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Case Reports
. 2017 Feb 8:5:2050313X17692902.
doi: 10.1177/2050313X17692902. eCollection 2017.

Well-differentiated adenocarcinoma associated with ulcerative colitis

Tomoko Yamamoto  1 , Atsuko Hiroi  1 , Hiroko Itagaki  1 , Yoichiro Kato  2 , Bunei Iizuka  3 , Michio Itabashi  4 , Noriyuki Shibata  1 , Yoji Nagashima  5
Affiliations
Case Reports

Well-differentiated adenocarcinoma associated with ulcerative colitis

Tomoko Yamamoto et al. SAGE Open Med Case Rep. .

Abstract

Objectives: Adenocarcinoma is known to be associated with ulcerative colitis, but the diagnosis is sometimes challenging, both clinically and pathologically.

Methods and results: We present a case of extremely well-differentiated adenocarcinoma associated with ulcerative colitis, in which preoperative diagnosis was not possible. Glands in biopsy specimens showed a serrated appearance that looked like low-grade dysplasia or regenerative mucosa. After an operation due to severe symptoms of stenosis, carcinoma was diagnosed. Tumor cells, especially in invasive glands, tended to show stronger immunoreactivity against anti-CK7, TNF-α and Aurora B antibodies compared to cells of mucosal lesion. Interestingly, CD44v6, one of the adhesion molecules, was less expressed in invasive glands, while those glands exhibited stronger expression of a disintegrin and metalloproteinase 17 (ADAM 17), one of the sheddases that cleaves an extracellular domain of CD44.

Conclusions: These observations appear interesting to consider the pathogenesis and to diagnose extremely well-differentiated adenocarcinoma in ulcerative colitis, although further investigation is needed.

Keywords: CD44v6; CK7; TNF-α; Ulcerative colitis; extremely well-differentiated adenocarcinoma.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Histological features of the biopsy specimens (a-c) 1 year and 7 months, (d-f) 2 years and 1 month and (g-i) 2 years and 7 months after the first operation. Serrated glands are observed: diagnosis was low-grade dysplasia in the specimen of 2 years and 1 month, but regenerative mucosa in the others.
Figure 2.
Figure 2.
Macroscopic appearance of the resected ileum and colon showing severe stenosis at the anastomosis site.
Figure 3.
Figure 3.
Histological features of the operated specimen. (a–c) Glands with minimal atypia tend to show a serrated appearance in the propria mucosa and were tubular below the submucosa. Nuclear atypia is more conspicuous in invasive glands (c). (d-e) In non-tumorous mucosa, mild-to-moderate inflammation with mild basal lymphoplasmacytosis is observed. Glands are shortened and distorted. sm: submucosa, mp: muscularis propria.
Figure 4.
Figure 4.
Immunohistochemical staining of the operated specimen: (a–c) p53-positive cells are a few. (d–i) Tumor cells show CK7+/CK20− patterns and (j–o) tend to be positive for TNF-α and Aurora B, especially in invasive glands. (p-u) CD44v6 and ADAM17 show staining in a reversed manner. TNF: tissue necrosis factor; ADAM17: a disintegrin and metalloproteinase 17.
Figure 5.
Figure 5.
Immunohistochemical staining of the biopsy specimens. Glands of 1 year and 7 months and of 2 years and 5 months are not clearly positive for (a, c) CK7, (d, f) TNF-α or (g, i) Aurora B, but (b, e, h) those of 2 years and 1 month are weakly positive or positive. There were glands showing reduced membranous positivity of CD44v6 (j–l), especially in (k).
See this image and copyright information in PMC

References

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