1
|
Ansari AZ, Razzak S, Patibandla S, Kumar S, Hafeez S, Kratz K. Tumefactive Crohn's Disease Mimicking Colon Carcinoma in a Young Female: A Case Report. Cureus 2024; 16:e52221. [PMID: 38347974 PMCID: PMC10861164 DOI: 10.7759/cureus.52221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
Tumefactive Crohn's disease is a rare form of Crohn's disease that may mimic colon carcinoma macroscopically. This case report describes a 28-year-old female who presented with right-sided abdominal pain and a palpable abdominal mass that had persisted for over a month. Multiple hospitalizations failed to provide an accurate diagnosis until an exploratory laparotomy revealed that the "mass" was the cecum and a perforated ascending colon. A partial right colectomy was performed, sending the specimen for biopsy. The microscopic description showed dense and confluent chronic inflammation in the colonic mucosa and wall, extending to the serosa in some regions. The infiltration comprised lymphocytes and plasma cells, with an admixture of some neutrophils. Aphthous mucosal ulcerations, intramural fissures, and fistulas were present. Immunostains for pan-keratin demonstrated no intramural epithelial elements. The characteristics of this lesion represent tumefactive Crohn's disease. This case highlights the key microscopic characteristics that pathologists look for when differentiating Crohn's disease from colon carcinoma in a patient presenting with abdominal pain and a colon mass.
Collapse
Affiliation(s)
- Ali Z Ansari
- Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Sania Razzak
- Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Srihita Patibandla
- Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Sarthak Kumar
- Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Sahar Hafeez
- Clinical Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Kurt Kratz
- Pathology, Merit Health Wesley, Hattiesburg, USA
| |
Collapse
|
2
|
Peixoto RD, Ferreira AR, Cleary JM, Fogacci JP, Vasconcelos JP, Jácome AA. Risk of Cancer in Inflammatory Bowel Disease and Pitfalls in Oncologic Therapy. J Gastrointest Cancer 2023; 54:357-367. [PMID: 35288863 DOI: 10.1007/s12029-022-00816-0] [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] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), represented by ulcerative colitis and Crohn's disease, is an idiopathic condition caused by a dysregulated immune response to host intestinal microflora, leading to chronic relapsing intestinal inflammation. Individuals with IBD are more prone to die from several diseases, including cancer. METHODS An extensive search was conducted of PubMed using the following medical subject heading-"inflammatory bowel disease" OR "Crohn's disease" OR "ulcerative colitis" AND "cancer." RESULTS In this review article, we discuss the oncogenic mechanisms and genomics of colitis-associated colorectal cancer. Beyond this, we describe the multiple other malignancies that IBD patients are at risk for, discuss caveats in the screening and diagnosis of those cancers, and shed light on pitfalls on the management and treatment of cancer in IBD patients. CONCLUSION Patients, caregivers, and health professionals who deal with IBD must be educated on how to identify warning signs so that cancers can be diagnosed and treated as early as possible.
Collapse
|
3
|
Karthikeyan S, Shen J, Keyashian K, Gubatan J. Small bowel adenocarcinoma in neoterminal ileum in setting of stricturing Crohn’s disease: A case report and review of literature. World J Clin Cases 2023; 11:2021-2028. [PMID: 36998944 PMCID: PMC10044945 DOI: 10.12998/wjcc.v11.i9.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Small bowel adenocarcinomas (SBA) are rare malignancies with exceedingly low survival rates, with different presentation in Crohn’s disease (CD). CD-induced SBA poses diagnostic challenges given overlapping presentation with stricturing CD and lack of diagnostics for early detection. Moreover, guidance is lacking on the impact of recently approved therapeutics in CD on SBA management. Here, we aim to highlight the future of CD-induced SBA management and discuss the potential merit of balloon enteroscopy and genetic testing for earlier detection.
CASE SUMMARY We report the case of a 60-year-old female with longstanding Crohn’s ileitis, presenting with acute obstructive symptoms attributed to stricturing phenotype. Her obstructive symptoms were refractory to intravenous (IV) steroids, with further investigation via computed tomography enterography not providing additional diagnostic yield. Ultimately, surgical resection revealed SBA in the neoterminal ileum, with oncologic therapy plan created. However, this therapy plan could not be initiated due to continued obstructive symptoms attributed to active CD. Ultimately, infused biologic therapy was initiated, but her obstructive symptoms continued to remain dependent on IV corticosteroids. Review of diagnostics by a multidisciplinary care team suggested metastatic disease in the peritoneum, lending to a shift in the goals of care to comfort.
CONCLUSION With the diagnostic and therapeutic challenges of concurrent SBA and CD, multidisciplinary care and algorithmic management can optimize outcomes.
Collapse
Affiliation(s)
- Shruthi Karthikeyan
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94306, United States
| | - Jeanne Shen
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94306, United States
| | - Kian Keyashian
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94306, United States
| | - John Gubatan
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94306, United States
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|