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- Title
Grossly and microscopically subtle adenocarcinoma arising in Crohn jejunitis.
- Authors
Knickle, Corey J.; Wightman, Robert
- Abstract
Background: Patients with Crohn disease are at increased risk of gastrointestinal malignancies, including small bowel adenocarcinoma. Diagnosis is difficult as symptoms of small bowel adenocarcinoma overlap with Crohn disease, and many cases are discovered incidentally. Additionally, the carcinomas can be difficult to detect grossly and diagnose microscopically. This case is illustrative of these issues. Case Report: A 52-year-old male had a 12-month history of iron deficiency anemia and a 15 pound weight loss. Colonoscopy revealed an ascending colon lesion suspicious for cancer. An abdominal CT scan revealed jejunal wall thickening with upstream small bowel dilatation. During surgery, stricturing and creeping fat were noted. Gross examination revealed creeping fat, mucosal pseudopolyps, stricturing, dilatation and wall thickening compatible with Crohn disease. Microscopic examination showed ulceration, pseudopolyps, and pyloric metaplasia consistent with Crohn disease. One block submitted as a random section showed well differentiated glands within the muscularis propria. 3/23 Lymph nodes showed metastatic high-grade adenocarcinoma. Additional sections of the small bowel revealed grossly inconspicuous adenocarcinoma with both low grade acinar and high-grade mucinous signet ring components. A diagnosis of small bowel adenocarcinoma in the setting of Crohn jejunitis was made. Conclusion Paragraph: Crohn disease increases the risk of small bowel adenocarcinoma. Careful examination of the gross specimen is crucial to rule out an inconspicuous malignancy as Crohn related adenocarcinoma is often undetected by preoperative work up.
- Publication
Canadian Journal of Pathology, 2016, Vol 8, p35
- ISSN
1918-915X
- Publication type
Article