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Early Diagnosis of a Small Adenocarcinoma in a Rectovaginal Fistula Related to Crohn's Disease.

Narasimhulu DM, Serur A, Khulpateea N - ACG Case Rep J (2015)

Bottom Line: While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases.We report a 73-year-old woman with Crohn's disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula.This rare disease poses many diagnostic challenges.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.

ABSTRACT
While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases. We report a 73-year-old woman with Crohn's disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula. This rare disease poses many diagnostic challenges.

No MeSH data available.


Related in: MedlinePlus

PET-CT showing increased uptake in the area of the fistula.
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Figure 2: PET-CT showing increased uptake in the area of the fistula.

Mentions: Proctoscopic examination revealed a distal rectum stenosis and irregularity of the anterior rectal wall, but the fistulous opening was not clearly visualized. Examination of the vagina revealed granularity of the posterior wall and a fistulous opening. Rectal and vaginal biopsies were negative for malignancy. A magnetic resonance imaging (MRI) study revealed a T2 hyperintense rectovaginal fistula surrounded by a 1.6 x 1.3-cm minimally enhancing soft tissue nodule (Figure 1). Positron emission tomography–computed tomography (PET-CT) showed linear uptake in the area of the fistula without evidence of local or distant spread (Figure 2). The patient underwent posterior exenteration with removal of her rectum, anus, posterior vaginal wall, uterus, fallopian tubes, and ovaries. Pathology revealed high-grade adenocarcinoma involving the rectovaginal fistula, 1.2 mm in greatest dimension, and 0.8-mm invasion into the perineal body (Figure 3). The vagina, rectum, pelvic lymph nodes, and excision margins were negative for tumor. The patient opted not to receive postoperative chemotherapy given the disease was diagnosed at an early stage and surgical margins were negative. The patient has no evidence of disease at follow-up 10 months later.


Early Diagnosis of a Small Adenocarcinoma in a Rectovaginal Fistula Related to Crohn's Disease.

Narasimhulu DM, Serur A, Khulpateea N - ACG Case Rep J (2015)

PET-CT showing increased uptake in the area of the fistula.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508951&req=5

Figure 2: PET-CT showing increased uptake in the area of the fistula.
Mentions: Proctoscopic examination revealed a distal rectum stenosis and irregularity of the anterior rectal wall, but the fistulous opening was not clearly visualized. Examination of the vagina revealed granularity of the posterior wall and a fistulous opening. Rectal and vaginal biopsies were negative for malignancy. A magnetic resonance imaging (MRI) study revealed a T2 hyperintense rectovaginal fistula surrounded by a 1.6 x 1.3-cm minimally enhancing soft tissue nodule (Figure 1). Positron emission tomography–computed tomography (PET-CT) showed linear uptake in the area of the fistula without evidence of local or distant spread (Figure 2). The patient underwent posterior exenteration with removal of her rectum, anus, posterior vaginal wall, uterus, fallopian tubes, and ovaries. Pathology revealed high-grade adenocarcinoma involving the rectovaginal fistula, 1.2 mm in greatest dimension, and 0.8-mm invasion into the perineal body (Figure 3). The vagina, rectum, pelvic lymph nodes, and excision margins were negative for tumor. The patient opted not to receive postoperative chemotherapy given the disease was diagnosed at an early stage and surgical margins were negative. The patient has no evidence of disease at follow-up 10 months later.

Bottom Line: While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases.We report a 73-year-old woman with Crohn's disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula.This rare disease poses many diagnostic challenges.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.

ABSTRACT
While adenocarcinomas have occasionally been reported in perianal fistulae, malignant changes occurring in rectovaginal fistulae are rare, with only a handful of reported cases. We report a 73-year-old woman with Crohn's disease who was diagnosed at an early stage with adenocarcinoma in a rectovaginal fistula. This rare disease poses many diagnostic challenges.

No MeSH data available.


Related in: MedlinePlus