Ky A, Sohn N, Weinstein M A, Korelitz B I
Department of Surgery, Lenox Hill Hospital, New York, New York, USA.
Dis Colon Rectum. 1998 Aug;41(8):992-6. doi: 10.1007/BF02237388.
Anorectal fistulas are commonly associated with Crohn's disease. Carcinoma arising in an anal fistula in the absence of Crohn's disease occurs rarely. Carcinoma arising in an anorectal fistula of Crohn's disease is likewise rare and is the subject of this article.
We have seen eight cases in seven patients. Four of these were squamous carcinoma and three were adenocarcinoma. Details of these seven patients are presented.
Two deaths in the four patients with squamous carcinoma and one in the two patients with adenocarcinoma with adequate follow-up suggest a poorer prognosis in both types of malignancy than when these lesions occur without Crohn's disease.
Carcinoma does arise in the midst of the anorectal fistulas and abscesses of Crohn's disease. Carcinoma arising in a Crohn's disease fistula can be very difficult to diagnose. Examination may be limited by pain, stricture, or induration of the perianal and perineal tissues. Examination under anesthesia can also overlook the lesion. Diagnostic examination under anesthesia yields increases with biopsies or curettage of the fistulous tracts.
肛瘘通常与克罗恩病相关。在无克罗恩病的肛瘘中发生的癌很少见。在克罗恩病的肛瘘中发生的癌同样罕见，本文将对此进行探讨。
我们共诊治了7例患者中的8个病例。其中4例为鳞状细胞癌，3例为腺癌。现将这7例患者的详细情况予以介绍。
4例鳞状细胞癌患者中有2例死亡，2例腺癌患者中有1例死亡，经充分随访发现，这两种恶性肿瘤的预后均比无克罗恩病时发生的同类病变差。
癌确实会在克罗恩病的肛瘘和脓肿中发生。在克罗恩病肛瘘中发生的癌可能很难诊断。检查可能会受到疼痛、肛周和会阴组织狭窄或硬结的限制。麻醉下检查也可能会遗漏病变。麻醉下诊断性检查通过对瘘管进行活检或刮除可提高检出率。
