Malignant melanoma of the ileo-anal pouch anastomosis after restorative proctocolectomy for ulcerative colitis: report of a case

Philipp Lingohr,Edwin Bölke,Azin Jafari,Eberhard Straub,Thomas Galetin,Karl-Heinz Vestweber,Hanno Matthaei,Jörg C Kalff

doi:10.1186/2047-783x-18-39

Abstract

A 62 year-old patient with therapy-refractory pouchitis after proctocolectomy for ulcerative colitis was admitted with hematochezia and abdominal discomfort. A malignant melanoma (MM) was found after repeated biopsies of the pouch. Complete staging revealed no evidence for distant metastases and the patient underwent abdominoperineal pouch resection. Six weeks later, the patient was readmitted because of severe general deterioration and diffuse metastatic spread to the liver was found. The patient died of hepatorenal syndrome shortly thereafter.Patients with inflammatory bowel disease are at increased risk of developing cancer, including rarities such as MM. Our experience stresses the importance of repeated biopsies in therapy-refractory pouchitis.

Highlights

Inflammatory bowel diseases (IBD) are characterized by recurrent or chronic inflammation of the gastrointestinal tract mainly represented by Crohns disease and ulcerative colitis
We present a patient with ulcerative colitis who developed a malignant melanoma of the ileo-anal pouch anastomosis after restorative proctocolectomy
Case presentation A 62 year-old man who had undergone proctocolectomy and ileal pouch anal anastomosis (IPAA) with a hand-sewn anastomosis for ulcerative colitis eight years previously developed pouchitis that did not respond to topical hydrocortisone and oral prednisolone 20 mg/day

Summary

Background

Inflammatory bowel diseases (IBD) are characterized by recurrent or chronic inflammation of the gastrointestinal tract mainly represented by Crohns disease and ulcerative colitis. We present a patient with ulcerative colitis who developed a malignant melanoma of the ileo-anal pouch anastomosis after restorative proctocolectomy. Case presentation A 62 year-old man who had undergone proctocolectomy and ileal pouch anal anastomosis (IPAA) with a hand-sewn anastomosis for ulcerative colitis eight years previously developed pouchitis that did not respond to topical hydrocortisone (rectal foam) and oral prednisolone 20 mg/day. Pouchoscopy of the IPAA showed hemorrhagic and ulcerating pouchitis with stenosis of the proximal pouch (Figures 1 and 2). Multiple percutaneous biopsies taken under ultrasound control showed tumor cells that were negative for S100, slightly positive for HMB-45 and strongly positive for vimentin, confirming metastases from the previously diagnosed MM. We administered palliative chemotherapy with dacarbazine but the patient died of hepatorenal syndrome and subsequent multiorgan failure three weeks later

Discussion

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