Adenocarcinoma in ileal pouch after proctocolectomy for familial adenomatous polyposis: report of a case

Abstract

Restorative proctocolectomy with ileal pouch-anal anastomosis is one of the surgical treatments of choice for patients with familial adenomatous polyposis. Although the risk of cancer developing in an ileal pouch is not yet clear, a few cases of adenocarcinoma arising in an ileal pouch have been reported. We report a case of adenocarcinoma in ileal pouch after proctocolectomy with ileal pouch-anal anastomosis. A 56-yr-old woman was diagnosed as having familial adenomatous polyposis. Total colectomy with ileorectal anastomosis was performed. Six years later, she underwent completion-proctectomy with ileal J pouch-anal anastomosis including anorectal mucosectomy for rectal cancer. After 7 yr, she presented with anal spotting. Endoscopic biopsies revealed adenocarcinoma at the ileal pouch. Resection of the ileal pouch and permanent ileostomy were performed. The risk of cancer in an ileal pouch and its prevention with regular surveillance must be emphasized.

Keywords: Adenocarcinoma; Adenomatous Polyposis Coli; Ileal Pouches.

Fig. 1

Computed tomography displayed a tumor (arrow) at ileal pouch extending into the peri-pouch tissue.

Fig. 2

Gross finding showed a large ulcerative lesion at the posterior wall of the ileal pouch, measuring 3×2.5 cm, located 12 cm from the proximal margin and 2.5 cm from the distal margin. The distal margin was previous anastomotic site.

Fig. 3

Photomicrograph shows a well-differentiated adenocarcinoma composed of anaplastic glandular epithelial cells in the mucosa and submucosa (H&E, ×200) (A), The lymph node is involved by adenocarcinoma (H&E, ×200) (B).