A case of primary jejunal endocrine cell carcinoma

A 60-year-old man visited our hospital for the purpose of further examination of the anemia. Physical examination showed no abnormalities except that his palpebral conjunctiva was slightly anemic. Laboratory data were as follws ; RBC 432 × 10⁴/mm³, Hb 11.5 g/dl, Ht 38.4%, Fe 22 μg/dl, Ferritin 25.4 ng/dl, CA19-9 134.4 ng/ml, and CEA 0.6 U/ml. Double contrast radiography of the small bowel revealed annular stenosis in the jejunum. Digital endoscopic examination showed an ulcerated, circumscribed tumor with clearly defined sharp margins and coated with dirty whitish exudate, like type 2 carcinoma in Borrmann's gross classification. We made a diagnosis of primary jejunal cancer. On microscopic study, the removed specimens showed sheet arrangement of small cells and tubular glands lined by columnal cells. Some small cells were positive for argylophil reaction (Grimelius stain), leading to a diagnosis of neuroendocrine cell carcinoma of the jejunum. No relapse was detected 11 months after the operation.