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De Deken J, Stavrou GA. Primary adenocarcinoma of an ileostomy in a Crohn patient: a case report. J Surg Case Rep 2022; 2022:rjac609. [PMID: 36601093 PMCID: PMC9803964 DOI: 10.1093/jscr/rjac609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/11/2022] [Indexed: 01/01/2023] Open
Abstract
Proctocolectomy with ileostomy is an established surgical treatment in patients with inflammatory bowel disease. Adenocarcinoma of an ileostomy is a rare complication in long-term ileostomies. We present the case of a 69-year-old man who presented with bloody stools and a tumour at the ileostomy site 37 years after ileostomy formation. Biopsies confirmed the presence of an adenocarcinoma. Imaging did not show any metastases or advanced local infiltration. A resection of the ileostomy with a broad safety margin and reimplantation of a new Ileostomy was performed. At 18-month follow-up, there is no sign of recurrence. Ileostomy adenocarcinoma in a Crohn's disease patient is rare with only four cases described in literature. An en-bloc resection and relocation of the ileostomy is the recommended treatment. Education of patients and healthcare professionals on this long-term ileostomy complication is vital for the early diagnosis and treatment.
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Affiliation(s)
- Julie De Deken
- Correspondence address. Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Winterberg 1, 66119 Saarbrücken, Germany. Tel: +49 681 963 34193; Fax: +49 681 963 2510; E-mail:
| | - Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbrücken, Saarbrücken, Germany
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Kendzia B, Kaerlev L, Ahrens W, Merletti F, Eriksson M, Guénel P, Lynge E, Costa-Pereira A, Morales Suárez-Varela M, Jöckel KH, Stang A, Behrens T. Lifetime Exposure to Welding Fumes and Risk of Some Rare Cancers. Am J Epidemiol 2022; 191:1753-1765. [PMID: 35872594 DOI: 10.1093/aje/kwac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 01/29/2023] Open
Abstract
We investigated the association between exposure to welding fumes and the risk of biliary tract, male breast, bone, and thymus cancer, as well as cancer of the small intestine, eye melanoma, and mycosis fungoides, among men in a European, multicenter case-control study. From 1995-1997, 644 cases and 1,959 control subjects from 7 countries were studied with respect to information on welding and potential confounders. We linked the welding histories of the participants with a measurement-based exposure matrix to calculate lifetime exposure to welding fumes. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models, conditional on country and 5-year age groups, and adjusted for education and relevant confounders. Regular welding was associated with an increased risk of cancer of the small intestine (OR = 2.30, 95% CI: 1.17, 4.50). Lifetime exposure to welding fumes above the median of exposed controls was associated with an increased risk of cancer of the small intestine (OR = 2.00, 95% CI: 1.07, 3.72) and male breast (OR = 2.07, 95% CI: 1.14, 3.77), and some elevation in risk was apparent for bone cancer (OR = 1.92, 95% CI: 0.85, 4.34) with increasing lifetime exposure to welding fumes. Welding fumes could contribute to an increased risk of some rare cancers.
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Chin YH, Jain SR, Lee MH, Ng CH, Lin SY, Mai AS, Muthiah MD, Foo FJ, Sundar R, Ong DEH, Leow WQ, Leong R, Chan WPW. Small bowel adenocarcinoma in Crohn's disease: a systematic review and meta-analysis of the prevalence, manifestation, histopathology, and outcomes. Int J Colorectal Dis 2022; 37:239-250. [PMID: 34704127 DOI: 10.1007/s00384-021-04050-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Small bowel adenocarcinoma (SBA) is a rare neoplasm that is associated with Crohn's disease (CD). This study aims to quantify the prevalence of CD-SBA, review the current evidence of histopathology and molecular analysis findings, and identify the clinical presentation and outcomes of CD-SBA. METHODS Electronic databases Medline and Embase were searched for articles describing SBA in inflammatory bowel disease patients. The histopathology, molecular analysis findings, clinical presentation, prevalence, and outcomes of CD-SBA were extracted, and results were pooled with random effects. RESULTS In total, 33 articles were included in the analysis. Prevalence of SBA was 1.15 (CI: 0.31-2.33) per 1000 CD patients. Only 11% (CI: 0.04-0.21) of CD-SBA patients had observable radiological features. CD-SBA was most commonly found in the ileum (84%), diagnosed at stage 2 (36%), with main presenting complaints including obstruction, weight loss, and abdominal pain. Significant histopathological findings included adjacent epithelial dysplasia, and an equal distribution of well-differentiated (49%) and poorly differentiated subtypes (46%). Most prevalent genetic mutation was KRAS mutation (18%), followed by mismatch repair deficiency (9.7%). The 5-year overall survival for CD-SBA patients was 29% (CI: 0.18-0.41), and 33% (CI: 0.26-0.41) for de novo SBA. No statistically significant increase in risk for CD-SBA was noted for treatment with thiopurines, steroids, and 5-ASA. CONCLUSION Our meta-analysis found the prevalence of CD-SBA to be 1.15 per 1000 CD patients. The 5-year overall survival for CD-SBA was poor. The presenting symptoms were non-specific, and therefore the diagnosis requires a high index of suspicion.
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Affiliation(s)
- Yip Han Chin
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ming Hui Lee
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
| | - Aaron Shengting Mai
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Fung Joon Foo
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
- Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Raghav Sundar
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
- Department of Haematology-Oncology, National University Health System, Singapore, Singapore
| | - David Eng Hui Ong
- Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore, 117597, Singapore
- National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
| | - Wei Qiang Leow
- Division of Pathology, Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
- Department of Anatomical Pathology, Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Rupert Leong
- The University of Sydney, Sydney, NSW, Australia
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Webber Pak Wo Chan
- Department of Gastroenterology, Singapore General Hospital, 16 College Road, Block 6 Level 6, Singapore, 169854, Singapore.
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Lynge E, Kaerlev L, Olsen J, Sabroe S, Afonso N, Ahrens W, Eriksson M, Merletti F, Morales-Suarez-Varelas M, Stengrevics A, Guénel P. Rare cancers of unknown etiology: lessons learned from a European multi-center case-control study. Eur J Epidemiol 2020; 35:937-948. [PMID: 32681390 PMCID: PMC7524829 DOI: 10.1007/s10654-020-00663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/10/2020] [Indexed: 11/05/2022]
Abstract
Rare cancers together constitute one fourth of cancers. As some rare cancers are caused by occupational exposures, a systematic search for further associations might contribute to future prevention. We undertook a European, multi-center case–control study of occupational risks for cancers of small intestine, bone sarcoma, uveal melanoma, mycosis fungoides, thymus, male biliary tract and breast. Incident cases aged 35–69 years and sex-and age-matched population/colon cancer controls were interviewed, including a complete list of jobs. Associations between occupational exposure and cancer were assessed with unconditional logistic regression controlled for sex, age, country, and known confounders, and reported as odds ratios (OR) with 95% confidence intervals (CI). Interviewed were 1053 cases, 2062 population, and 1084 colon cancer controls. Male biliary tract cancer was associated with exposure to oils with polychlorinated biphenyls; OR 2.8 (95% CI 1.3–5.9); male breast cancer with exposure to trichloroethylene; OR 1.9 (95% CI 1.1–3.3); bone sarcoma with job as a carpenter/joiner; OR 4.3 (95% CI 1.7–10.5); and uveal melanoma with job as a welder/sheet metal worker; OR 1.95 (95% CI 1.08–3.52); and cook; OR 2.4 (95% CI 1.4–4.3). A confirmatory study of printers enhanced suspicion of 1,2-dichloropropane as a risk for biliary tract cancer. Results contributed to evidence for classification of welding and 1,2-dichloropronane as human carcinogens. However, despite efforts across nine countries, for some cancer sites only about 100 cases were interviewed. The Rare Cancer Study illustrated both the strengths and limitations of explorative studies for identification of etiological leads.
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Affiliation(s)
- Elsebeth Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Ejegodvej 63, 4800, Nykøbing Falster, Denmark.
| | - Linda Kaerlev
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, 5000, Odense C, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Svend Sabroe
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Noemia Afonso
- Serviço de Oncologia, Centro Hospitalar E Universitário Do Porto, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Wolfgang Ahrens
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany.,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, E 28359, Bremen, Germany
| | - Mikael Eriksson
- Skane University Hospital and Lund University, Entrégatan 7, 222 42, Lund, Sweden
| | - Franco Merletti
- Cancer Epidemiology, Department of Medical Sciences, University of Turin, Via Santena 7, 10126, Torino, Italy
| | - Maria Morales-Suarez-Varelas
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, Avenida Vicente Andres Estellés s/n Burjassot, S46100, Valencia, Spain.,Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | | | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Cancer and Environment team, Inserm U1018, Université Paris Sud, Université Paris Saclay, 16 avenue Paul Vaillant-Couturier, 94800, Villejuif, France
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Barral M, Dohan A, Allez M, Boudiaf M, Camus M, Laurent V, Hoeffel C, Soyer P. Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings. Crit Rev Oncol Hematol 2016; 97:30-46. [DOI: 10.1016/j.critrevonc.2015.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 06/15/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022] Open
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Cahill C, Gordon PH, Petrucci A, Boutros M. Small bowel adenocarcinoma and Crohn's disease: Any further ahead than 50 years ago? World J Gastroenterol 2014; 20:11486-11495. [PMID: 25206256 PMCID: PMC4155342 DOI: 10.3748/wjg.v20.i33.11486] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
This review of the literature on small bowel carcinoma associated with Crohn’s disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn’s disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn’s disease.
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Tavani A, Rosato V, Di Palma F, Bosetti C, Talamini R, Dal Maso L, Zucchetto A, Levi F, Montella M, Negri E, Franceschi S, La Vecchia C. History of cholelithiasis and cancer risk in a network of case-control studies. Ann Oncol 2012; 23:2173-2178. [PMID: 22231026 DOI: 10.1093/annonc/mdr581] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND We analyzed the relationship between cholelithiasis and cancer risk in a network of case-control studies conducted in Italy and Switzerland in 1982-2009. METHODS The analyses included 1997 oropharyngeal, 917 esophageal, 999 gastric, 23 small intestinal, 3726 colorectal, 684 liver, 688 pancreatic, 1240 laryngeal, 6447 breast, 1458 endometrial, 2002 ovarian, 1582 prostate, 1125 renal cell, 741 bladder cancers, and 21 284 controls. The odds ratios (ORs) were estimated by multiple logistic regression models. RESULTS The ORs for subjects with history of cholelithiasis compared with those without were significantly elevated for small intestinal (OR=3.96), prostate (OR=1.36), and kidney cancers (OR=1.57). These positive associations were observed ≥10 years after diagnosis of cholelithiasis and were consistent across strata of age, sex, and body mass index. No relation was found with the other selected cancers. A meta-analysis including this and three other studies on the relation of cholelithiasis with small intestinal cancer gave a pooled relative risk of 2.35 [95% confidence interval (CI) 1.82-3.03]. CONCLUSION In subjects with cholelithiasis, we showed an appreciably increased risk of small intestinal cancer and suggested a moderate increased risk of prostate and kidney cancers. We found no material association with the other cancers considered.
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Affiliation(s)
- A Tavani
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan.
| | - V Rosato
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan
| | - F Di Palma
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan
| | - C Bosetti
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan
| | - R Talamini
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano
| | - L Dal Maso
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano; Department of Occupational Health, University of Milan, Milan, Italy
| | - A Zucchetto
- Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano
| | - F Levi
- Cancer Epidemiology Unit and Registre Vaudois des Tumeurs, Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland
| | - M Montella
- Unit of Epidemiology, Istituto Tumori "Fondazione Pascale", Naples, Italy
| | - E Negri
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan
| | - S Franceschi
- International Agency for Research on Cancer, Lyon
| | - C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan; Department of Occupational Health, University of Milan, Milan, Italy; International Prevention Research Institute, Lyon, France
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Kamiya T, Ando T, Ishiguro K, Maeda O, Watanabe O, Hibi S, Mimura S, Ujihara M, Hirayama Y, Nakamura M, Miyahara R, Ohmiya N, Goto H. Intestinal cancers occurring in patients with Crohn's disease. J Gastroenterol Hepatol 2012; 27 Suppl 3:103-7. [PMID: 22486881 DOI: 10.1111/j.1440-1746.2012.07082.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS The number of patients with Crohn's disease (CD) and the number of cases of intestinal cancer associated with CD have both been increasing in Japan. However, the number of reported cases is lower than for ulcerative colitis-associated cancer. The aim of this study was to identify the clinical picture of CD-associated intestinal cancer in a consecutive series of patients with CD and to stress the importance of surveillance. METHODS We enrolled 174 consecutive patients (130 men, 44 women, mean age 25 years) diagnosed with CD and investigated the development of intestinal cancer from October 1998 to July 2010. There were 104 cases of the ileocolitis type, 47 of ileitis, and 23 of colitis. RESULTS Intestinal cancer developed in two male patients (1.5% of the total), whose respective ages at onset of CD were 41 and 19 years, and 55 and 37 years at onset of cancer. Both cases were of ileocolitis-type CD; one cancer developed in the rectum and the other in the small bowel, and both were accompanied by severe stricture. Histopathological results revealed well and moderately differentiated adenocarcinoma, respectively. CONCLUSIONS Intestinal cancer developed in patients with ileocolitis-type CD of more than 10 years' duration. Our findings suggest that patients with chronic, widespread CD should be under cancer surveillance.
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Affiliation(s)
- Toru Kamiya
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Halfdanarson TR, McWilliams RR, Donohue JH, Quevedo JF. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg 2010; 199:797-803. [PMID: 20609724 DOI: 10.1016/j.amjsurg.2009.05.037] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 04/27/2009] [Accepted: 05/04/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The optimal treatment of small bowel adenocarcinoma is unknown. METHODS The records of 491 patients with small bowel adenocarcinoma diagnosis between 1970 and 2005 were reviewed for patient and tumor characteristics, treatment effects, and survival. RESULTS The median age at diagnosis was 62 years. The most common tumor locations were the duodenum (57%), jejunum (29%), and ileum (10%). The median overall survival was 20.1 months, with a 5-year overall survival of 26%. Greater age, male sex, higher stage and grade, residual disease after resection, and a lymph node ratio of 50% or greater predicted decreased overall survival in univariate analysis. Age and stage were predictive of survival in multivariate analysis. The overall survival with metastatic disease was poor. Adjuvant therapy was not associated with longer overall survival (P = .44). CONCLUSIONS The prognosis of patients with small bowel adenocarcinoma is poor. Complete resection provides the only means of cure, and the role for adjuvant therapy remains uncertain.
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Kodaira C, Osawa S, Mochizuki C, Sato Y, Nishino M, Yamada T, Takayanagi Y, Takagaki K, Sugimoto K, Kanaoka S, Furuta T, Ikuma M. A case of small bowel adenocarcinoma in a patient with Crohn’s disease detected by PET/CT and double-balloon enteroscopy. World J Gastroenterol 2009; 15:1774-8. [PMID: 19360924 PMCID: PMC2668786 DOI: 10.3748/wjg.15.1774] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) in patients with Crohn’s disease (CD) is quite rare, difficult to diagnose without surgery, and has a poor prognosis. Here, we report a 48-year-old man with SBA and a 21-year history of CD who was diagnosed by a combination of positron emission tomography/computed tomography (PET/CT) and double-balloon enteroscopy (DBE). Since the age of 27 years, the patient had been treated for ileal CD and was referred to our hospital with persistent melena. Multiple hepatic tumors were found by CT. PET/CT detected an accumulation spot in the small bowel. DBE revealed an ulcerative tumor in the ileum about 100 cm from the ileocecal valve. An endoscopic forceps biopsy specimen showed poorly differentiated adenocarcinoma. There were some longitudinal ulcer scars near the tumor, and the chronic inflammation in the small bowel appeared to be associated with the cancer development. Previous reports suggest the risk of SBA in patients with CD is higher than in the overall population. Since early diagnosis is extremely difficult in these cases, novel techniques, such as PET/CT and DBE, may be expected to help in making a preoperative diagnosis of the development of SBA in CD.
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Tougeron D, Lefebure B, Savoye G, Tuech JJ, di Fiore F, Michel P. Small-bowel adenocarcinoma in patient with Crohn's disease: report of a series of three cases. Scand J Gastroenterol 2009; 43:1397-400. [PMID: 18609183 DOI: 10.1080/00365520801918042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients affected with Crohn's disease (CD) have a recognized, but low relative risk of developing small-bowel adenocarcinoma (SBA). In fact, SBA develops in 2.2% of patients who have long-standing CD and it is seldom diagnosed preoperatively because of its rarity. A retrospective analysis of all cases of SBA in CD patients since 1980 was carried out in Rouen University Hospital. Three patients with known or unknown CD who presented with SBA with long-term follow-up were analysed. In our first case, the occlusive syndrome revealed SBA and CD simultaneously. Most ileal carcinomas in CD are located in strictures and are often incidentally diagnosed postoperatively, as in our three cases. Digestive surgeons and gastroenterologists must be aware that the diagnosis of SBA in CD is often made fortuitously on histological examination after surgical resection for an occlusive syndrome. Failure to detect SBA in patients with CD results in late diagnosis, with poor survival.
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Affiliation(s)
- David Tougeron
- Department of Hepatogastroenterology, Rouen University Hospital, Northwest Canceropole, France.
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Reddy VB, Aslanian H, Suh N, Longo WE. Asymptomatic ileal adenocarcinoma in the setting of undiagnosed Crohn’s disease. World J Gastroenterol 2008; 14:4690-3. [PMID: 18698685 PMCID: PMC2738795 DOI: 10.3748/wjg.14.4690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 53-year old previously healthy male underwent a screening colonoscopy for detection of a potential colorectal neoplasm. The terminal ileum was intubated and a mass was noted. Examination of the colon was normal. The biopsy of the ileal mass was consistent with an adenocarcinoma arising from the terminal ileum. His father who had never been previously ill from gastrointestinal disease died of natural causes, but was found to have Crohn’s disease postmortem. The patient underwent exploratory laparotomy and a right hemicolectomy with a 30 cm section of terminal ileum in continuity. Findings were consistent with ileal adenocarcinoma in the setting of Crohn’s disease. The patient made an uneventful recovery. The pathology was stage 1 adenocarcinoma. This is a unique case in that on a screening colonoscopy, a favorable ileal adenocarcinoma was discovered in the setting of asymptomatic, undiagnosed ileal Crohn’s disease in a patient whose father had Crohn’s disease diagnosed postmortem.
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13
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Ahrens W, Timmer A, Vyberg M, Fletcher T, Guénel P, Merler E, Merletti F, Morales M, Olsson H, Olsen J, Hardell L, Kaerlev L, Raverdy N, Lynge E. Risk factors for extrahepatic biliary tract carcinoma in men: medical conditions and lifestyle: results from a European multicentre case-control study. Eur J Gastroenterol Hepatol 2007; 19:623-30. [PMID: 17625430 DOI: 10.1097/01.meg.0000243876.79325.a1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To identify risk factors of carcinoma of the extrahepatic biliary tract in men. METHODS Newly diagnosed and histologically confirmed patients, 35-70 years old, were interviewed between 1995 and 1997 in Denmark, Sweden, France, Germany and Italy. Population controls were frequency-matched by age and region. Adjusted odds ratios and 95%-confidence intervals were estimated by logistic regression. RESULTS The analysis included 153 patients and 1421 controls. The participation proportion was 71% for patients and 61% for controls. Gallstone disease was corroborated as a risk factor for extrahepatic biliary tract carcinoma in men (odds ratio 2.49; 95% confidence interval 1.32-4.70), particularly for gall bladder tumors (odds ratio 4.68; 95% confidence interval 1.85-11.84). For a body mass index [height (m) divided by squared weight (kg2)] >30 at age 35 years, an excess risk was observed (odds ratio 2.58; 95% confidence interval 1.07-6.23, reference: body mass index 18.5-25) that was even stronger if the body mass index was >30 for the lowest weight in adulthood (odds ratio 4.68; 95% confidence interval 1.13-19.40). Infection of the gall bladder, chronic inflammatory bowel disease, hepatitis or smoking showed no clear association, whereas some increase in risk was suggested for consumption of 40-80 g alcohol per day and more. CONCLUSIONS Our study corroborates gallstones as a risk indicator in extrahepatic biliary tract carcinoma. Permanent overweight and obesity in adult life was identified as a strong risk factor for extrahepatic biliary tract carcinoma, whereas we did not find any strong lifestyle-associated risk factors. Inconsistent results across studies concerning the association of extrahepatic biliary tract carcinoma with overweight and obesity may be explained by the different approaches to assess this variable.
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Affiliation(s)
- Wolfgang Ahrens
- Bremen Institute for Prevention Research and Social Medicine, University Bremen, Germany.
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14
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Shack LG, Wood HE, Kang JY, Brewster DH, Quinn MJ, Maxwell JD, Majeed A. Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival. Aliment Pharmacol Ther 2006; 23:1297-306. [PMID: 16629934 DOI: 10.1111/j.1365-2036.2006.02891.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Time trends in mortality from small intestinal cancer have not been studied for the 1990s. OBJECTIVE To examine secular trends in incidence of, mortality from, and survival from, small intestinal cancer in England & Wales and Scotland from 1975 to 2002, considering also histological type (incidence), subsite (incidence) and indices of social deprivation (incidence and survival). METHODS Data were extracted from the Scottish Cancer Registry database and the General Register Office for Scotland, and from the National Cancer Intelligence Centre at the Office for National Statistics for England & Wales. RESULTS Incidence rates for small intestinal cancer increased for both England & Wales and Scotland over the study period. They were highest among older individuals and generally greater for males than for females. Despite the increase in incidence rates, mortality rates from small intestinal tumours tended to remain stable over the study period, and the general trend was towards increasing survival. Indices of social deprivation were not obviously related to the incidence of small intestinal cancer and did not influence survival. CONCLUSIONS Incidence rates for small intestinal cancer for both England & Wales and Scotland increased in the last quarter of the 20th century, but survival rates improved and mortality rates declined.
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Affiliation(s)
- L G Shack
- Scottish Cancer Registry, Information & Statistics Division, Edinburgh, UK
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15
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Kronberger IE, Graziadei IW, Vogel W. Small bowel adenocarcinoma in Crohn’s disease: A case report and review of literature. World J Gastroenterol 2006; 12:1317-20. [PMID: 16534894 PMCID: PMC4124452 DOI: 10.3748/wjg.v12.i8.1317] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Small bowel adenocarcinomas are remarkable for their rarity, difficult diagnosis and poor prognosis. Here we report an unusual case of a 33-year-old patient in whom infiltrative adenocarcinoma of the small bowel was diagnosed after a 10-year history of Crohn’s disease. In most previously reported cases, detection of Crohn’s disease was subsequent to that of carcinoma of the small bowel or the patients involved had an even longer history of the disease. Our literature review suggests that the risk of small bowel adenocarcinoma is higher in patients with Crohn’s disease than in the overall population. We present details on epidemiology as well as clinical and diagnostic aspects of this rare disease entity.
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Affiliation(s)
- Irmgard E Kronberger
- Department of Gastroenterology and Hepatology, Anichstrasse 35, A-6020 Innsbruck, Austria.
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16
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Merletti F, Richiardi L, Bertoni F, Ahrens W, Buemi A, Costa-Santos C, Eriksson M, Guénel P, Kaerlev L, Jöckel KH, Llopis-Gonzalez A, Merler E, Miranda A, Morales-Suárez-Varela MM, Olsson H, Fletcher T, Olsen J. Occupational factors and risk of adult bone sarcomas: a multicentric case-control study in Europe. Int J Cancer 2006; 118:721-7. [PMID: 16108052 DOI: 10.1002/ijc.21388] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We investigated the association between occupational factors and risk of bone sarcoma, a rare tumor with a largely unknown aetiology. A multicentric case-control study was conducted in 7 European countries in 1995-97. Ninety-six cases aged 35-69 years with a centrally reviewed diagnosis of bone sarcoma (68 chondrosarcomas and 28 osteosarcomas) were compared to 2,632 population (68%) or colon cancer (32%) controls. Subjects were interviewed to obtain information on occupational, medical and reproductive history, smoking and alcohol consumption and selected exposures including use of pesticides. Response proportions were 90% among cases and 66% among controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for selected categories of job titles and branches of industry and for use of pesticides. We found an increased OR for bone sarcoma among blacksmiths, toolmakers, machine-tool operators (OR = 2.14, 95% CI 1.08-4.26), woodworkers (OR = 2.68, 95% CI 1.36-5.29) and construction workers (OR = 1.62, 95% CI 0.92-2.87). Ever users of pesticide had an OR of 2.33 (95% CI 1.31-4.13), with similar risks for exposure to insecticides and exposure to herbicides. Neither duration of employment in any of the analyzed occupational categories nor duration of use of pesticides showed an increasing trend in the risk of bone sarcoma. ORs of bone sarcoma were 1.03 (95% CI 0.23-4.57), 3.13 (95% CI 1.26-7.76) and 1.44 (95% CI 0.43-4.85) for the first, second and third tertile of days of use of pesticides. Our study suggests that novel and previously reported (woodworking) occupational factors play a role in the aetiology of bone sarcomas.
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Affiliation(s)
- Franco Merletti
- Cancer Epidemiology Unit, CERMS and Centre for Oncologic Prevention, University of Turin, Turin, Italy
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17
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Shenderey RL, Thompson N, Mansfield JC, Rees C. Adenocarcinoma as a complication of small bowel Crohn's disease. Eur J Gastroenterol Hepatol 2005; 17:1255-7. [PMID: 16215441 DOI: 10.1097/00042737-200511000-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Carcinoma is a recognized but rare complication of small bowel Crohn's disease. This case series emphasizes the importance of considering this diagnosis in patients with small bowel Crohn's disease. We report three cases in which patients were treated for presumed exacerbations of Crohn's, but were subsequently found to have underlying small bowel adenocarcinoma. This case series will demonstrate the need for the surgical assessment of patients with long-standing symptomatic Crohn's disease that fails to settle with conservative management.
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18
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Palascak-Juif V, Bouvier AM, Cosnes J, Flourié B, Bouché O, Cadiot G, Lémann M, Bonaz B, Denet C, Marteau P, Gambiez L, Beaugerie L, Faivre J, Carbonnel F. Small bowel adenocarcinoma in patients with Crohn's disease compared with small bowel adenocarcinoma de novo. Inflamm Bowel Dis 2005; 11:828-32. [PMID: 16116317 DOI: 10.1097/01.mib.0000179211.03650.b6] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data concerning small bowel adenocarcinoma (SBA) in Crohn's disease (CD) come from case reports and small retrospective series. The aim of this study was to further describe SBA in patients with CD and compare it with SBA de novo. METHODS Twenty patients with CD with SBA recruited in French university hospitals were studied and compared with 40 patients with SBA de novo recruited from a population-based registry. SBA occurred after a median time of 15 years of CD and was located within the inflamed areas of the ileum (n=19) or jejunum (n=1), whereas in patients with SBA de novo, it was distributed all along the small intestine. Median age at diagnosis of SBA was 47 years (range, 33-72 yr) in patients with CD and 68 years (range, 41-95 yr) in those with SBA de novo. RESULTS The cumulative risk of SBA, assessed in a subgroup of patients, was 0.2% and 2.2% after 10 and 25 years of ileal CD, respectively. SBA accounted for 25% and 45% of the risk of gastrointestinal carcinoma after 10 and 25 years of CD, respectively. Diagnosis was made preoperatively in 1/20 patients with CD and 22/40 patients with SBA de novo. Signet ring cells were found in 35% of patients with CD but not in patients with SBA de novo. Relative survival was not significantly different in these 2 categories of patients (54 versus 37% and 35 versus 30% in patients with and without CD at 2 and 5 yr, respectively). CONCLUSIONS SBA in CD is different from SBA de novo. It arises from longstanding ileal inflammation and is difficult to diagnose. SBA cumulative risk increases after 10 years of CD and is likely to cause premature mortality in patients with early-onset CD.
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19
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Achneck HE, Wong IY, Kim PJ, Fernandes MA, Walther Z, Seymour NE, Jain D. Ileostomy adenocarcinomas in the setting of ulcerative colitis. J Clin Gastroenterol 2005; 39:396-400. [PMID: 15815208 DOI: 10.1097/01.mcg.0000159216.39795.4a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Adenocarcinomas arising at ileostomy sites in patients after colon resection for various diseases, such as ulcerative colitis (UC), familial adenomatous polyposis coli, and Crohn's disease, are rare occurrences but have been reported increasingly in the last 20 years. We report a case of adenocarcinoma arising in an ileostomy site in an 85-year-old woman with longstanding UC. She had pancolitis and underwent total proctocolectomy. Thirty-nine years later, her ileostomy site developed a granulation tissue-type lesion, which on initial biopsy revealed cytologic atypia in the presence of marked inflammation. A subsequent biopsy revealed adenocarcinoma with signet-ring cells and abundant extracellular mucin. Resection of the ileostomy was undertaken and a new ileostomy was performed. The literature on adenocarcinoma arising in the 23 patients with ulcerative colitis who received a Brooke or Kock ileostomy and had no prior history of neoplasm is reviewed.
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Affiliation(s)
- Hardean E Achneck
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8023, USA
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20
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Lynge E, Afonso N, Kaerlev L, Olsen J, Sabroe S, Ahrens W, Eriksson M, Guénel P, Merletti F, Stengrevics A, Suarez-Varela M, Costa-Pererra A, Vyberg M. European multi-centre case-control study on risk factors for rare cancers of unknown aetiology. Eur J Cancer 2005; 41:601-12. [PMID: 15737566 DOI: 10.1016/j.ejca.2004.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Revised: 11/12/2004] [Accepted: 12/16/2004] [Indexed: 11/29/2022]
Abstract
To search for occupational risk factors, we conducted a case-control study in nine European countries of cancers of the small intestine, male gall bladder, thymus, bone, male breast, melanoma of the eye, and mycosis fungoides. Recruitment was population based in Denmark, Latvia, France, Germany, Italy, and Sweden, from hospital areas in Spain and Portugal, and from one United Kingdom (UK) hospital. We recruited 1457 cases (84% interviewed). Numbers identified corresponded to those in the EUROCIM database for Denmark, but were below those observed for France, Italy and Sweden in the database. We recruited 3374 population (61% interviewed) and 1284 colon cancer controls (86% interviewed). It was possible to undertake this complicated study across Europe, but we encountered three main problems. It was difficult to ensure complete case ascertainment, for population controls, we found a clear divide in the response rate from 75% in the South to only 55% in the North, and a somewhat selective recruitment was noted for the colon cancer controls. The study showed there is a clear dose-response relationship between alcohol intake and the risk of male breast cancer, and an excess risk of mycosis fungoides among glass formers, pottery and ceramic workers. Further data are expected.
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Affiliation(s)
- Elsebeth Lynge
- Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK 2200 København N, Denmark.
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21
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Delaunoit T, Neczyporenko F, Limburg PJ, Erlichman C. Small Bowel Adenocarcinoma: A Rare but Aggressive Disease. Clin Colorectal Cancer 2004; 4:241-8; discussion 249-51. [PMID: 15555205 DOI: 10.3816/ccc.2004.n.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Unlike the colon and rectum, the small intestine is associated with a very low rate of tumor occurrence. Adenocarcinomas represent the most frequent of these rare digestive tumors and are often fatal as a result of tardy diagnosis. Regardless of the stage, surgery usually remains the cornerstone of small bowel adenocarcinoma therapy. Because of the rarity of the disease, very few significant clinical trials have identified any efficient nonsurgical treatment; however, recent data indicate these tumors might be sensitive to chemotherapy alone or in association with radiation therapy. Conversely, a great deal of progress has been achieved in diagnosis of the tumor, whether by adaptation of existing techniques or development of new ones. We reviewed the clinical aspects of this rare but aggressive disease, focusing on new diagnostic procedures as well as on recent advances in their therapeutic management.
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22
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Abstract
Celiac disease remains a challenge to the clinician and scientist. It is clearly more prevalent than was previously suspected. Much interest is seen in identifying the genetic factors, which predispose to disease and the environmental agents that can trigger it. Genome-wide searches have identified a number of chromosomal susceptibility loci. Specific gliadin epitopes are being analyzed. New diagnostic options include the tissue transglutaminase enzyme-linked immunosorbent assay. Neurologic disease and bone disease are intriguing complications of celiac disease and are gradually being defined.
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Affiliation(s)
- Jason S R Jennings
- Academic Unit of General Surgery, Medicine, and Anaesthesia, St. James's University Hospital, Leeds, United Kingdom.
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23
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Abstract
Despite the apparent continuous increase of the incidence of inflammatory bowel disease (IBD) in some populations, or some sections of populations such as British children, the origin of these conditions remains obscure. Epidemiological studies of specific risk factors continue to yield contradictory and inconclusive results. However, studies of exposure and comorbidity, coupled with genetic and molecular studies, expand our knowledge and will facilitate more sophisticated research in the near future. Our understanding of the genetic basis of IBD is improving, but genetic anticipation as an explanation for increasing incidence rates appears less probable. The benefit of giving up smoking has been demonstrated in Crohn's disease patients, because smoking influences disease activity. The increased cancer risk in IBD is a concern, but despite this, the overall mortality in IBD is no higher than that of the general population.
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Affiliation(s)
- Scott M Montgomery
- Enheten för Klinisk Epidemiologi, Institutionen för medicin vid Karolinska Sjukhuset, Karolinska Institutet, Stockholm, Sweden.
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