The difficulties of differential diagnosis of Crohn’s disease and metastatic breast cancer (case report)

Abstract

AIM: to present a rare clinical observation of a combination of Crohn’s disease (CD) and breast cancer (BC).PATIENTS AND METHODS: the case of accidental detection of metastatic lesions of the mesentery of the small intestine and the walls of the small and large intestines in patient A., 46 years old, during reconstructive surgery after ileum resection for CD is described. A preoperative standard examination (chest X-ray, mammography, CT scan of the abdominal cavity), except for infiltration in the middle third of the transverse colon, revealed no other pathology. RESULTS: laparotomy, right-sided hemicolectomy, resection of the terminal ileum, formation of ilotransverse anastomosis side by side were performed elective. During the operation, the loop of the ileum and its mesentery 20 cm from the edge of the ileostomy had specific signs of CD. Histology revealed metastasis of breast carcinoma ICD-O code 8500/6. The postoperative period was uneventful. The patient was discharged on the 8th day with recommendations to continue anti-relapse therapy with vedolizumab. After receiving the results of the IHC study, further examination by an oncologist-mammologist was also recommended. Upon further checkup in the oncological institution, signs of lung metastases, pleural carcinomatosis, damage to the lymph nodes of the mediastinum, lymph nodes of the axillary region, the left subsectoral group and supraclavicular nodes on the left were revealed. Chemotherapists, along with recommendations for the treatment of breast cancer, confirmed the need to continue taking vedolizumab for the treatment of CD.CONCLUSION: the clinical case demonstrates the detection of CD and breast cancer in one patient at the same time, which is rare in routine practice. The common pathogenesis of CD and breast cancer causes both the complexity of differential diagnosis and complicates the search for adequate treatment. The emergence of new biological drugs, such as vedolizumab, provides additional opportunities for the management of such a complex category of patients, demonstrating a high safety profile in relation to the risk of development and progression of cancer.