PMC4586912_01
Computed tomography scans showing (A) extravasated oral contrast (arrow) and an enlarged periaortic lymph node (arrow head) and (B) a 1.1 cm noncalcified, nonspiculated pulmonary nodule of the right upper lobe.
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CT imaging of the abdomen demonstrated free intraperitoneal air and small bowel thickening, as well as intraperitoneal extravasation of contrast into the left upper quadrant (Figure 1A), indicating bowel perforation. CT imaging also showed lymphadenopathy of the chest and abdomen and 2 pulmonary nodules in the right upper lobe measuring up to 1.1 cm in maximal diameter (Figure 1B).
Jejunum biopsy. Hematoxylin-eosin staining (A-C) and immunohistochemistry (D-F).. (A) Low-power view of transmural wall involvement with tumor cell infiltration and necrosis. (B) Low-power small intestine villi infiltrated with tumor cells. (C) High-power view of tumor cells and mitotic figure (center). (D) CK7 cytoplasmic immunostaining. (E) TTF-1 nuclear immunostaining. (F) Napsin A, granular cytoplasmic immunostaining.
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Histopathology of the resected specimens revealed metastatic adenocarcinoma with transmural involvement of the small intestine, with mucosal ulceration, necrosis, and perforation (Figure 2A-C). A (Figure 2F) and were negative for CD20, CDX2, P63, chromogranin, synaptophysin, and CD56.