Neoplastic Imitators of Small Bowel Crohn’s Disease

Abstract

OBJECTIVE: To identify the problem of small bowel neoplasia masquerading as Crohn's disease. DATA AND METHODS: Sixteen articles reviewing the frequency of small bowel neoplasia were identified. Articles were selected if they assessed frequency of small bowel tumours in the general population. All articles were retrospective reviews of experience. Data on frequency were extracted and Ct)mpiled. Three case reports as illustrative examples and a Mcclline search of small bowel neoplasms with manual searching of references from identified articles arc presented. RESULTS: A total of 2507 cases of small bowel tumours was compiled. The frequency of tumours in decreasing order was adenocarcinoma, carcinoid, lymphoma, le iomyoma, le iomyosarcoma, adenoma a nd lipoma. CONCLUSIONS: Crohn's disease is the most preva lent d isease affecting terminal ileum. Malignant disease may affect the terminal small bowel in ways which are clinically indistinguishable from Crohn's disease. Surgery is the last therapeutic option for Crohn's disease, whe reas it is potent iall y curative anJ therefore the first option for small bowel neoplasia. Misdiagnos ing malignant processes as being Crohn's disease causes delays in effective treatment and worsens prognosis.

An Unusual Presentation of Metastatic Squamous Cell Cervical Carcinoma Involving the Distal Ileum Mimicking Crohn’s Disease

“…As in our patient, neoplastic disease and/or sequelae of treatment may resemble Crohn's disease clinically and radiologically (18,19). Both primary and secondary malignancies have been reported to mimic Crohn's disease.…”

“…Locally invasive adenocarcinoma of the colon has, radiologically, been mistaken for Crohn's disease (20), as has primary adenocarcinoma of the ileocecal region (18,20). Carc inoid tumours (18,19,21) and lymphomas, both Hodgkin's (18) and non-Hodgkin's (22), have also been reported to simulate Crohn's enteritis and colitis, respectively. There have been reports of primary malignancies, including lung (23 ), melanoma (24 ), thyroid (25) and hepatocellular carcinoma (26), metastasizing to the ileum and jejunum.…”