Abstract
PURPOSE: Anorectal fistulas are commonly associated with Crohn's disease. Carcinoma arising in an anal fistula in the absence of Crohn's disease occurs rarely. Carcinoma arising in an anorectal fistula of Crohn's disease is likewise rare and is the subject of this article. METHODS: We have seen eight cases in seven patients. Four of these were squamous carcinoma and three were adenocarcinoma. Details of these seven patients are presented. RESULTS: Two deaths in the four patients with squamous carcinoma and one in the two patients with adenocarcinoma with adequate follow-up suggest a poorer prognosis in both types of malignancy than when these lesions occur without Crohn's disease. CONCLUSION: Carcinoma does arise in the midst of the anorectal fistulas and abscesses of Crohn's disease. Carcinoma arising in a Crohn's disease fistula can be very difficult to diagnose. Examination may be limited by pain, stricture, or induration of the perianal and perineal tissues. Examination under anesthesia can also overlook the lesion. Diagnostic examination under anesthesia yields increases with biopsies or curettage of the fistulous tracts.
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References
Choi PM. Malignancy in Crohn's disease. In: Prantera C, Korelitz BI, eds. Crohn's disease. New York: Marcel Dekker, 1996:509–27.
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.
Church JM, Weakley FL, Fazio VW, Sebek BA, Achkar E, Carwell M. The relationship between fistulas in Crohn's disease and associated carcinoma: report of four cases and review of the literature. Dis Colon Rectum 1985;28:361–6.
Chaikhouni A, Regueyra FI, Stevens JR. Adenocarcinoma in perineal fistulas of Crohn's disease. Dis Colon Rectum 1981;24:639–43.
Lightdale CJ, Sternberg SS, Posner G, Sherlock P. Carcinoma complicating Crohn's disease: report of seven cases and review of the literature. Am J Med 1975;59:262–8.
Leichman L, Nigro N, Vaaitkevicius VK,et al. Cancer of the anal canal. Model for preoperative adjuvant combined modality therapy. Am J Med 1985;78:211–5.
Onerheim RM. A case of perianal mucinous adenocarcinoma arising in a fistula-in-ano: a clue to the early pathologic diagnosis. Am J Clin Pathol 1988;89:809–12.
Korelitz BI. Carcinoma of the intestinal tract in Crohn's disease: results of a survey conducted by the national foundation for ileitis and colitis. Am J Gastroenterol 1983;78:44–6.
Buchmann P, Allan RN, Thompson H, Alexander-Williams J. Carcinoma in a rectovaginal fistula in a patient with Crohn's disease. Am J Surg 1980;140:462–3.
Ball CS, Wujanto R, Haboubi NY, Schoefiled PF. Carcinoma in anal Crohn's disease: discussion paper. J R Soc Med 1988;81:217–9.
Gyde SN, Prior P, Macarmey JC, Thompson H, Waterhouse JA, Allen RN. Malignancy in Crohn's disease. Gut 1980;21:1024–9.
Connell AU, Sheffield JP, Kamm MA, Ritchie JK, Hawley PR, Lennard-Jones JR. Lower gastrointestinal malignancy in Crohn's disease. Gut 1994;35:347–52.
Kyle J, Ewen SW. Two types of colorectal carcinoma in Crohn's disease. Ann R Coll Surg Engl 1992;74:387–90.
Inamdar NV, Schwarz P, Bacley HR, Skibber JM, Rich TA, Sellin J. Development of mucinous adenocarcinoma in Crohn's disease fistulae without luminal involvement. Inflammatory Bowel Disease 1995;1:280–3.
Lumley JW, Stitz EW. Crohn's disease and anal carcinoma: an association? A case report and review of the literature. Aust N Z J Surg 1991;61:76–7.
Richards ME, Rickert RR, Nance FC. Crohn's disease: associated carcinoma. Ann Surg 1989;209:764–73.
Slater G, Greenstein A, Aufses AH. Anal carcinoma in patients with Crohn's disease. Ann Surg 1984;199:348–50.
Somerville KW, Langman MJ, Da Cruz DJ, Balfour TW, Sully L. Malignant transformation of anal skin tags in Crohn's disease. Gut 1984;25:1124–5.
Weedon DD, Shorter RG, Ilstrup DM, Huizenga KA, Taylor WF. Crohn's disease and cancer. N Engl J Med 1973;289:1099–103.
Traube J, Simpson S, Riddell RH, Levin B, Kirsner JB. Crohn's disease and adenocarcinoma of the bowel. Dig Dis Sci 1980;25:939–44.
Spencer JA, Ward, J, Beckingham IJ, Adams C, Ambrose NS. Dynamic contrast-enhanced MR imaging of perianal fistulas. AJR Am J Roentgenol 1996;167:735–41.
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Ky, A., Sohn, N., Weinstein, M.A. et al. Carcinoma arising in anorectal fistulas of Crohn's disease. Dis Colon Rectum 41, 992–996 (1998). https://doi.org/10.1007/BF02237388
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DOI: https://doi.org/10.1007/BF02237388