PMC3658228_01
A) Abdominal ultrasound demonstrating a) "pseudokidney sign" and b) "donut sign". B) Abdominal computed tomography showing bowel intussusception.
imcrj-4-001f1.jpg
PMC3658228_01_imcrj-4-001f1.jpg
f1-imcrj-4-001
Abdominal sonography demonstrated a typical "donut sign" at axial view and "pseudokidney sign" at longitudinal view (Figure 1A). Further imaging studies with abdominal computed tomography (CT) showed multiple protruding small bowel tumors with enteroenteric intussusceptions at two sites (Figure 1B).
A smooth-surfaced protruding mass without ulceration at the afferent loop just below the gastrojejunal anastomosis. Biopsy favored adenocarcinoma.
imcrj-4-001f2.jpg
PMC3658228_01_imcrj-4-001f2.jpg
f2-imcrj-4-001
Another bulging tumor was seen at the efferent loop 50 cm distal to the anastomotic site (Figure 2).
Tumor pathologic characteristics. A biopsy report favored adenocarcinoma A). Immunohistological staining showed positivity to the epithelial marker, cytokeratin B) and positivity to the mesenchymal marker, vimentin C). D) A thyroid transcription factor-1-positive stain indirectly confirmed the lung origin.
imcrj-4-001f3.jpg
PMC3658228_01_imcrj-4-001f3.jpg
f3-imcrj-4-001
A biopsy was taken and the pathology report favored adenocarcinoma (Figure 3). They contained both epithelial and mesenchymal elements (Figure 3B and 3C). Special staining demonstrated positivity for thyroid transcription factor-1, indirectly suggesting that the tumors were of lung origin (Figure 3D).
A) Laparotomy demonstrated small bowel intussusceptions (arrowhead) and a reduced second site of intussusception (asterisk). Multiple intraluminal tumors (black arrows) with appearances of serosal invasion (white arrows) and B) multiple fungating tumors (black arrows) with the appearances of gross serosal invasion (white arrows). Three of these contributed to small bowel intussusceptions (arrowhead).
imcrj-4-001f4.jpg
PMC3658228_01_imcrj-4-001f4.jpg
f4-imcrj-4-001
The larger one, located in the left lower abdomen, had a sausage-like appearance and resulted in proximal jejunal dilatation (Figure 4A). Three of the seven tumors resulted in the larger intussusception (Figure 4B).
Chest computed tomography revealed left upper lung mass (white arrow) half a year previously A) and at admission B).
imcrj-4-001f5.jpg
PMC3658228_01_imcrj-4-001f5.jpg
f5-imcrj-4-001
Review of previous medical records and imaging studies showed that a progressively enlarging left upper lung tumor had been found in the preceding six months (Figure 5A and 5B).