Small bowel adenocarcinoma arising in longstanding fibrostenotic Crohn’s disease

Dumitrescu, D.; Dumitru, Adrian; Alexandra, Dimienescu; Badiu, Cristinel Dumitru; Dumitrescu, Victor

doi:10.22551/msj.2021.01.16

Cited by 1 publication

(3 citation statements)

References 19 publications

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“…1). Twenty articles (15 case reports and five case series) were included for subsequent bias assessment (Supplementary Material 1, 2, www.wjon.org) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Two case reports were deemed high risk for bias, while the remaining articles were all rated as moderate risk for bias (Supplementary Material 1, 2, www.wjon.org).…”

Section: Systematic Review Of Crohn's Disease Patients With Srccmentioning

confidence: 99%

“…In summary, the 20 articles included 40 patients with both Crohn's disease and a diagnosis of small bowel SRCC, with nearly all cases arising in the distal/terminal ileum (Table 1) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Patients presented at an approximate mean age of 59 years old, with a range from 31 to 76.…”

Section: Systematic Review Of Crohn's Disease Patients With Srccmentioning

confidence: 99%

“…Limited follow-up/survival time data was only on the order of a few months. All but four of the studies were published in 2012 and later (Table 1) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Systematic Review Of Crohn's Disease Patients With Srccmentioning

confidence: 99%

See 2 more Smart Citations

Malignant Transformation of Long-Standing Ileal Crohn’s Disease Likely Favors Signet Ring Cell Adenocarcinoma Histology

Benesch,

Nelson,

O’Brien

2023

World J Oncol

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Signet ring cell adenocarcinomas (SRCCs) are a rare and aggressive histological subtype of adenocarcinomas typically with poor prognosis usually secondary to late stage at detection. In the small bowel, they constitute only 1% of all malignancies. In the last decade, there have been multiple case reports and small case series that have identified SRCCs, typically in the ileum, in patients with Crohn's disease. Crohn's disease is a transmural inflammatory condition that normally manifests in the distal ileum and colon, and is known to temporally increase the risk of malignancy. Given the profound rarity of SRC-Cs, establishing an association between Crohn's disease and SRCC is challenging. In this study, we performed a systematic review of case reports and small case series describing small bowel SRCCs in Crohn's disease patients. Most cases were found in the distal/terminal ileum, at a mean age of 59 years old. Virtually all tumors were locally advanced (pathological T stage 3 and 4), typically with at least N1 nodal disease. Two case studies (one is a case-control study and the other a cohort design) demonstrated that small bowel SRCC, as opposed to conventional adenocarcinoma, was significantly correlated to a history of Crohn's disease (35% vs. 0%, 73.5% vs. 28.5%), with a propensity to arise in the ileum (95% vs. 30%, 66.7% vs. 42.1%), and at earlier mean age (43 vs. 68 years, 53.7 vs. 61.7 years). We additionally used the Surveillance, Epidemiology, and End Results (SEER) database for insights into the clinicoepidemiological characteristics of ileum SRCCs. SRCCs composed 28.1% of all ileal SRC-Cs, compared to 11.0% for the adenocarcinomas, with a younger age at diagnosis (60.7 vs. 64.6 years), more distant disease at presentation (41.3% vs. 26.4%), and shorter overall median survival time (20 vs. 39 months). In summary, while there is limited direct evidence to support an association between small bowel SRCC and Crohn's disease, the phenomenon has been increasingly documented in the literature in the last decade. Clinicians treating Crohn's disease patients should consider this in their differential diagnosis, particularly when managing disease complications, as early detection and surgical intervention offer the best prognosis.

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