Vnitřní lékařství 7/2020

CASE REPORT Small bowel adenocarcinoma diagnosed by video capsule endoscopy in a patient with celiac disease: a case report and review of literature E42 | VNITŘNÍ LÉKAŘSTVÍ / Vnitř Lék 2020; 66(7): e39–e42 /  www.casopisvnitrnilekarstvi.cz in the diagnostic approach. The availability of VCE and device assisted enteroscopy could help in early diagnosis. In our case VCE was the only examinationwhich revealed the infiltration of the jejunum, when even the CT enterography was negative. However, a recent study showed that the diagnostic implementation of new techniques did not yield a significant advantage in terms of an early diagnosis and better outcome, but there is a need for further investigation (18). Due to a lack of data and an absence of guidelines, treatment of a small bowel adenocarcinoma is based on expert agreement and guidelines for colon cancer. A prospective phase III clinical trial PRODIGE 33-BALLAD comparing adjuvant chemotherapy vs observation among patients with small bowel adenocarcinoma with stage I-III is still ongoing. Surgical treatment is the only potentially curative option. However, 40% of patients have a relapse after primary tumor resection. The main prognostic factors are lymph node invasion and localization, with duodenal tumors having a worse prognosis. Five-year survival in cases of lymph node invasion is poor (28–32%) (19–21). For stage II with risk factors (pT4) and stage III (N+) adjuvant chemotherapy should be considered. Regimens are based on fluoropyrimidine in com- bination with oxaliplatin (22). Conclusion We presented the case of a woman who was diagnosed with atypical CD at the age of 53 years. The disease was complicated by small bowel adenocarcinoma, which was detected by VCE. The patient underwent surgical resection and received adjuvant chemotherapy. 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Peroperative view of infiltration of jejunum (red arrow) with the lodged capsule which was extracted by enterotomy (green arrow) Fig. 5. Histological section: invasive adenocarcinoma infiltrating submu- cosal tissue, spreading under small intestine epithelium, HE staining, 100 ×