Colorectal Carcinoma at Diagnosis of Ulcerative Colitis in a 17 Years Old Female - Abstract
Inflammatory bowel disease (IBD) is a known risk factor for colorectal cancer (CRC). The degree of risk is related to the duration and extent of colitis, as well as the severity of inflammation over time. We present a 17 years old female diagnosed with carcinoma in situ associated with ulcerative colitis (UC) at first colonoscopy for suspected IBD. She presented with non-bloody diarrhea of 3 years’ duration. A clinical diagnosis of irritable bowel syndrome (IBS) was suggested elsewhere and her symptoms improved with loperamide. Hematochezia triggered an investigation for IBD. The colonoscopy revealed pancolitis and no tumor was seen. Histology confirmed characteristic signs of chronic colitis with focal ulcerations, crypt branching and abscesses and dense acute and chronic inflammatory infiltrates. Multiple biopsies showed signs of definite dysplasia, as well as the presence of P53 and k167 expression. Two independent pathologists confirmed high-grade dysplasia with carcinoma in situ in the descending colon. A proctocolectomy with ileo-anal J pouch anastomosis was performed. The pathology specimen confirmed a diagnosis of UC without skip lesions and a carcinoma in situ in the descending colon.
Rare cases of CRC at or shortly after diagnosis of IBD exist. Our case is exceptional in that CRC was found at the time of initial colonoscopy for suspected IBD. This emphasizes the fact that CRC can be present early after the onset of symptoms and may be delayed or missed when conducting surveillance strictly
according to formal guidelines.