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Case Reports
. 2021 Oct 18:2021:3278392.
doi: 10.1155/2021/3278392. eCollection 2021.

A Novel Cause of Bowel Obstruction in a Patient with Long-Standing Crohn's Disease

Satya V Vedula  1 , T Paul Nickerson  2 , Douglas J Grider  3   4
Affiliations
Case Reports

A Novel Cause of Bowel Obstruction in a Patient with Long-Standing Crohn's Disease

Satya V Vedula et al. Case Rep Pathol. .

Abstract

Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A 70-year-old male with complicated Crohn's disease presented with 3 days of nausea, emesis, constipation, and abdominal pain. Computed Tomography (CT) demonstrated mucosal thickening of the middescending colon, consistent with fibrosing stricture. Surgical excision revealed an unusual, 5 cm mass originating in the subserosa. Histopathology of the lesion was notable for a proliferation of cells with spindle and stellate-shaped nuclei and no appreciable mitotic figures, which extended into the muscularis and submucosa. Immunohistochemistry was STAT6 nuclear positive and cytoplasmic CD34 positive, diagnostic for solitary fibrous tumor (SFT). In this case, the SFT infiltrating into the muscularis propria and subserosa caused the stricture and bowel obstruction. This illustrates that while fibrosing strictures are usually the etiology of bowel obstruction in the setting of Crohn's disease, other rare possible causes should be considered.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Figure 1
Figure 1
Abdominal CT scan taken at the L5 level, demonstrating focal mucosal thickening and dilation of the ascending and proximal descending colon.
Figure 2
Figure 2
H&E demonstrating fissuring ulcer (tumor not in view) at 40 magnification (4x).
Figure 3
Figure 3
H&E demonstrating SFT with focal invasion of the submucosa at 20 magnification (2x).
Figure 4
Figure 4
H&E from stricture site with tumor in view (bottom right) at 40 magnification (4x).
Figure 5
Figure 5
Nuclear STAT-6 positivity at 600 magnification (60x).
Figure 6
Figure 6
CD34 stain marking the cytoplasm of the stellate and spindle cells as well as a staghorn vessel at 200 magnification (20x).
See this image and copyright information in PMC

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