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Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation

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Abstract

Purpose

The aim of this study was to analyze the clinical, pathological, and CT-enterography findings of small bowel adenocarcinomas in Crohn disease patients.

Materials and methods

Clinical, histopathological, and imaging findings were retrospectively evaluated in seven Crohn disease patients with small bowel adenocarcinoma. CT-enterography examinations were reviewed for morphologic features and location of tumor, presence of stratification, luminal stenosis, proximal dilatation, adjacent lymph nodes, and correlated with findings at histological examination.

Results

The tumor was located in the terminal (n = 6) or distal (n = 1) ileum. On CT-enterography, the tumor was visible in five patients, whereas two patients had no visible tumor. Four different patterns were individualized including small bowel mass (n = 2), long stenosis with heterogeneous submucosal layer (n = 2), short and severe stenosis with proximal small bowel dilatation (n = 2), and sacculated small bowel loop with irregular and asymmetric circumferential thickening (n = 1). Stratification, fat stranding, and comb sign were present in two, two, and one patients, respectively.

Conclusion

Identification of a mass being clearly visible suggests strongly the presence of small bowel adenocarcinoma in Crohn disease patients but adenocarcinoma may be completely indistinguishable from benign fibrotic or acute inflammatory stricture. Knowledge of these findings is critical to help suggest the diagnosis of this rare but severe complication of Crohn disease.

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Authors and Affiliations

  1. Department of Abdominal Imaging, Hôpital Lariboisière-APHP and Université Diderot-Paris 7, 2, rue Ambroise Paré, 75010, Paris, France

    Philippe Soyer, Lora Hristova & Mourad Boudiaf

  2. Department of Radiology, Hôpital Tenon-APHP and Université Paris 6, 4 rue de la Chine, 75020, Paris, France

    Frank Boudghène

  3. Department of Radiology, Hôpital Robert Debré, 11 Boulevard Pasteur, 51092, Reims Cedex, France

    Christine Hoeffel

  4. Department of Digestive Diseases, Hôpital Lariboisière-APHP and Université Diderot-Paris 7, 2, rue Ambroise Paré, 75010, Paris, France

    Xavier Dray

  5. Department of Radiology, CHU Nancy-Brabois, Allée du Morvan, 54511, Nancy Cedex, France

    Valérie Laurent

  6. Department of Radiology, Johns-Hopkins Medical Institutions, 601 N. Caroline Street, Room 3251, Baltimore, MD, 21287, USA

    Elliot K. Fishman

Authors
  1. Philippe Soyer
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  2. Lora Hristova
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  3. Frank Boudghène
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  4. Christine Hoeffel
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  5. Xavier Dray
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  6. Valérie Laurent
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  7. Elliot K. Fishman
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  8. Mourad Boudiaf
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Corresponding author

Correspondence to Philippe Soyer.

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Soyer, P., Hristova, L., Boudghène, F. et al. Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation. Abdom Imaging 37, 338–349 (2012). https://doi.org/10.1007/s00261-011-9772-3

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  • DOI: https://doi.org/10.1007/s00261-011-9772-3

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