Ying L T, Hurlbut D J, Depew W T, Boag A H, Taguchi K
Department of Medicine, Queen's University, Kingston, Ontario.
Can J Gastroenterol. 1998 May-Jun;12(4):265-9. doi: 10.1155/1998/125235.
Increasing numbers of intestinal adenocarcinomas in patients with Crohn's disease have been reported, but the strength of this association still needs to be elucidated. Adenocarcinoma has also been documented in different types of fistulous tracts associated with Crohn's disease. The first case of well-differentiated mucinous adenocarcinoma involving only enterocutaneous fistulae is reported in a patient with long-standing Crohn's disease complicated by persistent abdominal wall fistulous tracts. The malignant lesion arose from neoplastic transformation of columnar epithelium lining portions of the fistulae occurring as a result of either re-epithelialization of these inflammatory tracts or mural implantation of mucosal tissue secondary to prior ulceration. The patient has remained disease-free eight years after surgical resection of the tumour. Even though intestinal carcinoma is not as strongly associated with Crohn's disease as with ulcerative colitis, intestinal carcinoma should be considered in the setting of long-standing disease, previous intestinal exclusion surgeries and complications such as enterocutaneous or other types of fistulous tracts. The prognosis of such patients may be excellent with early diagnosis and treatment.
已有报道称，克罗恩病患者中肠道腺癌的数量在不断增加，但这种关联的强度仍有待阐明。腺癌也已在与克罗恩病相关的不同类型瘘管中被记录。本文报道了首例仅累及肠皮肤瘘的高分化黏液腺癌病例，该患者患有长期克罗恩病，并伴有持续性腹壁瘘管。恶性病变源于瘘管内衬柱状上皮的肿瘤转化，这是由于这些炎性管道的再上皮化或先前溃疡继发的黏膜组织壁内植入所致。该患者在肿瘤手术切除后八年一直无病生存。尽管肠道癌与克罗恩病的关联不像与溃疡性结肠炎那样紧密，但在长期疾病、既往肠道切除术以及肠皮肤或其他类型瘘管等并发症的情况下，仍应考虑肠道癌。早期诊断和治疗此类患者的预后可能很好。
