P0260 - Primary Signet Cell Carcinoma of the Ileum: A Rare Differential Diagnosis of Acute Abdominal Pain

Farah Heis, MD¹, Jayasree Ravilla, MD², Mahrukh Khan, MD^1
1Rutgers Health/Monmouth Medical Center, Long Branch, NJ; ²Monmouth Medical Center/RWJBH, Long Branch, NJ

Introduction: Signet cell carcinoma is most commonly found in the glandular cells of the stomach but had also been reported in literature in the bladder, prostate, and jejunum. We present the case of a 42- year-old patient with no past medical history who was diagnosed with signet cell carcinoma of the ileum. Primary signet cell carcinoma of the ileum is extremely rare with a few cases reported in the literature only in the setting of Crohn’s disease or Schistosomiasis.

Case Description/Methods: Our patient is a 42-year-old Hispanic Male with no past medical history who presented with acute, LLQ abdominal pain for one day. It was not associated with nausea, vomiting or changes in bowel habits. However, unintentional weight loss was reported. In the ED, patient was afebrile and his vitals were normal. PE was significant for RLQ mass with no tenderness. Hb was 5.9 g/dL, so 2 units of PRBC were transfused. CT of the abdomen showed extensive thickening of the terminal ileum and ascending colon with pericolic stranding and lymphadenopathy. He was then admitted with a differential diagnosis of intestinal TB, Crohn’s, and lymphoma. CRP, CEA and Calprotectin were high, Intestinal TB was ruled out by a negative QFT. EGD with normal findings and biopsies of the stomach and duodenum were negative. Colonoscopy showed congested, ulcerated mucosa in the ileum, no mass was found, the rest of the colon was normal. Biopsy showed signet-cell carcinoma. Patient was a non-smoker, however he consumed alcohol heavily. Open right hemicolectomy showed a large firm palpable tumor with bulky retroperitoneal lymphadenopathy. Patient completed 12 cycles of FOLFOX. Two months after, the disease recurred on CT imaging, so he received 8 cycles of FOLFIRI/Avastin. Later, patient presented to ED for chest discomfort. Labs demonstrated direct hyperbilirubinemia and cholestatic pattern transaminitis. US of the abdomen showed mild intrahepatic biliary ductal dilation. MRCP showed retroperitoneal mass compressing the CBD. Patient failed stent placement by ERCP due to subtotal obstructive duodenal neoplasm. Consequently, PTC was placed by IR. He later passed away from sepsis.

Discussion: Primary signet cell carcinoma of the ileum might present with microcytic anemia and vague abdominal pain. It can mimic intestinal TB, lymphoma, or Crohn’s disease on radiological and endoscopic findings. Therefore, it should be considered as a differential diagnosis for right or left lower quadrant abdominal pain.




Disclosures:


Farah Heis, MD¹, Jayasree Ravilla, MD², Mahrukh Khan, MD¹. P0260 - Primary Signet Cell Carcinoma of the Ileum: A Rare Differential Diagnosis of Acute Abdominal Pain, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.