Adenocarcinoma of the jejunum: A lesson learned from a delayed diagnosis.

Abstract

A 65-year-old previously healthy woman presented with general malaise, headache, and unintentional weight loss of 7 kg of one-month progression. She sought medical attention in the private sector and the physician documented anemia, with hemoglobin of 4.6 g/dl, mean corpuscular volume of 66.60 fl, and mean corpuscular hemoglobin of 19.60 pg. Considering the diagnosis of hypochromic microcytic anemia, complementary laboratory studies with an iron profile were performed: serum iron, 14.70 g/dl (50--212 g/dl); total iron binding capacity, 501.30 g/dL (155--355 g/dl); ferritin, 11.52 ng/ml (11--306.8 ng/ml); and transferrin saturation index, 2.93% (14--50%). Iron deficiency anemia was suspected, and treatment was begun with oral and intravenous iron. Endoscopy of the proximal gastrointestinal tract, reaching the third portion of the duodenum, was carried out, with normal macroscopic findings. Colonoscopy was performed up to the ileocecal valve with no relevant data. Three months later, the patient continued to present with anemia and general malaise. Bone marrow biopsy and aspirate were carried out that showed adequate development of the 3 hematopoietic lines. Due to symptom persistence, the patient was referred to our hospital center. The initial evaluation revealed hemoglobin of 9.2 g/dl, mean corpuscular volume of 28.2 pg, and reticulocytes of 3.42%. The iron profile showed serum iron, 3 g/g; total iron binding capacity, 237 g/dl; ferritin, 13.6 ng/ml; and transferrin saturation index, 1%. Abdominal computed tomography scan identified jejunal thickening secondary to a lesion with an infiltrating aspect that conditioned partial intestinal obstruction (Fig. 1A). Enteroscopy study revealed an exophytic tumor located 50 cm from the