Colorectal cancer complicating Crohn’s disease: CASE PRESENTATIONS Part 3

Crohn’s disease

Case 5: A 28-year-old man initially noticed bleeding from his rectum in 1965. A sigmoidoscopic examination showed segmental inflammatory changes, and ‘colitis’ was diagnosed; he was treated with sulphasalazine. Symptoms resolved after 14 months, and medications were discontinued.

In 1985, bloody diarrhea recurred; results of fecal cultures and parasite studies were negative. Sulphasalazine was associated with symptom resolution, then recurrence. Colonoscopy showed segmental mucosal inflammatory changes with focal aphthoid and serpiginous ulcers; biopsies showed granulomatous inflammation consistent with Crohn’s disease. In addition, a localized rectal cancer was detected. Low anterior resection showed that the tumour had infiltrated the serosa. Subsequent sulphasalazine treatment was associated with resolution of his diarrhea. Results of a colonoscopy in 1987 were normal, except for the presence of a few scattered aphthoid ulcers; results of biopsies from uninvolved colonic mucosa were normal. Results of laboratory tests, including liver chemistry tests and arcinoembryonic antigen, as well as abdominal-pelvic ultrasound studies, were normal. Cheapest medications online – buy cheap antibiotics for you to get healthy very soon.

Case 6: A 64-year-old male physician developed rectal stump cancer in 1998. ‘Colitis’ was diagnosed in 1958, and a subtotal colectomy was done. An ileostomy was created with a rectal stump. He remained well until 1988, when he was hospitalized for a clinical diagnosis of a bowel obstruction. He was reluctant to have any further surgical treatment. Over the past five years, sigmoidoscopic examinations of a rectal stump revealed some inflammatory changes; there were no granulomas. He was treated with azathioprine, intermittent prednisone and corticosteroid enemas. In 1998, a fistulous tract developed from the apex of the rectal stump to the small bowel, and mucosal biopsies from the rectal stump showed focal dysplastic change. He was referred for a second opinion in 1998. Examination revealed an anorectal stricture, but a flexible sigmoidoscopy showed a diffusely hyperemic and friable rectal mucosa. Biopsies showed dysplastic colonic mucosal changes with invasive rectal carcinoma. An abdominoperineal resection was done, with removal of the rectal stump and fistulous tract. Pathological evaluation showed an infiltrating, moderately differentiated adenocarcinoma extending into the subserosal mesentery; changes of Crohn’s disease with fis-suring ulceration and subserosal abscess formation; and an unexpected focal squamous cell carcinoma at the anorectal junction. Lymph nodes in the resected specimen were negative for any metastatic neoplasm. Subsequently, radiation treatment and a course of chemotherapy were completed.

Category: Gastroenterology

Tags: Colon cancer, Crohn’s disease, Inflammatory bowel disease, Rectal cancer, Rectal stump cancer

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