1/83. Coincidence of Crohn's disease and a high-risk gastrointestinal stromal tumor of the terminal ileum.A 51-year-old male patient presented with characteristic radiologic features of Crohn's disease in the terminal ileum plus a large tumorous lesion in the right lower abdomen. Because of rapid crescent symptoms of bowel obstruction, the patient underwent surgery revealing a high-risk gastrointestinal stromal tumor (GIST) of the terminal ileum within an area of Crohn's ileitis. Whereas the association of chronic inflammatory bowel disease (IBD) and gastrointestinal adenocarcinoma is well known, other primary intestinal tumors are rare in these patients, particularly at the time of onset of clinical symptoms. This is the 3rd patient reported in the literature with a sarcoma complicating IBD, and in fact, the first description of the coincidence of Crohn's disease and GIST. Though the present case is likely to be a mere coincidence of two pathologically distinct entities (without any potential causal relationship), it should remind one of the possibility of small bowel 'Crohn's carcinoma' in patients with a sudden change in symptomatology as well as in those in whom intestinal obstruction fails to resolve with adequate therapy.- - - - - - - - - - ranking = 1keywords = adenocarcinoma (Clic here for more details about this article) |
2/83. pancreatitis associated with Crohn's disease: a premalignant state for cystadenocarcinoma of pancreas?We report a 74-yr-old woman with Crohn's disease and acute pancreatitis who, 3 yr after resolution of the latter, developed cystadenocarcinoma of the pancreas. No drug, toxin, or other etiologies including contiguous duodenal involvement were identified as responsible for the pancreatitis, suggesting that pancreatitis was an extraintestinal manifestation of her Crohn's disease. Could Crohn's-associated pancreatitis be a premalignant state for cystadenocarcinoma of the pancreas?- - - - - - - - - - ranking = 6keywords = adenocarcinoma (Clic here for more details about this article) |
3/83. Case report: adenocarcinoma arising in a Crohn's stricture of the jejunum.patients with Crohn's disease affecting the small intestine appear to have an increased risk of developing adenocarcinoma. However, it remains an uncommon complication of an uncommon disease. The diagnosis is difficult to make both pre- and intra-operatively, and is most commonly made postoperatively on histopathology. Hence, at laparotomy, consideration should be given to performing a frozen section on all small bowel strictures due to Crohn's disease to define the presence of dysplasia or cancer. This will assist the surgeon in deciding whether to perform a stricturoplasty or a resection.- - - - - - - - - - ranking = 5keywords = adenocarcinoma (Clic here for more details about this article) |
4/83. A case of adenocarcinoma of the small intestine in a Japanese patient with Crohn disease: a report with immunohistochemical and oncogenic analyses.We report a rare case of crohn disease accompanied by a small-bowel carcinoma that developed in a 54-year-old Japanese man. The ulcerating tumor, which histologically proved to be a poorly differentiated adenocarcinoma and dysplasia surrounding the carcinoma, was located in the diseased ileum. The Ki-67 immunoreactive epithelial cells were increased in regenerative mucosa as compared with values for normal mucosa. The Ki-67- and p53-positive cells were increased in dysplasia and carcinoma as compared with values for regenerative or normal mucosa. In contrast, the p21(WAF1/CIP1) immunoreactive cells were decreased in this order. Intense DCC (deleted in colorectal cancer) expression was constantly shown among normal, regenerative, dysplastic and cancerous tissues. No bcl-2 expression and c-Ki-ras mutations were apparent. In conclusion, enhanced epithelial cell proliferation, p53 overexpression, and decrease of p21(WAF1/CIP1) expression may predispose the small-bowel mucosa to dysplasia and carcinoma development in crohn disease.- - - - - - - - - - ranking = 5keywords = adenocarcinoma (Clic here for more details about this article) |
5/83. Is Hartmann's procedure safe in Crohn's disease? Report of three cases.INTRODUCTION: Crohn's disease-associated colorectal cancer may occur in an area of defunctioning bowel. Some patients with Crohn's colitis undergo subtotal colectomy, ileostomy, and low Hartmann's procedure in an effort to preserve the rectum. This procedure has also been advocated for patients with severe anorectal Crohn's disease, in whom nonhealing of the perineal wound after proctectomy occurs with alarming frequency. The authors present a review of the literature and three cases of cancer developing in the defunctioning rectal stump despite surveillance proctoscopy. methods: Twenty-five patients underwent low Hartmann's procedure for severe anorectal Crohn's disease. Surveillance proctoscopy was performed as follow-up. Development of cancer in the rectal remnant or anus or recurrence of symptoms was managed by resection and adjuvant therapy. RESULTS: One patient developed squamous-cell carcinoma of the anal canal, underwent resection and adjuvant therapy, and was disease free at the time of this study. Two patients developed adenocarcinoma of the rectum. Both underwent resection and adjuvant therapy. One patient died and the other developed a recurrence. CONCLUSIONS: The authors recommend interval perineal proctectomy in all patients undergoing low Hartmann's procedure for severe anorectal Crohn's disease in whom rectal preservation is not possible. Regularly scheduled interim surveillance proctoscopy performed every two years, with biopsies of macroscopically normal-appearing and abnormal-appearing rectal mucosa and curetting of fistulous tracts, is also recommended to decrease the possibility of missing occult malignancies.- - - - - - - - - - ranking = 1keywords = adenocarcinoma (Clic here for more details about this article) |
6/83. Adenocarcinoma of the rectum with various grades of atypia in association with Crohn's disease: a case report and immunohistochemistry of p53 and Ki-67.A case of adenocarcinoma of the rectum in a 41-year-old woman, in association with Crohn's disease is presented. The patient had suffered diarrhea and constipation, and Crohn's disease was suspected. Although the endoscopy did not reveal the presence of any tumors, biopsy specimens demonstrated adenocarcinoma. A Miles' operation was performed. The adenocarcinoma was composed of various grades of atypia and had invaded the non-peritonealized perirectal tissues. The infiltration of lymphocytes and plasma cells was moderate at the perimeter of the carcinoma and mild in the distant regions. Epithelioid cell granulomas were found. The p53 labeling index (LI) increased with the grade of atypia over the entire length of the carcinomatous gland. In carcinomas with high grade atypia, the p53 LI was high in both the upper and the lower halves of the gland. In carcinomas with low or moderate grade atypia however, the p53 LI was high in the lower half and low in the upper half of the gland. The Ki-67 LI over the entire gland was higher in carcinomas with high grade atypia than in carcinomas with low or moderate grade atypia.- - - - - - - - - - ranking = 3keywords = adenocarcinoma (Clic here for more details about this article) |
7/83. Enterolithiasis in Crohn's disease.Enterolithiasis of the small bowel is unusual. Etiologic factors include stasis secondary to intestinal strictures or diverticula. There have been 19 reported cases of enteroliths associated with Crohn's disease and we report three additional patients. Enteroliths only occur in longstanding Crohn's disease and are important clues to the presence of underlying strictures; they may occur as a result of adenocarcinoma complicating Crohn's disease. The radiologic features of enteroliths are discussed.- - - - - - - - - - ranking = 1keywords = adenocarcinoma (Clic here for more details about this article) |
8/83. Adenocarcinoma at a strictureplasty site in Crohn's disease: report of a case.Strictureplasties have proven useful and safe in Crohn's disease. Concerns have been raised, however, about the potential of carcinoma arising at the strictureplasty site. Here the authors report a case of a small-bowel adenocarcinoma developing at the site of a prior strictureplasty in a middle-aged male patient seven years postoperatively in the absence of any other preneoplastic disease of the small bowel. Presenting symptoms were of progressive obstruction after a long period of quiescent disease. With this report comes stronger evidence that adenocarcinoma does occur at strictureplasty sites, raising questions of its long-term safety.- - - - - - - - - - ranking = 2keywords = adenocarcinoma (Clic here for more details about this article) |
9/83. Adenocarcinoma of the colon developing on the basis of Crohn's disease in childhood.Colorectal carcinoma rarely affects children and has a dismal prognosis with 5-year survival rates as low as 2.5%-7% despite apparently radical surgery. Here we report the case of an adenocarcinoma of the sigmoid colon in a 15-year-old girl preceded by uncertain abdominal complaints of 5 years' duration. Pathological work-up revealed a tumour with lymph node metastases (pT3NI). Immunohistochemical evidence of p53 overexpression by the tumour cells raised the suspicion of an underlying li-fraumeni syndrome. In addition, there were aphthoid ulceration, fissuration of the non-tumorous mucosa, along with a mixed transmural infiltrate composed of macrophages, eosinophils, and non-typical giant cells, which were compatible with simultaneous Crohn's disease. Anamnestic data concerning the occurrence of idiopathic inflammatory bowel disease or colorectal carcinoma in the patient's relatives were non-contributory. The present results suggest a possible relationship between Crohn's disease and colon cancer due to the defective p53 gene product.- - - - - - - - - - ranking = 1keywords = adenocarcinoma (Clic here for more details about this article) |
10/83. Adenocarcinoma at the site of ileoanal anastomosis in Crohn's disease: report of a case.PURPOSE: Proctocolectomy with ileoanal anastomosis has gained acceptance for the treatment of patients with ulcerative colitis. However, there are some patients with Crohn's disease who received ileoanal anastomosis, because some Crohn's colitis is difficult to differentiate from ulcerative colitis. The risk of cancer development at the site of ileoanal anastomosis has not been emphasized in Crohn's disease. methods: A 12-year-old patient with Crohn's disease was treated by proctocolectomy with straight ileoanal anastomosis. Twenty-five years after the operation, the patient noticed the tumor that developed at the site of ileoanal anastomosis. RESULTS: This article presents a patient with Crohn's disease who developed invasive adenocarcinoma at the site of ileoanal anastomosis 25 years after proctocolectomy with ileoanal anastomosis. CONCLUSIONS: An ileoanal anastomosis does not eliminate the risk of cancer development, and surveillance after this operation seems advisable.- - - - - - - - - - ranking = 1keywords = adenocarcinoma (Clic here for more details about this article) |
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