Rubio C A, Befritz R, Poppen B, Svenberg T, Slezak P
Department of Pathology, Karolinska Hospital, Stockholm, Sweden.
Dis Colon Rectum. 1991 Feb;34(2):174-80. doi: 10.1007/BF02049994.
Four patients with intestinal adenocarcinoma complicating Crohn's disease are reported. The youngest of the four patients was a 21-year-old female with a 9-year history of Crohn's disease of the terminal ileum as well as of the entire colon. She developed mucus-producing moderately differentiated adenocarcinoma in the cecum. Of the remaining three patients with Crohn's disease, one presented an adenocarcinoma in the ascending colon, one in the rectum and the remaining one in the duodenum. All three colorectal adenocarcinomas originated in areas of high-grade dysplasia and all four in areas with chronic transmural inflammation. The review of the literature indicates that a total of 174 small and large bowel cancers occurring in Crohn's disease have been recorded (including the four reported herein). The vast majority of the reported cases have been found in the North American subcontinent. Only in a few instances were bowel adenocarcinoma and Crohn's disease observed in the European continent. It is therefore remarkable that three of our four cases were seen within a period of 12 months. Interestingly, six patients having colorectal adenocarcinoma in association with Crohn's disease were recently reported from a single hospital in England. The question therefore arises whether our cases and those reported recently from England are unrelated and merely coincidental or whether carcinomas are now also affecting European CD patients. If the latter is the case, the surveillance policy for patients with CD should be reconsidered at this hospital.
本文报告了4例合并克罗恩病的肠腺癌患者。4例患者中最年轻的是一名21岁女性，患有末端回肠及全结肠克罗恩病9年。她在盲肠发生了黏液性中分化腺癌。其余3例克罗恩病患者中，1例升结肠发生腺癌，1例直肠发生腺癌，另1例十二指肠发生腺癌。所有3例结直肠癌均起源于高级别发育异常区域，4例均发生于慢性透壁性炎症区域。文献回顾表明，已记录到总共174例发生于克罗恩病的大肠和小肠癌（包括本文报告的4例）。绝大多数报告病例见于北美次大陆。在欧洲大陆仅在少数情况下观察到肠腺癌与克罗恩病并存。因此，值得注意的是，我们的4例病例中有3例在12个月内出现。有趣的是，最近有一家英国医院报告了6例合并克罗恩病的结直肠癌患者。因此问题就出现了，我们的病例与最近英国报告的病例是毫无关联且纯属巧合，还是现在癌症也在影响欧洲的克罗恩病患者。如果是后一种情况，该医院应对克罗恩病患者的监测策略重新进行考虑。
