Abstract
BackgroundAs in ulcerative colitis, there is an increased incidence of colorectal carcinoma in Crohn's disease. While carcinoma formation originating from ano-rectal fistulas is generally considered as a rare event there are different publications reporting on mucinous adenocarcinoma formation in association with a neovagina and rectovaginal fistulas. To the best of our knowledge this is the first description of a perianal mucinous adenocarcinoma arising in a patient after Crohn's disease proctocolectomy.Case presentationWe report the case of a 50-year old female with a mucinous adenocarcinoma forming in the perineum eleven years after proctocolectomy for Crohn's disease. The patient was readmitted with perineal pain, leucocytosis and a perineal mass highly suspicious of abscess formation in the MRI-Scan. Histological examination revealed a mucinous adenocarcinoma. Exenteration including vagina, uterus and ovaries together with the coccygeal-bone was performed.ConclusionMucinous adenocarcinoma formation is a rare complication of Crohn's disease and so far unreported after proctocolectomy.
Highlights
As in ulcerative colitis, there is an increased incidence of colorectal carcinoma in Crohn's disease
Several cases have been reported in which carcinoma formation originated from ano-rectal fistulas which are commonly associated with Crohn's disease [3]
While carcinoma formation originating from anorectal fistulas is generally considered as a rare event, these tumors are most commonly either mucinous carcinomas or squamous cell carcinomas [4]
Summary
There is an increased incidence of colorectal carcinoma in Crohn's disease [1]. Several cases have been reported in which carcinoma formation originated from ano-rectal fistulas which are commonly associated with Crohn's disease [3]. We report late formation of a mucinous adenocarcinoma in a patient with Crohn's disease who (page number not for citation purposes). The MRI-scanning revealed a large formation in the lower pelvis reaching to the sacrum This mass showed a thickened, contrast-enhancing wall and necrotic, liquid inner parts suggestive of abscess-formation. Ten years later (1991), the patient was readmitted because of severe perineal fistula disease. The histopathological examination showed signs of Crohn's disease with some epitheloid cell granulomas and giant cells as well as microgranulomas in both the large bowel and the rectum. No fistulas and no signs of Crohn's disease could be found in the small bowel.
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