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Metachronous, colitis-associated rectal cancer that developed after sporadic adenocarcinoma in an adenoma in a patient with longstanding Crohn's disease: a case report.

Takeyama H, Mizushima T, Nakajima K, Uemura M, Haraguchi N, Nishimura J, Hata T, Takemasa I, Yamamoto H, Doki Y, Mori M - World J Surg Oncol (2013)

Bottom Line: Colorectal cancer associated with Crohn's disease (CD) is increasing in proportion to the number of patients with CD in Japan.Here, we describe a case of metachronous, colitis-associated rectal cancer that developed after the complete resection of an adenoma that became a sporadic adenocarcinoma in a patient with longstanding CD.No signs of recurrence were noted at a follow-up 18 months after the third surgery and 60 months after the second surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Osaka 565-0871, Japan. tmizushima@gesurg.med.osaka-u.ac.jp.

ABSTRACT

Background: Colorectal cancer associated with Crohn's disease (CD) is increasing in proportion to the number of patients with CD in Japan. There are two subtypes of colorectal cancer with CD: sporadic cancer and colitis-associated cancer. Early diagnosis of colitis-associated cancer is sometimes difficult; when colorectal cancer is found in patients with CD, both colitis-associated cancer and sporadic cancer should be kept in mind. Here, we describe a case of metachronous, colitis-associated rectal cancer that developed after the complete resection of an adenoma that became a sporadic adenocarcinoma in a patient with longstanding CD. To the best of our knowledge, this is the first report of colitis-associated cancer in a patient with CD after removal of a sporadic cancer.

Case presentation: We describe a 51-year old man with CD who had difficulty in defecation. A rectal polyp was detected and a transanal resection of the polyp was performed. A histopathological examination showed an adenoma with sporadic adenocarcinoma. After three years, a follow-up colonoscopy revealed a reddish, elevated lesion in the patient's rectum. A colonoscopic biopsy showed a signet ring cell carcinoma. We performed an abdominoperineal resection of the rectum and a bilateral pelvic lymph node dissection. A histopathological examination revealed a mucinous adenocarcinoma with signet ring cell carcinoma and lymph node metastasis. The patient received adjuvant chemotherapy with oral uracil 224 mg combined with tegafur 100 mg plus leucovorin. No signs of recurrence were noted at a follow-up 18 months after the third surgery and 60 months after the second surgery.

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Histopathological images. (A) The polyp was diagnosed as sporadic adenocarcinoma in an adenoma, rather than colitis-associated adenocarcinoma (×200, H & E). (B) Section of tissue that bordered the polyp; there is no dysplasia or inflammation (×100, H & E stain).
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Figure 3: Histopathological images. (A) The polyp was diagnosed as sporadic adenocarcinoma in an adenoma, rather than colitis-associated adenocarcinoma (×200, H & E). (B) Section of tissue that bordered the polyp; there is no dysplasia or inflammation (×100, H & E stain).

Mentions: In August 2008, the patient complained of difficulty in defecation and consulted a physician at our hospital. A colonoscopy examination showed a pedunculated rectal polyp, 4 cm in diameter (Figure 1) and an anal stricture due to proctitis. Histological examination of the biopsy from the lesion showed an adenoma; no dysplasia was detected around the polyp. A transanal resection of the polyp was performed for treatment and final diagnosis (Figure 2). The pathological findings revealed that the polyp was an adenoma with well-differentiated adenocarcinoma without lymphatic or vascular invasion with negative margin of cut end, and that no dysplasia or inflammation was present around the polyp; thus, the polyp was diagnosed as a sporadic adenocarcinoma in an adenoma, rather than a colitis-associated adenocarcinoma (Figure 3). Consistent with the results of the biopsy, an endoscopic exploration showed no dysplasia in the rectal mucosa, and immunohistochemistry showed no p53-staining of the crypt base. These findings were not consistent with colitis-associated CRC (Figure 4). In July 2010, follow-up colonoscopy showed a longitudinal ulcer scar from the descending colon to the ascending colon and stenosis of the ileocolic anastomosis. We did not find any apparent lesion in the rectum.


Metachronous, colitis-associated rectal cancer that developed after sporadic adenocarcinoma in an adenoma in a patient with longstanding Crohn's disease: a case report.

Takeyama H, Mizushima T, Nakajima K, Uemura M, Haraguchi N, Nishimura J, Hata T, Takemasa I, Yamamoto H, Doki Y, Mori M - World J Surg Oncol (2013)

Histopathological images. (A) The polyp was diagnosed as sporadic adenocarcinoma in an adenoma, rather than colitis-associated adenocarcinoma (×200, H & E). (B) Section of tissue that bordered the polyp; there is no dysplasia or inflammation (×100, H & E stain).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225674&req=5

Figure 3: Histopathological images. (A) The polyp was diagnosed as sporadic adenocarcinoma in an adenoma, rather than colitis-associated adenocarcinoma (×200, H & E). (B) Section of tissue that bordered the polyp; there is no dysplasia or inflammation (×100, H & E stain).
Mentions: In August 2008, the patient complained of difficulty in defecation and consulted a physician at our hospital. A colonoscopy examination showed a pedunculated rectal polyp, 4 cm in diameter (Figure 1) and an anal stricture due to proctitis. Histological examination of the biopsy from the lesion showed an adenoma; no dysplasia was detected around the polyp. A transanal resection of the polyp was performed for treatment and final diagnosis (Figure 2). The pathological findings revealed that the polyp was an adenoma with well-differentiated adenocarcinoma without lymphatic or vascular invasion with negative margin of cut end, and that no dysplasia or inflammation was present around the polyp; thus, the polyp was diagnosed as a sporadic adenocarcinoma in an adenoma, rather than a colitis-associated adenocarcinoma (Figure 3). Consistent with the results of the biopsy, an endoscopic exploration showed no dysplasia in the rectal mucosa, and immunohistochemistry showed no p53-staining of the crypt base. These findings were not consistent with colitis-associated CRC (Figure 4). In July 2010, follow-up colonoscopy showed a longitudinal ulcer scar from the descending colon to the ascending colon and stenosis of the ileocolic anastomosis. We did not find any apparent lesion in the rectum.

Bottom Line: Colorectal cancer associated with Crohn's disease (CD) is increasing in proportion to the number of patients with CD in Japan.Here, we describe a case of metachronous, colitis-associated rectal cancer that developed after the complete resection of an adenoma that became a sporadic adenocarcinoma in a patient with longstanding CD.No signs of recurrence were noted at a follow-up 18 months after the third surgery and 60 months after the second surgery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Osaka 565-0871, Japan. tmizushima@gesurg.med.osaka-u.ac.jp.

ABSTRACT

Background: Colorectal cancer associated with Crohn's disease (CD) is increasing in proportion to the number of patients with CD in Japan. There are two subtypes of colorectal cancer with CD: sporadic cancer and colitis-associated cancer. Early diagnosis of colitis-associated cancer is sometimes difficult; when colorectal cancer is found in patients with CD, both colitis-associated cancer and sporadic cancer should be kept in mind. Here, we describe a case of metachronous, colitis-associated rectal cancer that developed after the complete resection of an adenoma that became a sporadic adenocarcinoma in a patient with longstanding CD. To the best of our knowledge, this is the first report of colitis-associated cancer in a patient with CD after removal of a sporadic cancer.

Case presentation: We describe a 51-year old man with CD who had difficulty in defecation. A rectal polyp was detected and a transanal resection of the polyp was performed. A histopathological examination showed an adenoma with sporadic adenocarcinoma. After three years, a follow-up colonoscopy revealed a reddish, elevated lesion in the patient's rectum. A colonoscopic biopsy showed a signet ring cell carcinoma. We performed an abdominoperineal resection of the rectum and a bilateral pelvic lymph node dissection. A histopathological examination revealed a mucinous adenocarcinoma with signet ring cell carcinoma and lymph node metastasis. The patient received adjuvant chemotherapy with oral uracil 224 mg combined with tegafur 100 mg plus leucovorin. No signs of recurrence were noted at a follow-up 18 months after the third surgery and 60 months after the second surgery.

Show MeSH
Related in: MedlinePlus