Clinical characteristics and imaging features of small bowel adenocarcinomas in Crohn’s disease

Abstract

Small bowel adenocarcinoma is rare in patients with Crohn's disease but results in significant mortality. CT or MR imaging findings can be suggestive of the pre-operative diagnosis, but it is usually diagnosed at an advanced stage with laparotomy.

Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings

“…Similarly, MR-enteroclysis has a sensitivity of 86-91%, a specificity of 95-98%, and an accuracy of 97% (Masselli et al, 2009;Van Weyenberg et al, 2010). However, the diagnostic capabilities of these imaging techniques for the detection of small bowel adenocarcinoma in the specific context of IBD are not known because of the retrospective nature of the published studies that consisted of case collection (Weber et al, 2015;Soyer et al, 2012b).…”

“…In CD patients, an identification of a clearly visible mass, present in 50% of the cases (Weber et al, 2015) strongly suggests the presence of small bowel adenocarcinoma but adenocarcinoma may be completely indistinguishable from benign fibrotic or acute inflammatory stricture (Weber et al, 2015;Soyer et al, 2012b). In this regard, up to 3/4 of adenocarcinomas develop in a region of chronic inflammation (Weber et al, 2015;Soyer et al, 2012b). As a consequence, it is important to distend the small bowel to Fig.…”

“…In case of smallbowel obstruction, CT must be performed without enteral contrast agent because of spontaneous small bowel dilatation. When small bowel obstruction is the presenting symptom, CT can show small bowel perforation with surrounding abscess (Weber et al, 2015). Of interest, Weber et al (2015) have reported that 25% of IBD patients with small bowel adenocarcinoma had a perforation visible on CT. Extra-digestive characteristics include fat stranding and comb sign in association with enlarged adjacent mesenteric lymph nodes (Weber et al, 2015;Soyer et al, 2012b).…”

Extra-intestinal malignancies in inflammatory bowel diseases: An update with emphasis on MDCT and MR imaging features

“…Multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging are now screening modalities of major importance for diagnosing complications in IBD patients as well as problem-solving tools for IBD patients presenting with unusual symptoms [2][3][4]8]. Consequently, radiologists are currently on the frontline of management of IBD patients in many occasions.…”

“…Gastrointestinal cancers are of major concern in the followup of IBD patients, so that they have already received a great attention in the gastroenterological and radiological literatures [4][5][6][7][8][9]. However, although they are somewhat rarer, extra-intestinal malignancies associated with IBD, such as cholangiocarcinoma, lymphoma and skin cancers may occur and the risk is increased by immunosuppressive treatments [10][11][12][13][14][15][16][17][18][19][20].…”