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CASE 1
Arterial phase
Portal phase
Case summary
Ileocecal wall and three short segmental
ileal wall thickening with bowel dilatatio
n.
Homogeneous wall enhancement on po
rtal phase.
No perienteric infiltration of fat.
Rt omental infiltration and nodules.
No ascites or LN enlargement.
Differential diagnosis
Relatively
homogeneous
enhancement
Multiple wall
thickening with
skip lesion
Distal ileum
with
marked narrowing
either neoplastic
or
non-neoplastic
Crohns disease
Crohns disease
GI GVHD
Tuberculous enteritis
(more frequent
with
non-neoplastic
entities)
Mesenteric
vasculitis
Behcet disease
Tuberculous
enteritis
Lymphoma
Lymphoma
Metastasis
Metastasis
Differential
diagnosis
Possibility
Crohns disease
Lymphoma
Metastasis
Tuberculous enteritis
Colonoscopy finding
IC valve
3cm length
stenotic lesion
of terminal
ileum, mucosal
nodularity,
hyperemia,
edma
.
Colonoscopy finding
Pathology report
Colonoscopic biopsy
A. Terminal ileum: Signet ring cell carcinoma
in the mucosa and submucosa
B. Cecum: Signet ring cell carcinoma in the
mucosa and submucosa
Multifocal signet ring cell carcinoma
Our case
Multifocal signet ring cell carcinoma in cecal and ileum
CASE 2
Female, 31 years old
C.C: 2004 Crohns disease .
2006 , F/U .
fever, abdominal pain .
CRP 59.7mg/L
Aug 5, 2015
Case summary
Current
Multiloculated abscesses adjacent to
thickened distal ileal loop, involving appendix tip.
Severe pelvic fat infiltration.
Multiple enlarged lymph nodes at ileocolic chain.
Past
Multisegmental asymmetric wall thickening
with hyperenhancement in distal ileum.
Comb sign, pseudodiverticulum of small bowel.
Prominent inflammatory stricture at distal ileal loop.
Differential diagnosis
DDx. 1. Active Crohns disease with
complicated abscesses formation.
DDx. 2. Appendiceal tip perforation
with periappendiceal abscess,
less likely
Laparoscopic ileocecectomy
cecum
ileum
Pathology report
Main diagnosis: Signet ring cell carcinoma with neu
roendocrine differentiation (mixed adenomeuroendocr
ine carcinoma)
Location: distal ileum, gross type: ulcerative
Size: 5.9x4.9cm
Depth of invasion: Invades subserosa (pT3)
Resection margin : Free of carcinoma
Lymph nodes, regional (5/17): Metastasis in 5 out of 17 regi
onal lymph nodes (pN2a)
Lymphovascular invasion: Not identified
Associated lesions: Mucosal atrophy with histologic evidenc
e of chronic crypt change, pyloric gland metaplasia, and non
-caseating granuloma, consistent with Crohn's disease
Appendix: Free of carcinoma
Case report
2007;50:51-55