinoid tumor is rare in Japan. The mesenteric lymph node metastasis in our case was huge, although the primary carcinoid tumor was small with depth sm, leading to detection of the primary lesion in the jejunum.

Key words
carcinoid, jejunum, lymph node metastasis

Reprint requests
Kazuma Yamakawa Department of Emergency Medicine, Osaka General Medical Center
3-1-56 Mandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558 JAPAN

Accepted
December 17, 2008

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