Protyniak Bogdan, Shutt Travis, Farmer Russell
University of Louisville Division of Colon and Rectal Surgery, Louisville, KY, USA.
Geisinger Health System, Danville, PA, USA.
Case Rep Surg. 2017;2017:1929182. doi: 10.1155/2017/1929182. Epub 2017 Apr 9.
. Squamous cell carcinoma (SCC) developing within fistulae and chronic wounds in patients with Crohn's disease is a rare phenomenon with few reported studies in the literature. Clinical suspicion for SCC in Crohn's disease patients with chronic painful fistulae is low, leading to delayed diagnosis and treatment. We present a patient with long-standing Crohn's disease complicated by malignant degeneration of an enterocutaneous fistula tract. . Workup with MRI, CT, and fistulogram revealed a 7 × 3 cm fistulous connection between a loop of small intestine and the patient's perineum. Biopsies of the fistula tract confirmed the diagnosis of SCC. . The patient underwent an abdominoperineal resection with positive margins and is currently awaiting radiation therapy. . This is the second case reported within the English literature of SCC arising from an enterocutaneous fistula in the setting of Crohn's disease. Based on the findings in this case report and others presented in the literature, a high degree of suspicion of malignancy should be present in patients with chronic painful, poor-healing fistulae, especially in the absence of infection.
在克罗恩病患者的瘘管和慢性伤口内发生的鳞状细胞癌（SCC）是一种罕见现象，文献中报道的研究很少。对于患有慢性疼痛性瘘管的克罗恩病患者，对SCC的临床怀疑度较低，导致诊断和治疗延迟。我们报告一例长期患有克罗恩病并伴有肠皮肤瘘管恶性变的患者。磁共振成像（MRI）、计算机断层扫描（CT）和瘘管造影检查显示一段小肠与患者会阴部之间存在一个7×3厘米的瘘管连接。瘘管组织活检确诊为SCC。该患者接受了腹会阴联合切除术，切缘阳性，目前正在等待放疗。这是英文文献中报道的第二例克罗恩病患者肠皮肤瘘管发生SCC的病例。根据本病例报告及文献中其他病例的研究结果，对于患有慢性疼痛、愈合不良的瘘管患者，尤其是在没有感染的情况下，应高度怀疑存在恶性肿瘤。
