Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2013; 5(6): 293-296
Published online Jun 16, 2013. doi: 10.4253/wjge.v5.i6.293
Carcinoma in gut-associated lymphoid tissue in ulcerative colitis: Case report and review of literature
Carlos A Rubio, Ragnar Befrits, Jannis Ericsson
Carlos A Rubio, Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute and University Hospital, 7176 Stockholm, Sweden
Ragnar Befrits, Department of Gastroenterology, Karolinska University Hospital, 7176 Stockholm, Sweden
Jannis Ericsson, Department of Pathology, Karolinska Institute and University Hospital, 7176 Stockholm, Sweden
Author contributions: Rubio CA and Befrits R contributed equally to the manuscript writing and revision; Rubio CA diagnosed the carcinoma in gut-associated lymphoid tissue at histology, designed and wrote the report; Befrits R provided the clinical data, the endoscopic illustration, critically revised the draft and approved the final version; Ericsson J provided technical assistance and approved the final version.
Correspondence to: Dr. Carlos A Rubio, Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute and University Hospital, 171 76 Solna, 7176 Stockholm, Sweden. carlos.rubio@ki.se
Telephone: +46-8-51774527 Fax: +46-8-51774524
Received: February 26, 2013
Revised: April 8, 2013
Accepted: April 13, 2013
Published online: June 16, 2013
Processing time: 102 Days and 21.7 Hours
Abstract

The colorectal mucosa includes two quantitatively, structurally and functionally dissimilar areas: one, built with columnar and goblet cells, covers the vast majority of the mucosa, and the other consists of scattered minute gut-associated lymphoid tissue (GALT). The overwhelming majority of colorectal carcinomas evolve in GALT-free mucosal areas and very rarely in GALT aggregates. Remarkably, the colonic mucosa in patients with ulcerative colitis (UC) displays a high number of newly formed GALT-aggregates. The patient here described is a 68-year-old female with a history of UC since 1984. At surveillance colonoscopy in 2012, one of two detected polyps was a tubular adenoma with high-grade dysplasia. Beneath this adenoma, a well-circumscribed GALT sheltering a carcinoma was found. Serial sections revealed no connection between the villous adenoma and the GALT-carcinoma. The GALT-carcinoma here reported seems to have evolved in a newly formed, UC-dependent, GALT complex. This notion is substantiated by the fact that 27% or 4 out of the 15 cases of GALT-carcinomas in the colon reported in the literature (including the present case) evolved in patients with UC.

Keywords: Colon; Advanced adenoma; Gut-associated lymphoid tissue; Carcinoma; Ulcerative colitis

Core tip: Of the 15 cases of gut-associated lymphoid tissue (GALT)-carcinomas in the colon reported in the literature (including the present case) 27% (n = 4) have evolved in patients with ulcerative colitis. The possibilities that the advanced adenoma on top had invaded the GALT-complex underneath or that the GALT-carcinoma was a metastasis from the adenoma on top were rejected, since serial sections revealed neither continuity between the adenoma and the GALT-carcinoma, nor invasive growth in the adenoma.