Adenocarcinoma Arising from Chronic Perianal Crohn's Disease: Case Report and Review of the Literature

Perianal disease is a common manifestation of Crohn's disease. Rarely malignancy arises in perianal fistulas. The etiology of fistula related cancer remains a subject of debate. We present a unique case of a perianal Crohn's disease with adenomatous epithelialization of a fistula tract and an associated mucinous adenocarcinoma. Our case demonstrates that mucinous adenocarcinoma can arise in long standing perianal Crohn's disease and may be associated with adenomatous transformation of the epithelial lining of the fistula tract.

Download Full-text

DOP058 Does biologic therapy increase the risk for fistula-associated mucinous adenocarcinoma in long standing perianal Crohn's disease?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjx002.095 ◽

2017 ◽

Vol 11 (suppl_1) ◽

pp. S60-S61

Author(s):

S. Laureti ◽

M. Coscia ◽

L. Gentilini ◽

P. Gionchetti ◽

N. Renzi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Mucinous Adenocarcinoma ◽

Biologic Therapy ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

Download Full-text

Adalimumab and perianal Crohn's disease: Case report

Digestive and Liver Disease Supplements ◽

10.1016/s1594-5804(11)60011-9 ◽

2010 ◽

Vol 4 (1) ◽

pp. 31-33

Author(s):

Mariabeatrice Principi ◽

Nicola De Tullio ◽

Alfredo di Leo

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Crohn's Disease ◽

Perianal Crohn’S Disease ◽

Disease Case ◽

Perianal Crohn's Disease

Download Full-text

The role of pelvic MRI in assessment of combined surgical and Infliximab treatment for perianal Crohn's disease

Acta chirurgica iugoslavica ◽

10.2298/aci1003089g ◽

2010 ◽

Vol 57 (3) ◽

pp. 89-95 ◽

Cited By ~ 6

Author(s):

V. Gligorijevic ◽

N. Spasic ◽

D. Bojic ◽

M. Protic ◽

P. Svorcan ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Activity Index ◽

Fistula Tract ◽

Infliximab Treatment ◽

Adequate Treatment ◽

Pelvic Mri ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

AIM: To evaluate the role of pelvic MRI in diagnosis and assesment of combined surgical and infliximab treatment of perianal Crohn's disease (PACD). METHOD: 24 patients with signs of PACD were prospectively evaluated. They were previously treated with azathyoprin for a period of 6 months to 7 years and antibiotics and than started on Infliximab 5 mg/kg (IFX) at 0,2 and 6 weeks induction protocol. Luminal CD activity was assesed by colonoscopy. Perianal Disease Activity Index (PDAI) was calculated to evaluate perianal fistulae activity. Surgical examination under anesthesia (EUA) was performed and noncutting seton placed where appropriate. Pelvic MRI was performed in each patient before Infliximab treatment, and in half of the patients after IFX. MRI criteria were used to asses activity and remission of PACD. RESULTS: 14/24(58.5%) patients had ileocolitis, 10/24 (41.5%) colitis, and in 22/24(91.7%) rectum was affected. Median disease duration was 5.5+2.5 years. MRI revealed simple fistula in 4/24 (16.7%) and complex fistula in 20/24 (83.3%) patients. Abscess was present in 19/24(79%) patients. Enterocutaneous and recto-vaginal fistula was found in 2(8.3%) and 3(12.5%) patients, respectively. Median PDAI before and 8 weeks after IFX treatment was 8.3+2.08 and 3.5+1.03, respectively (p=0.00064). Incomplete response (reduction fistulae drainage by 50%) was found in 10/24(42%) patients, complete response (no drainage) in 11/24 (46%) patients, while in 3/24(12.5%) new fistula opened. Control pelvic MRI was performed in 13/24 (54%) patients. Of those, 9/13(69%) had complete remission according to MRI criteria. Seton was removed after second IFX dose in 15/24 (62.5%) patients and placed again in 2/24 (8%) patients 4 months after completion of IFX treatment. CONCLUSION: In patients with PACD, pelvic MRI before and after IFX treatment is an important diagnostic tool to asses fistula tract localization, reveal abscess, planning adequate treatment approach and assess the effect of treatment. Surgical decision to remove seton was in accordance with MRI criteria for remission in PACD.

Download Full-text

Mucinous Rectal Adenocarcinoma in Perianal Crohn’s Disease Fistulas

Canadian Journal of Gastroenterology ◽

10.1155/1991/730534 ◽

1991 ◽

Vol 5 (2) ◽

pp. 59-61 ◽

Cited By ~ 3

Author(s):

Wing C Peter Kwan ◽

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Mucinous Adenocarcinoma ◽

High Frequency ◽

Rectal Adenocarcinoma ◽

Disease Diagnosis ◽

Perianal Crohn’S Disease ◽

Patient Presentation ◽

Ischiorectal Abscess ◽

Perianal Crohn's Disease

A 47-year-old male with longstanding Crohn’s disease complicated by perianal fistulous disease is described. In this patient, presentation with a large acute ischiorectal abscess resulted in diagnosis of a complicating mucinous adenocarcinoma. Despite the relatively high frequency of perianal complications in Crohn’s disease, diagnosis of carcinoma in this setting is difficult, and survival remains poor.

Download Full-text

P762 Prevalence association between HPV and fistulising perianal Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.890 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S606-S607

Author(s):

L RODRIGUES BOARINI ◽

C W Sobrado ◽

V R Guzela ◽

A Pozzebon Gonçalves ◽

L Lina Villa ◽

...

Keyword(s):

Crohn’S Disease ◽

High Risk ◽

Crohn's Disease ◽

Surgical Intervention ◽

Perianal Fistula ◽

Epidemiological Studies ◽

Hpv Infection ◽

Fistula Tract ◽

Perianal Crohn’S Disease ◽

Perianal Crohn's Disease

Abstract Background Perianal Crohn’s disease (PCD) is the main risk factor for squamous cells carcinoma (SCC). The incidence of SCC in PCD patients is 0.26 per 1000 patients-years, affects females more than males, develops on average at 42 years of age, which is earlier than general population. Although epidemiological studies have shown that most anal cancers are associated with HPV infection, predominantly oncogenic types 16 and 18.1 prevalence of HPV on perianal Crohn`s disease (PCD) remains unknown. We aimed to estimate the Prevalence of HPV and the subtypes more frequently associated with PCD. Methods Adults with fistulising PCD under immunosuppressed medications who have required surgical intervention, were transversally recruited. A biopsy sample was obtained from perianal fistula tract during under anesthesia exam. INNO-LiPA test was performed on paraffin blocks containing fistula path for HPV testing. Results A total number of 45 PCD patients were recruited and underwent surgical intervention. All patients were under biologic therapy, 42.2% Adalimumab, 40.1% Infliximab, 11.1% Certolizumab, 4.4% Ustekinumab and 2.2% Vedolizumab. The prevalence of fistula tract HPV infection in PCD patients was 37.8% and 22.2% for high-risk HPV in particular. The subtypes more frequently identified were HPV-11 (15.5%), HPV-16 (8.9%) and HPV-53 (6.7%). Conclusion This study shows a high point-prevalence of HPV, specially high-risk subtypes in fistulising PCD population. More studies are necessary to define a screening for cancer in this population.

Download Full-text