Ansari Ali Z, Razzak Sania, Patibandla Srihita, Kumar Sarthak, Hafeez Sahar, Kratz Kurt
Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Clinical Pathology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Cureus. 2024 Jan 13;16(1):e52221. doi: 10.7759/cureus.52221. eCollection 2024 Jan.
Tumefactive Crohn's disease is a rare form of Crohn's disease that may mimic colon carcinoma macroscopically. This case report describes a 28-year-old female who presented with right-sided abdominal pain and a palpable abdominal mass that had persisted for over a month. Multiple hospitalizations failed to provide an accurate diagnosis until an exploratory laparotomy revealed that the "mass" was the cecum and a perforated ascending colon. A partial right colectomy was performed, sending the specimen for biopsy. The microscopic description showed dense and confluent chronic inflammation in the colonic mucosa and wall, extending to the serosa in some regions. The infiltration comprised lymphocytes and plasma cells, with an admixture of some neutrophils. Aphthous mucosal ulcerations, intramural fissures, and fistulas were present. Immunostains for pan-keratin demonstrated no intramural epithelial elements. The characteristics of this lesion represent tumefactive Crohn's disease. This case highlights the key microscopic characteristics that pathologists look for when differentiating Crohn's disease from colon carcinoma in a patient presenting with abdominal pain and a colon mass.
肿块样克罗恩病是克罗恩病的一种罕见形式，在宏观上可能类似结肠癌。本病例报告描述了一名28岁女性，她出现右侧腹痛且可触及腹部肿块，这种情况持续了一个多月。多次住院均未能做出准确诊断，直到剖腹探查发现“肿块”是盲肠和升结肠穿孔。进行了部分右半结肠切除术，并将标本送去做活检。显微镜下描述显示结肠黏膜和肠壁有密集且融合的慢性炎症，部分区域延伸至浆膜层。浸润细胞包括淋巴细胞和浆细胞，还有一些中性粒细胞混合其中。存在阿弗他黏膜溃疡、壁内裂隙和瘘管。全角蛋白免疫染色显示壁内无上皮成分。该病变的特征代表肿块样克罗恩病。本病例突出了病理学家在鉴别腹痛和结肠肿块患者的克罗恩病与结肠癌时所寻找的关键微观特征。
