Xiao Lin, Sun Lie, Zhao Kang, Pan Yi-Sheng
Department of General Surgery, Peking University First Hospital, Beijing 100034, China.
World J Gastrointest Oncol. 2021 Apr 15;13(4):305-311. doi: 10.4251/wjgo.v13.i4.305.
Crohn's disease (CD) causes a range of digestive symptoms including recurrent diarrhea, abdominalgia, and flatulence, and severely impacts the quality of life of patients. Infliximab, a monoclonal antibody against tumor necrosis factor alpha, has recently been promoted as a therapeutic treatment for CD, but its safety margins remain uncertain. We report a case of rapidly progressive colorectal cancer that was diagnosed in a patient with CD who had previously been treated with infliximab.
This case report refers to a 40-year-old male with a 6-year history of CD. The patient underwent transverse colostomy because of inflammatory ileus in 2017. He subsequently received infliximab treatment in 2018. Ten months later, worsening contracture of the transverse colostomy was observed. Imaging tests indicated that the patient may have developed colon cancer with extensive peritoneal implantation. At the same time, colonoscopy revealed a rectal mass and pathological examination indicated well-differentiated adenocarcinoma. Palliative ileostomy was performed to improve defecation in 2019. During the operation, a small nodular mass in the mesentery of the small intestine was identified and pathological examination of the mass revealed advanced adenocarcinoma. The patient was diagnosed with advanced colorectal cancer and administered palliative chemotherapy. He died in June 2020.
We stress the importance of recognizing the possible occurrence of malignance in patients with CD receiving infliximab.
克罗恩病（CD）会引发一系列消化症状，包括反复腹泻、腹痛和气胀，严重影响患者的生活质量。英夫利昔单抗是一种抗肿瘤坏死因子α的单克隆抗体，最近被推广用于CD的治疗，但其安全边际仍不确定。我们报告了一例在先前接受英夫利昔单抗治疗的CD患者中诊断出的快速进展性结直肠癌病例。
本病例报告涉及一名有6年CD病史的40岁男性。该患者因2017年的炎性肠梗阻接受了横结肠造口术。他随后在2018年接受了英夫利昔单抗治疗。十个月后，观察到横结肠造口术挛缩加重。影像学检查表明患者可能已发展为伴有广泛腹膜种植的结肠癌。同时，结肠镜检查发现直肠肿物，病理检查显示为高分化腺癌。2019年进行了姑息性回肠造口术以改善排便。手术期间，在小肠系膜中发现一个小结节状肿物，肿物的病理检查显示为晚期腺癌。该患者被诊断为晚期结直肠癌并接受了姑息化疗。他于2020年6月去世。
我们强调认识到接受英夫利昔单抗治疗的CD患者可能发生恶性肿瘤的重要性。
