Advertisement

Diseases of the Colon & Rectum

, Volume 34, Issue 2, pp 174–180 | Cite as

Crohn's disease and adenocarcinoma of the intestinal tract

Report of four cases
  • C. A. Rubio
  • R. Befritz
  • B. Poppen
  • T. Svenberg
  • P. Slezak
Case Reports

Abstract

Four patients with intestinal adenocarcinoma complicating Crohn's disease are reported. The youngest of the four patients was a 21-year-old female with a 9-year history of Crohn's disease of the terminal ileum as well as of the entire colon. She developed mucus-producing moderately differentiated adenocarcinoma in the cecum. Of the remaining three patients with Crohn's disease, one presented an adenocarcinoma in the ascending colon, one in the rectum and the remaining one in the duodenum. All three colorectal adenocarcinomas originated in areas of high-grade dysplasia and all four in areas with chronic transmural inflammation. The review of the literature indicates that a total of 174 small and large bowel cancers occurring in Crohn's disease have been recorded (including the four reported herein). The vast majority of the reported cases have been found in the North American subcontinent. Only in a few instances were bowel adenocarcinoma and Crohn's disease observed in the European continent. It is therefore remarkable that three of our four cases were seen within a period of 12 months. Interestingly, six patients having colorectal adenocarcinoma in association with Crohn's disease were recently reported from a single hospital in England. The question therefore arises whether our cases and those reported recently from England are unrelated and merely coincidental or whether carcinomas are now also affecting European CD patients. If the latter is the case, the surveillance policy for patients with CD should be reconsidered at this hospital.

Key words

Crohn's disease Adenocarcinoma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Craft CF, Mendelsohn G, Cooper HS, Yardley JH. Colonic “Precancer” in Crohn's disease. Gastroenterology 1981;80:578–84.PubMedGoogle Scholar
  2. 2.
    Fresko D, Lazarus SS, Dotan J, Reingold M. Early presentation of carcinoma of the small bowel in Crohn's disease (“Crohn's carcinoma”). Gastroenterology 1982;82:783–9.PubMedGoogle Scholar
  3. 3.
    Greenstein AJ, Janowitz HD. Cancer in Crohn's disease. Am J Gastroenterol 1975;64:2:122–4.PubMedGoogle Scholar
  4. 4.
    Greenstein AJ, Sachar D, Smith H, Janowitz HD, Aufses AH. Patterns of neoplasia in Crohn's disease and ulcerative colitis. Cancer 1980;46:403–7.PubMedGoogle Scholar
  5. 5.
    Hawker PC, Gyde SN, Thompson H, Allan RN. Adenocarcinoma of the small intestine complicating Crohn's disease. Gut 1982;23:188–93.PubMedGoogle Scholar
  6. 6.
    Hoffman JP, Taft DA, Wheelis RF, Walker JH. Adenocarcinoma in regional enteritis of the small intestine. Arch Surg 1977;112:606–11.PubMedGoogle Scholar
  7. 7.
    Hamilton SR. Colorectal carcinoma in patients with Crohn's disease. Gastroenterology 1985;89:398–407.PubMedGoogle Scholar
  8. 8.
    Keighley MR, Thompson H, Alexander-Williams J. Multifocal colonic carcinoma and Crohn's disease. Surgery 1975;78:534–7.PubMedGoogle Scholar
  9. 9.
    Lightdale JC, Sternberg SS, Posner G, Sherlock P. Carcinoma complicating Crohn's disease. Am J Med 1975;59:261–8.CrossRefGoogle Scholar
  10. 10.
    Mayberry JF. Recent epidemiology of ulcerative colitis and Crohn's disease. Int J Color Dis 1989;4:59–66.CrossRefGoogle Scholar
  11. 11.
    Petras RE, Mir-Madjlessi SH, Farmer RG. Crohn's disease and intestinal carcinoma: a report of 11 cases with emphasis on associated epithelial dysplasia. Gastroenterology 1987;93:1307–14.PubMedGoogle Scholar
  12. 12.
    Senay E, Sachar DB, Keohane M, Greenstein AJ. Small bowel cracinoma in Crohn's disease: distinguishing features and risk factors. Cancer 1989;63:360–3.PubMedGoogle Scholar
  13. 13.
    Simpson S, Traube J, Riddell RH. The histologic appearance of dysplasia (precarcinomatous change) in Crohn's disease of the small and large intestine. Gastroenterology 1981;81:492–501.PubMedGoogle Scholar
  14. 14.
    Shamsuddin AK, Phillips RM. Preneoplastic and neoplastic changes in colonic mucosa in Crohn's disease. Arch Pathol Lab Med 1981;15:283–6.Google Scholar
  15. 15.
    Valdes-Dapena A, Rudolph I, Hidayat A, Roth JL, Laucks RB. Adenocarcinoma of the small bowel in association with regional enteritis. Cancer 1976;37:2938–47.PubMedGoogle Scholar
  16. 16.
    Warren R, Barwick KW. Crohn's colitis with carcinoma and dysplasia. Am J Surg Pathol 1983;7:151–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Wyatt MG, Houghton PW, Mortensen NJ, Williamson RC. The malignant potential of colorectal Crohn's disease. Ann R Coll Surg Engl 1987;69:196–8.PubMedGoogle Scholar
  18. 18.
    Savoca PE, Ballantyne GH, Cahow CE. Gastrointestinal malignancies in Crohn's disease: a 20-year experience. Dis Colon Rectum 1990;33:7–11.PubMedGoogle Scholar
  19. 19.
    Åhren LC. Risk of malignancy in Crohn's disease. Ital J Gastroenterol 1979;11:131.Google Scholar
  20. 20.
    Hellers GK, Bergstrand OL, Ewerth SJ. Malignancy in Crohn's disease in Stockholm county. Ital J Gastroenterol 1979;2:131–2.Google Scholar
  21. 21.
    Kvist N, Jacobsen O, Norgaard P, et al. Malignancy in Crohn's disease. Scand J Gastroenterol 1986;21:82–6.PubMedGoogle Scholar
  22. 22.
    Cuvelier C, Bekaert E, De Potter C, Pauwels C, De Vos M, Roels H. Crohn's disease with adenocarcinoma and dysplasia. Am J Surg Pathol 1989;13:187–96.PubMedGoogle Scholar
  23. 23.
    Cooper DJ, Weinstein MA, Korelitz BI. Complications of Crohn's disease predisposing to dysplasia and cancer of the intestinal tract: considerations of a surveillance program. J Clin Gastroenterol 1984;6:217–24.PubMedGoogle Scholar
  24. 24.
    Ginzburg L, Schneider KM, Dreizin DH, Levinson C. Carcinoma of the jejunum in a case of regional enteritis. Surgery 1956;39:347–51.PubMedGoogle Scholar
  25. 25.
    Weedon DD, Shorter RG, Ilstrup DM, Huizenga KA, Taylor LF. Crohn's disease and cancer. N Engl J Med 1973;21:1099–1103.CrossRefGoogle Scholar
  26. 26.
    Mayberry JF, Rhodes J. Epidemiological aspects of Crohn's disease: a review of the literature. Gut 1984;25:886–99.PubMedGoogle Scholar
  27. 27.
    Smith TR, Conradi H, Bernstein R, Greweldinger J. Adenocarcinoma arising in Crohn's disease: report of two cases. Colon Rectum 1980;23:498–503.CrossRefGoogle Scholar
  28. 28.
    Johnson WR, McDermott FR, Hughes ES, Pihl EA, Milne BJ, Price AB. Carcinoma of the colon and rectum in inflammatory disease of the intestine. Surg Gynecol Obstet 1983;156:193–7.PubMedGoogle Scholar
  29. 29.
    Allen DC, Hughes DF, Calvert CH. Carcinoma in Crohn's disease of the colon. Dis Colon Rectum 1985;29:760–5.Google Scholar
  30. 30.
    Butt JH, Lennard-Jones JE, Ritchie JK. A practical approach to the risk of cancer in inflammatory bowel disease. Med Clin North Am 1980;64:1203–19.PubMedGoogle Scholar
  31. 31.
    Fielding JF, Prior P, Waterhouse JA, Cooke WT. Malignancy in Crohn's disease. Scand J Gastroenterol 1972;7:3–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Prior P, Gyde S, Cooke WT, Waterhourse JA, Allan RN. Mortality in Crohn's disease. Gastroenterology 1981;80:307–12.PubMedGoogle Scholar

Copyright information

© The American Society of Colon & Rectal Surgeons 1991

Authors and Affiliations

  • C. A. Rubio
    • 1
  • R. Befritz
    • 1
  • B. Poppen
    • 1
  • T. Svenberg
    • 1
  • P. Slezak
    • 1
  1. 1.Departments of Pathology, Gastroenterology, Surgery, and RadiologyKarolinska HospitalStockholmSweden

Personalised recommendations