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• W3093741833 abstract "INTRODUCTION: Colon adenomas are seen in over 10% of the patients on colonoscopy. However, small bowel adenomas are uncommon and often found incidentally, given the low tumorigenic potential of small bowel. We present an unusual case of a patient with history of (h/o) endoscopic mucosal resection (EMR) of jejunal tubulovillous adenoma (TVA), found to have a recurrent jejunal tubular adenoma (TA) 4 years later on VCE during evaluation of anemia and blood per rectum (BPR). CASE DESCRIPTION/METHODS: A 78-year-old female with h/o stage III colon cancer (T1N1) status post right colectomy and chemotherapy 5 years ago, had a surveillance abdominopelvic computerized tomography scan with no evidence of metastatic disease but incidentally showed short segment jejunal intussusception, and nodular wall thickening distal to the intussusception (Figure 1). The patient denied gastrointestinal (GI) symptoms. Push enteroscopy showed jejunal polyp, removed through piecemeal EMR. Histopathology showed TVA with focal severe dysplasia/carcinoma in situ, and undetermined margins (Figure 2A). A year later, surveillance push enteroscopy did not demonstrate any recurrent small bowel lesions. Four years after the EMR, she had episodes of BPR. She was on coumadin for history of embolic cerebrovascular accident and pulmonary embolism. Labs showed anemia (hemoglobin 10.4 g/dL), with iron panel (iron saturation 11%, iron 27 HG/dL) and bone marrow biopsy suggestive of iron deficiency. INR was therapeutic (2.2). Colonoscopy showed 3 small TA. Video capsule endoscopy (VCE) was performed showing irregular mucosa from possible jejunal neoplasia (Figure 3A). Push enteroscopy showed a large Paris IIa polyp 15 cm distal to the tattoo from previous EMR occupying ½ to 2/3rd of the jejunal lumen (Figure 3B); piecemeal EMR was performed (Figure 3C). Histopathology showed TA with low grade dysplasia (Figure 2B). The patient was recommended follow-up to discuss continued surveillance of small bowel adenomas. DISCUSSION: Small bowel adenomas are rare but can be precursors of small bowel adenocarcinoma. These adenomas may be TA, TVA or villous, with villous adenomas carrying the highest malignancy risk. Small bowel adenomas are often asymptomatic, especially when located in the proximal small bowel, but symptomatic jejunal adenomas associated with GI bleeding and anemia have been reported. Recurrent small bowel adenomas are rare but may be seen on VCE during routine surveillance or workup of BPR.Figure 1.: Coronal view of a surveillance abdominopelvic computerized tomography scan of a patient with history of colon cancer status post right colectomy and chemotherapy showing (asymptomatic) short segment jejunal intussusception just distal to the ligament of Treitz, and nodular wall thickening distal to the intussusception (as shown in the circle).Figure 2.: A) Tubulovillous adenoma with high-grade dysplastic nuclear features of vesicular nuclei with occasional prominent nucleoli (H&E stain, 400x magnification). B) Tubular adenoma with closely packed tubules lined by adenomatous epithelium, with low-grade dysplastic nuclear features of enlarged, elongated and hyperchromatic nuclei, with inconspicuous nucleoli (H&E stain, 400x magnification).Figure 3.: A) Video capsule endoscopy of a patient with history of jejunal adenoma status post endoscopic mucosal resection showing irregular mucosa in the proximal jejunal neoplasia suggestive of possible neoplasia. B) Subsequent push enteroscopy showed a large Paris IIa polyp 15 cm distal to the tattoo from previous EMR occupying ½ to 2/3rd of the jejunal lumen. C) Endoscopic mucosal resection of the polyp was performed." @default.
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• W3093741833 date "2020-10-01" @default.
• W3093741833 modified "2023-09-27" @default.
• W3093741833 title "S2849 Recurrent Jejunal Adenoma in a Patient With Rectal Bleeding and Iron Deficiency Anemia" @default.
• W3093741833 doi "https://doi.org/10.14309/01.ajg.0000713444.86924.58" @default.
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