Crohn's Disease Hard to Differentiate from the Diffusely Infiltrating Type of Colon Cancer, Report of a Case H. Ueda 1 , M. Mai 1 , T. Imahori 1 , I. Nishino 2 , I. Nakanishi 3 1Department of Surgery, Cancer Research Institute Hospital, Kanazawa University 2Department of Internal Medicine, Cancer Research Institute Hospital, Kanazawa University 3The First Department of Pathology, School of Medicine, Kanazawa University pp.891-896
Published Date 1983/8/25
DOI https://doi.org/10.11477/mf.1403109449
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 Segmental stenosis between the rectum and the sigmoid colon could be seen in inflammatory disease such as Crohn's disease and ulcerative colitis as well as diffuse invasive type of carcinoma, and their differential diagnosis is sometimes quite difficult. This case was one of such difficult cases and was finally diagnosed as Crohn's disease.

 The patient was 37 year-old man who came to our institution with six months' history of progressive constipation and blood in stool. Laboratory data disclosed elevated ESR, positive CRP and increased α2-globulin but otherwise non-remarkable. However, radiologic and endoscopic examination revealed tubular stenosis of 8 cm long mainly at the rectum, serrated marginal change and cobblestone appearance without longitudinal ulcerations. Diffuse invasive carcinoma was strongly suspected and biopsy was performed three times but they were negative for carcinoma. There were no abnormalities in the stomach and the small intestine. Salicylazosulfapyridine was administerted for one month with a diagnosis of inflammatory disease, but no significant improvement was obtained and rectosigmoidectomy was performed between middle portion of the rectum and recto-sigmoid junction. Ileo-cecal resection was also performed because of adhesion and reconstruction of the colon was done by pull-through method.

 Macroscopic findings showed stenosis due to thickening of the wall and cobblestoning. Histological evaluation disclosed severe submucosal inflammation as well as transmural inflammation with fissuring. Furthermore, multiple non-caseating granulomas were found in every layer of the wall. At the terminal ileum, there were erosion, submucosal edema and proliferation of lymphoid follicles but it was hard to be considered as a skip lesion.

 Therefore, it was diagnosed as Crohn's disease of the colon although atypical, and the patient has been placed on salicylazosulfapyridine for over the last one year and nine months, and no recurrence has been noted so far. however, a long-term follow-up is important for this case.

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