Gastroenterology

Gastroenterology

Volume 93, Issue 6, December 1987, Pages 1307-1314
Gastroenterology

Crohn's disease and intestinal carcinoma: A report of 11 cases with emphasis on associated epithelial dysplasia

https://doi.org/10.1016/0016-5085(87)90260-5Get rights and content

Abstract

Eleven patients with intestinal carcinoma complicating Crohn's disease are reported. In the 4 patients with small intestinal carcinoma, carcinomas were poorly differentiated or signet-ring cell type in 3 cases and mucinous type in 1 case. All 4 patients had high-grade dysplasia in the mucosa immediately adjacent to the carcinoma only. In the 7 patients with colonic carcinoma, tumors were mucinous type in 3, signet-ring cell type in 1, and well or moderately differentiated in 3. Dysplasia could be assessed in 6 patients. In 4 patients it was both adjacent to and distant from the invasive carcinoma. This distant dysplasia was focal in 2 cases. One patient showed dysplasia adjacent to the carcinoma only and in 1 other patient no dysplasia was seen. In a comparison group, all 7 cases of carcinoma associated with ulcerative colitis showed dysplasia adjacent to and distant from the invasive carcinomas. The authors conclude that (a) associated dysplasia is prevalent enough in Crohn's disease-associated carcinomas to support a dysplasia-carcinoma sequence and (b) dysplasia is more limited with carcinoma in Crohn's disease than ulcerative colitis, and this may make dysplasia less useful as a cancer surveillance marker in Crohn's disease.

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      Citation Excerpt :

      However, some findings suggestive of Crohn's disease complicating diverticulosis could be the presence of fissuring ulcerations, evidence of ulcers not in the areas of active diverticulitis, as well as the presence of internal fistulae [4–6]. Patients with long standing ulcerative colitis or Crohn's disease seem to present a higher risk for intestinal carcinoma [7–9]. Pathognomonic finding of Crohn's disease is the presence of a noncaseating epithelioid granuloma containing giant cells [10], however, primary changes in this pathologic entity included disruption of the intercellular tight junctions in the mucosa and changes in size and morphology of the intestinal villi, with fusion, hypertrophy and hyperplasia of the goblet cells, as well as an increased secretion of mucus [10].

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    Copyright © 1987 Published by Elsevier Inc.