Mucinous adenocarcinoma arising from chronic perianal crohn’s disease: A case report
- Gastroenterology & Hepatology: Open Access
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Haithem Zaafouri,¹ Wiem Almahmoudi,¹ Meriam Sabbah,² Mona Cherif,¹ Nizar Khedhiri,¹ Raja Jouini,³ Dhafer Haddad,¹ Meryam Mesbahi,¹ Anis Ben Maamer¹
Abstract
Background: Carcinoma associated with chronic fistulous Crohn’s disease (CD) is considered as a rare event. Malignant transformation of perineal fistula in CD has rarely been reported in literature.
Case presentation: We report a case of a 44-year-old patient with a 20-year medical history of CD. He was referred to our hospital for recurrent and refractory perineal complex fistula. The digital rectal examination did not find any mass. Colonoscopy showed left congestive and ulcerative recto colitis with inflammatory pseudo-polyps. Pelvic MRI revealed a trans-sphincteric complex fistula associated with a perianal abcess without any signs of
malignancy. Examination under anaesthesia was performed, abcess was drained and multiple biopsies were taken. Histopathology concluding to a mucinous adenocarcinoma developed on anal fistula.Conclusion: The diagnosis of carcinoma arising from a perianal fistula in patients with Crohn’s disease stills a big challenge. The incidence is estimated to be 0.3-0.7% of all patients with Crohn’s disease. Given the difficulty in diagnosis of carcinoma arising in complicated perianal fistula in patients with Crohn’s disease, it is important that the clinician perform systematic biopsy or curettage at examination under anesthesia to avoid delaying the diagnosis of a low rectal malignancy and the radiologist be aware of the findings that may distinguish cancer from inflammatory changes.
Keywords
Crohn’s disease, anal fistula, biopsy, adenocarcinoma
