Yoshimura Kosuke, Ohge Hiroki, Uegami Shinnosuke, Watadani Yusuke, Nakashima Ikki, Shimbara Kensuke, Doi Hirofumi, Kuhara Yuta, Miyata Masahide, Takahashi Shinya
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan.
Division of Patient Safety, Yamaguchi University Hospital, 1-1-1, Minami-Kogushi, Ube City, Yamaguchi, 755-8505, Japan.
Clin J Gastroenterol. 2025 Sep 9. doi: 10.1007/s12328-025-02215-x.
Crohn's-disease-associated colorectal cancer, where chronic inflammation increases the risk of cancer development, is less common than other types of colorectal cancer. Pathological analyses of Crohn's-disease-associated colorectal cancer are limited. Herein, we present a case of Crohn's disease-associated colorectal cancer, suggesting stepwise carcinogenesis from the chronic inflammatory mucosa. A man in his 40s had a 28-year history of Crohn's disease with perianal involvement for over 20 years. He visited our hospital due to worsening anal pain and fecal incontinence. Following clinical evaluation, he was diagnosed with anal canal cancer and subsequently underwent surgery. Histopathological examination revealed cancer originating from the chronically inflamed mucosa, suggesting p53-positive dysplasia, well-differentiated adenocarcinoma, and subsequently, mucinous adenocarcinoma. The final diagnosis was Crohn's-disease-associated anal canal cancer. Despite postoperative adjuvant chemotherapy, he exhibited pelvic recurrence and distant metastasis 20 months postoperatively. A comprehensive multidisciplinary treatment intervention was implemented; however, he eventually succumbed to cancer progression 3 years after surgery. This case suggests inflammation-associated stepwise carcinogenesis, demonstrating tumor heterogeneity and providing insights into dysplasia. Despite improved understanding from recent registry studies, the diagnosis and treatment of CD-CRC remain challenging in clinical practice, as seen in this case.
克罗恩病相关的结直肠癌中，慢性炎症会增加癌症发生风险，但其比其他类型的结直肠癌少见。对克罗恩病相关结直肠癌的病理分析有限。在此，我们报告一例克罗恩病相关的结直肠癌病例，提示从慢性炎症黏膜逐步发生癌变。一名40多岁男性有28年克罗恩病病史，肛周受累超过20年。他因肛门疼痛加重和大便失禁前来我院就诊。经过临床评估，他被诊断为肛管癌，随后接受了手术。组织病理学检查显示癌症起源于慢性炎症黏膜，提示p53阳性发育异常、高分化腺癌，随后为黏液腺癌。最终诊断为克罗恩病相关肛管癌。尽管术后进行了辅助化疗，但他在术后20个月出现盆腔复发和远处转移。实施了综合多学科治疗干预；然而，他最终在手术后3年死于癌症进展。该病例提示炎症相关的逐步癌变，显示了肿瘤异质性并为发育异常提供了见解。尽管最近的登记研究增进了认识，但如本病例所示，克罗恩病相关结直肠癌的诊断和治疗在临床实践中仍然具有挑战性。
