Senay E, Sachar D B, Keohane M, Greenstein A J
Department of Surgery, Mount Sinai School of Medicine, City University of New York 10029.
Cancer. 1989 Jan 15;63(2):360-3. doi: 10.1002/1097-0142(19890115)63:2<360::aid-cncr2820630227>3.0.co;2-9.
An 86-year-old woman who developed small bowel adenocarcinoma 40 years following in-continuity bypass of a 60-cm segment of regional ileitis represents the 22nd reported patient with this complication of bypassed Crohn's disease. Her case demonstrates several of the typical clinical features of such cancers: late recrudescence of disease following a 40-year period of relative quiescence; delayed diagnosis due to misinterpretation of the clinical picture (intestinal obstruction, abdominal mass, intraabdominal abscess, and fistula formation) as due to inflammatory bowel disease; and an exceedingly poor prognosis with rapid widespread local dissemination and death. Histologically, severe dysplasia was demonstrated both in close proximity to and at a distance from the lesion. The increasing number of case reports of adenocarcinoma arising at the site of long-standing Crohn's disease, many with dysplasia within areas of diseased bowel, is further evidence that Crohn's disease is a precancerous condition. Physicians must continue to search for methods of earlier diagnosis to improve the prognosis of small bowel carcinoma in Crohn's disease.
一名86岁女性在60厘米节段性回肠炎行连续性旁路手术后40年发生小肠腺癌，这是第22例报道的患有这种克罗恩病旁路并发症的患者。她的病例展示了此类癌症的几个典型临床特征：在相对静止40年后疾病的晚期复发；由于将临床表现（肠梗阻、腹部肿块、腹腔内脓肿和瘘管形成）误解为炎症性肠病而导致诊断延迟；以及预后极差，局部迅速广泛扩散并导致死亡。组织学检查显示，病变附近和远处均有严重发育异常。越来越多关于在长期克罗恩病部位发生腺癌的病例报告，其中许多在患病肠段内有发育异常，进一步证明克罗恩病是一种癌前状态。医生必须继续寻找早期诊断方法，以改善克罗恩病中小肠癌的预后。
