Signet-ring cell carcinoma of the jejunum diagnosed by double balloon enteroscopy

The small bowel rarely develops neoplasms, accounting for only 1-2% of all gastrointestinal neoplasms. Most cases of jejunal and ileal adenocarcinoma are of well or moderately differentiated type, and other types are rare. This study reports a rare case of signet-ring cell carcinoma of the jejunum diagnosed by double balloon enteroscopy. The patient was a 79-year-old woman who complained of passing tarry stool. Esophagogastroduodenoscopy and total colonoscopy yielded no evidence of gastrointestinal bleeding. Small intestinal barium study demonstrated stenosis with pocket formation in the middle portion of the jejunum. Double balloon enteroscopy was performed to identify the cause of stenosis. Double balloon enteroscopy showed stenosis of the middle portion of the jejunum with pocket formation. The surface of the stenotic portion was covered with shallow ulcerations, but was not markedly irregular. Histologically, the lesion was found to be a signet-ring cell carcinoma of the jejunum. Formation of a lesion of this type may be associated with a rare type of histological morphology such as signet-ring cell carcinoma. The endoscopic findings are important in diagnosing such lesions, and are useful in distinguishing them from other diseases.