Abstract
A 52-year-old woman was seen at the department of internal medicine in our hospital for close exploration of anemia and constipation. A CT scan showed a 12×8×13 cm huge tumor at the midline of the pelvis and a 4.5 cm-sized tumor with a narrowing lumen at the proximate end of the jejunum, as well as multiple metastases in the both hepatic lobes ad lungs. Upper and lower gastrointestinal examinations revealed no tumor lesions. As for the serum levels of tumor markers, CEA was 300 ng/ml, CA125 was 10.5 U/ml, and CA19-9 was 76,800 U/ml. Preoperative diagnostic procedures could not determine whether the primary lesion was of the ovary or the small intestine. During these examinations, the patient developed intraabdominal bleeding so that emergency operation was performed. Partial excision of the small intestine and removal of the right ovarian tumor were performed. Immunohistological studies resulted in that the both small bowel and ovarian lesions were CDX2 positive, CK7 negative, and CK20 positive. Accordingly the small bowel tumor was diagnosed as the primary lesion.
We herein present this case of small bowel carcinoma which was eventually diagnosed by immunohistological studies after great difficulties in differentiating it from primary ovarian carcinoma, together with bibliographic comments.
