Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2010; 2(7): 307-310
Published online Jul 15, 2010. doi: 10.4251/wjgo.v2.i7.307
Mucinous carcinoma in Crohn’s disease originating in a fistulous tract
Hugh J Freeman, Tom Perry, Douglas L Webber, Silvia D Chang, Mong-Yang Loh
Hugh J Freeman, Tom Perry, Douglas L Webber, Silvia D Chang, Mong-Yang Loh, Departments of Medicine (Gastroenterology), Anesthesia, Pharmacology and Therapeutics, Pathology and Radiology, University of British Columbia, Vancouver, BC, V6T 1W5, Canada
Author contributions: Freeman HJ and Perry T drafted, revised and edited manuscript; Webber DL performed pathological studies and edited manuscript; Chang SD and Loh MY performed radiological imaging studies and edited manuscript.
Correspondence to: Dr. Hugh J Freeman, MD, Professor, Departments of Medicine (Gastroenterology), UBC Hospital, 2211 Wesbrook Mall,Vancouver, BC, V6T 1W5, Canada.
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: December 16, 2009
Revised: February 10, 2010
Accepted: February 17, 2010
Published online: July 15, 2010

Malignant disease, including mucinous carcinomas of the colorectum, may complicate long-standing Crohn’s disease. An 18-year-old male with extensive small and large bowel involvement with Crohn’s disease developed recurrent peri-rectal fistulous disease that persisted for more than a decade despite pharmacological and surgical therapy as well as later therapy with biological agents. Eventually, an extensive and difficult-to-detect mucinous carcinoma developed in the fistulous tract. Although fistula cancer is rarely described in Crohn’s disease, use of immunosuppressant and biological agents may play an initiating or exacerbating role in its development or progression. As potent biological agents are frequently used, often to avoid surgical treatment, clinicians should have an increasingly high index of suspicion for this potential complication, especially if fistulous drainage persists and remains refractory to medical therapy.

Keywords: Tumor necrosis factor antibodies, Anorectal adenocarcinoma, Crohn’s disease, Infliximab, Adalimumab, Anal fistula, Fistula carcinoma