Adenocarcinoma of an ileostomy in a patient with familial adenomatous polyposis

Abstract

A case of adenocarcinoma arising in an ileostomy of 39 years' duration is presented. The patient had undergone proctocolectomy in 1949 for familial adenomatous polyposis, with subsequent ileostomy in 1950, and presented in April 1989 with bleeding and a mass at the stoma site. Biopsy of the mass revealed adenocarcinoma. Adenocarcinoma of an ileostomy is a rare but well-documented complication, with the present patient bringing the total number of reported cases to 18. The literature is reviewed, and surveillance measures are suggested.

Mucosal Dysplasia in Ileal Pelvic Pouches After Restorative Proctocolectomy

“…More than 20 cases of adenocarcinomas occurring within the ileostomy in patients with UC and patients with FAP have been reported. [39][40][41][42][43][44][45][46][47][48][49][50] The risk of cancer forming within a Kock pouch or ileal J-pouch based on the current literature seems to be no greater than the risk in a Brooke ileostomy.…”

Familial adenomatous polyposis

“…However, a permanent ileostomy is a major drawback for most young FAP patients, and is rarely considered in young patients [80]. Interestingly, two cases of cancer have been reported in ileostomies in FAP [81,82], although most ileostomy polyps are inflammatory, not adenomatous.…”

Primary Mucinous Adenocarcinoma in an Ileostomy with Adjacent Skin Invasion: A Late Complication of Surgery for Ulcerative Colitis

“…Polypoidal adenocarcinomas tend to arise more than 20 years after the construction of the ileostomy. The interval between the surgical excision and occurrence of malignancy ranges from 2 to 39 years in the reported cases [9][10][11]. The most common carcinoma being reported in previous literature was mucin-secreting adenocarcinoma [6].…”

“…Two cases have been reported following ileostomy for Crohn's disease [13]. A handful of cases have been reported following similar procedures performed for familial adenomatous polyposis [10,11,14]. Hence, some authors suggest that the regenerative epithelial hyperproliferation brought about by chronic irritation at the mucocutaneous junction appears to be a factor in the unclear aetiology of the growth as well as trauma and/or chemical agents, such as those used as stomal adhesives [6,9,[14][15][16][17][18].…”