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Case Reports
. 2020 May;35(5):963-966.
doi: 10.1007/s00384-020-03554-6. Epub 2020 Mar 6.

Ileostomy adenocarcinoma in Crohn's disease

Ahmed Yousaf  1 , Colleen Beatty  1 , Zachary Zinn  1 , Riaz Cassim  2 , Swapna Gayam  3
Affiliations
Case Reports

Ileostomy adenocarcinoma in Crohn's disease

Ahmed Yousaf et al. Int J Colorectal Dis. 2020 May.

Abstract

Purpose: Adenocarcinoma of an ileostomy is rare with less than 50 reported cases in the literature. Ileostomy adenocarcinoma in Crohn's disease is even more rare, with only 4 reported cases. We present a case of ileostomy adenocarcinoma with lymph node metastasis occurring 51 years after proctocolectomy and Brooke ileostomy in a female with Crohn's disease. This case represents the longest documented interval between Brooke ileostomy and ileostomy adenocarcinoma diagnosis and summarizes clinical signs that warrant biopsy of a peristomal plaque to differentiate adenocarcinoma from clinical mimics such as pyoderma gangrenosum (PG).

Methods: Clinical, histological, and surgical patient data were reviewed. A literature review of adenocarcinoma arising from ileostomy sites was performed.

Results: We report a case of a 67-year-old woman that presented with a peristomal skin lesion developing over 10 years. After multidisciplinary discussion between gastroenterology, colorectal surgery, and dermatology, ileoscopy revealed moderately differentiated, invasive adenocarcinoma arising from the ileostomy site. Wide surgical excision and en bloc resection of the peristomal lesions were performed, and the final pathology revealed lymph node metastasis. The patient is currently undergoing adjuvant chemotherapy.

Conclusions: Clinicians should maintain a high level of suspicion when ileostomy patients develop a peristomal lesion.

Keywords: Colonic adenocarcinoma; Crohn’s disease; Ileostomy; Peristomal.

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Conflict of interest statement

Conflict of interest The authors declare that have no conflict of interest.

Figures

Fig. 1
Fig. 1
A chronic peristomal skin lesion. A well-defined, sharply demarcated 13 × 5 cm beefy, red plaque localized to the peristomal skin developed over 10 years without regression
Fig. 2
Fig. 2
Reactive colonic-type mucosa. Hematoxylin and eosin at × 4, inset at × 10; Biopsy taken from peristomal skin shows an erosion with underlying glandular tissue throughout the dermis, along with marked inflammation and fibrosis. The glandular tissue shows mild atypia. Due to the extensive inflammation and erosion, the glandular atypia was favored to be reactive in nature
Fig. 3
Fig. 3
Transformation of the peristomal skin lesion. Over 19 months, the plaque transformed, developing a new friable nodule with increased intermixed, white, atrophic plaques
Fig. 4
Fig. 4
Moderately differentiated adenocarcinoma arising from the ileostomy. Hematoxylin and eosin at × 40; this biopsy from the stoma shows multiple, atypical glandular structures located within the dermis. The glands are irregular and crowded, with a high nuclear to cytoplasmic ratio and pleomorphic nuclei. Abundant mitotic figures are present (arrow). This is invasive, moderately differentiated adenocarcinoma, consistent with colonic primary
Fig. 5
Fig. 5
Postoperative view. En bloc resection of the peristomal skin lesion, relocation of the ileostomy, and abdominoplasty were performed
See this image and copyright information in PMC

References

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