Hassan Cesare, Zullo Angelo, Speziale Giuseppe, Stella Francesca, Lorenzetti Roberto, Morini Sergio
Department of Gastroenterology, Nuovo Regina Margherita Hospital, Via E. Morosini 30, 00153 Rome, Italy.
Int J Colorectal Dis. 2003 May;18(3):276-8. doi: 10.1007/s00384-002-0452-1.
Restorative proctocolectomy with ileoanal pouch anastomosis (IPAA) is currently the surgical treatment of choice for ulcerative colitis. Although dysplastic changes to the native ileal mucosa of the pouch occur in a subgroup of patients with severe chronic pouchitis, the development of cancer in the pouch itself is a very rare event. To date, only two cases of carcinoma of the IPAA have been reported, namely in patients operated on for colon cancer complicating ulcerative colitis and with a previous diagnosis of backwash ileitis.
We report a patient with carcinoma in an ileoanal pouch who had been suffering from chronic atrophic pouchitis early after surgery. He had no previous history of colon cancer or backwash ileitis. The adenocarcinoma was detected 22 months after IPAA, and it was deeply infiltrating the adjacent structures (pT4N0M0, grade 2). Histology revealed the passage from chronic atrophic pouchitis to dysplastic epithelium and to cancer.
Our case suggests that malignant transformation of the IPAA may occur as a pure complication of the severe chronic pouchitis, even in the absence of backwash ileitis or a previous history of colon cancer.
回肠贮袋肛管吻合术（IPAA）全直肠系膜切除术目前是溃疡性结肠炎的手术治疗选择。尽管在一部分患有严重慢性贮袋炎的患者中，贮袋的回肠黏膜会出现发育异常改变，但贮袋本身发生癌变是非常罕见的事件。迄今为止，仅报道了两例IPAA癌变病例，分别是因溃疡性结肠炎合并结肠癌且先前诊断为反流性回肠炎而接受手术的患者。
我们报告一例回肠贮袋癌变患者，该患者术后早期患有慢性萎缩性贮袋炎。他既往无结肠癌或反流性回肠炎病史。IPAA术后22个月检测到腺癌，且癌灶已深度浸润相邻结构（pT4N0M0，2级）。组织学检查显示从慢性萎缩性贮袋炎发展为发育异常上皮，进而发展为癌症。
我们的病例表明，即使没有反流性回肠炎或既往结肠癌病史，IPAA的恶性转化也可能作为严重慢性贮袋炎的单纯并发症而发生。
