Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 3-4, Pages: 232-236
https://doi.org/10.2298/SARH1304232I
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Small bowel adenocarcinoma mimicking a large adrenal tumor
Ivović Miomira (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Živaljević Vladan (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Vujović Svetlana (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Marina Ljiljana (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Tančić-Gajić Milina (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Dunđerović Dušan (Medicinski fakultet, Institut za patologiju, Beograd)
Barać Marija (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Micić Dragan (Klinički centar Srbije, Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Beograd + Medicinski fakultet, Beograd)
Introduction. Adenocarcinoma of the small bowel is a rare gastrointestinal
neoplasm usually affecting the distal duodenum and proximal jejunum. Because
of their rarity and poorly defined abdominal symptoms, a correct diagnosis is
often delayed. Case Outline. We present a 43-year-old woman admitted at the
Clinic for Endocrinology due to a large tumor (over 7 cm) of the left adrenal
gland. The tumor was detected by ultrasound and confirmed by CT scan. The
patient complained of abdominal pain in the left upper quadrant, fatigue and
septic fever. Normal urinary catecholamines excluded pheochromocytoma. The
endocrine evaluations revealed laboratory signs of subclinical
hypercorticism: midnight cortisol 235 nmol/L, post 1 mg - overnight
Dexamethasone suppression test for cortisol 95.5 nmol/L and basal ACTH 4.2
pg/mL. Plasma rennin activity and aldosterone were within the normal range.
Surgery was performed. Intraoperative findings showed signs of acute
peritonitis and a small ulceration of the jejunum below at 70 cm on the anal
side from the Treitz’s ligament. Adrenal glands were not enlarged.
Patohistology and immunochemistry identified adenocarcinoma of the jejunum
without infiltration of the lymphatic nodules. The extensive jejunal
resection and lavage of the peritoneum were performed. Due to complications
of massive peritonitis, the patient died seven days after surgery.
Conclusion. Poorly defined symptoms and a low incidence make the diagnosis of
small bowel carcinoma, particularly of the jejunal region, very difficult in
spite of the new endoscopic techniques.
Keywords: small bowel adenocarcinoma, adrenal incidentaloma, peritonitis