Adenocarcinoma of the ileoanal pouch anastomosis: an emerging complication?
Adenocarcinoma of the ileoanal pouch anastomosis: an emerging complication?
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DOI：
10.1007/s00384-002-0452-1
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发表时间：
2003-05-01
影响因子：
2.8
通讯作者：
Morini, S
中科院分区：
文献类型：
--
作者：
Hassan, C;Zullo, A;Morini, S
背景和目标：恢复性直肠结肠切除回肠肛管吻合术（IPAA）是目前溃疡性结肠炎的首选手术治疗。虽然在患有严重慢性结肠袋炎的一个亚组患者中发生了结肠袋的原生回肠粘膜的发育异常变化，但结肠袋本身发生癌症是非常罕见的事件。迄今为止，仅报告了两例IPAA癌病例，即因结肠癌并发溃疡性结肠炎而接受手术的患者和既往诊断为回肠炎的患者。病例报告：我们报告一位在手术后早期患有慢性萎缩性结肠袋炎的回肠肛管癌患者。他以前没有结肠癌或回肠炎的病史。在IPAA后22个月检测到腺癌，并且它深深地浸润邻近结构（pT4N0M0，2级）。组织学检查显示慢性萎缩性结肠袋炎转变为上皮发育不良和癌症。结论：我们的病例表明，即使没有回肠炎或结肠癌病史，IPAA的恶性转化也可能是严重慢性结肠袋炎的单纯并发症。
Background and aims: Restorative proctocolectomy with ileoanal pouch anastomosis (IPAA) is currently the surgical treatment of choice for ulcerative colitis. Although dysplastic changes to the native ileal mucosa of the pouch occur in a subgroup of patients with severe chronic pouchitis, the development of cancer in the pouch itself is a very rare event. To date, only two cases of carcinoma of the IPAA have been reported, namely in patients operated on for colon cancer complicating ulcerative colitis and with a previous diagnosis of backwash ileitis. Case report: We report a patient with carcinoma in an ileoanal pouch who had been suffering from chronic atrophic pouchitis early after surgery. He had no previous history of colon cancer or backwash ileitis. The adenocarcinoma was detected 22 months after IPAA, and it was deeply infiltrating the adjacent structures (pT4N0M0, grade 2). Histology revealed the passage from chronic atrophic pouchitis to dysplastic epithelium and to cancer. Conclusion: Our case suggests that malignant transformation of the IPAA may occur as a pure complication of the severe chronic pouchitis, even in the absence of backwash ileitis or a previous history of colon cancer.