Asymptomatic ileal adenocarcinoma in the setting of undiagnosed Crohn's disease

Abstract

A 53-year old previously healthy male underwent a screening colonoscopy for detection of a potential colorectal neoplasm. The terminal ileum was intubated and a mass was noted. Examination of the colon was normal. The biopsy of the ileal mass was consistent with an adenocarcinoma arising from the terminal ileum. His father who had never been previously ill from gastrointestinal disease died of natural causes, but was found to have Crohn's disease postmortem. The patient underwent exploratory laparotomy and a right hemicolectomy with a 30 cm section of terminal ileum in continuity. Findings were consistent with ileal adenocarcinoma in the setting of Crohn's disease. The patient made an uneventful recovery. The pathology was stage 1 adenocarcinoma. This is a unique case in that on a screening colonoscopy, a favorable ileal adenocarcinoma was discovered in the setting of asymptomatic, undiagnosed ileal Crohn's disease in a patient whose father had Crohn's disease diagnosed postmortem.

Figure 1

CT scan of the abdomen showing thickened and spiculated ileal wall.

Figure 2

A: Stricture adjacent to the ileocecal valve; B: 3 cm polyp, sections of which revealed a white spiculated area extending into the underlying fat.

Figure 3

Crohn’s changes in the terminal ileum (HE, × 400).

Figure 4

Adenocarcinoma invading the muscularis propria (HE, × 400).