Ahmed Yousaf1, Colleen Beatty1, Zachary Zinn1, Riaz Cassim2, Swapna Gayam3. 1. Department of Dermatology, West Virginia University, Morgantown, WV, USA. 2. Department of Surgery, West Virginia University, Morgantown, WV, USA. 3. Division of Digestive Diseases, West Virginia University, Morgantown, WV, USA. sgayam@hsc.wvu.edu.
Abstract
PURPOSE: Adenocarcinoma of an ileostomy is rare with less than 50 reported cases in the literature. Ileostomy adenocarcinoma in Crohn's disease is even more rare, with only 4 reported cases. We present a case of ileostomy adenocarcinoma with lymph node metastasis occurring 51 years after proctocolectomy and Brooke ileostomy in a female with Crohn's disease. This case represents the longest documented interval between Brooke ileostomy and ileostomy adenocarcinoma diagnosis and summarizes clinical signs that warrant biopsy of a peristomal plaque to differentiate adenocarcinoma from clinical mimics such as pyoderma gangrenosum (PG). METHODS: Clinical, histological, and surgical patient data were reviewed. A literature review of adenocarcinoma arising from ileostomy sites was performed. RESULTS: We report a case of a 67-year-old woman that presented with a peristomal skin lesion developing over 10 years. After multidisciplinary discussion between gastroenterology, colorectal surgery, and dermatology, ileoscopy revealed moderately differentiated, invasive adenocarcinoma arising from the ileostomy site. Wide surgical excision and en bloc resection of the peristomal lesions were performed, and the final pathology revealed lymph node metastasis. The patient is currently undergoing adjuvant chemotherapy. CONCLUSIONS: Clinicians should maintain a high level of suspicion when ileostomy patients develop a peristomal lesion.
PURPOSE:Adenocarcinoma of an ileostomy is rare with less than 50 reported cases in the literature. Ileostomy adenocarcinoma in Crohn's disease is even more rare, with only 4 reported cases. We present a case of ileostomy adenocarcinoma with lymph node metastasis occurring 51 years after proctocolectomy and Brooke ileostomy in a female with Crohn's disease. This case represents the longest documented interval between Brooke ileostomy and ileostomy adenocarcinoma diagnosis and summarizes clinical signs that warrant biopsy of a peristomal plaque to differentiate adenocarcinoma from clinical mimics such as pyoderma gangrenosum (PG). METHODS: Clinical, histological, and surgical patient data were reviewed. A literature review of adenocarcinoma arising from ileostomy sites was performed. RESULTS: We report a case of a 67-year-old woman that presented with a peristomal skin lesion developing over 10 years. After multidisciplinary discussion between gastroenterology, colorectal surgery, and dermatology, ileoscopy revealed moderately differentiated, invasive adenocarcinoma arising from the ileostomy site. Wide surgical excision and en bloc resection of the peristomal lesions were performed, and the final pathology revealed lymph node metastasis. The patient is currently undergoing adjuvant chemotherapy. CONCLUSIONS: Clinicians should maintain a high level of suspicion when ileostomy patients develop a peristomal lesion.
Authors: V Suarez; J Alexander-Williams; H J O'Connor; A Campos; W J Fuggle; H Thompson; W E Enker; A J Greenstein Journal: Gastroenterology Date: 1988-07 Impact factor: 22.682