A Case of Duodenal Cancer in a Patient with Prolonged Crohn's Disease

Case report

A Case of Duodenal Cancer in a Patient with Prolonged Crohn's Disease

Tetsuro Miyazaki MD ¹
Yuko Sakakibara MD ^1*
Shoichi Nakazuru MD ¹
Eiji Mita MD, PhD ¹
Kiyoshi Mori MD, PhD ²

1Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan.

2Department of Pathology, National Hospital Organization Osaka National Hospital, Osaka, Japan.

*Corresponding Author: Yuko Sakakibara, Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka city, Japan.

Citation: T Miyazaki, Y Sakakibara, S Nakazuru, E Mita, K Mori. (2022). A case of duodenal cancer in a patient with prolonged Crohn's disease. Clinical Case Reports and Studies. 1(1); DOI: 10.59657/2837-2565.brs.22.003

Copyright: © 2022 Yuko Sakakibara, this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: October 01, 2022 | Accepted: November 09, 2022 | Published: November 14, 2022

Abstract

The incidence of colorectal and small bowel cancers associated with CD development is often accompanied by chronic active inflammation at the site. Although the duodenum can be accessed easily during endoscopy, it is challenging to diagnose malignant transformation prior to the surgery. Early diagnosis of CD-associated cancers is necessary.

Keywords: crohn’s disease; duodenal cancer; esophagogastroduodenoscopy

Introduction

Case Report

A 55-year-old woman was treated for Crohn's disease (CD) for more than 30 years. Ten years ago, she was diagnosed with duodenal stenosis related to CD on the distal side of the vater papilla, 3 cm in the descending duodenum. Biopsy results from the proximal stricture showed inflammatory changes. Endoscopy performed 5 years later revealed redness immediately proximal to a high-grade obstruction of the descending duodenum (Figure 1). Biopsy of the lesion confirmed adenocarcinoma. Chronic inflammation was present at the cancer site, and the boundary between neoplastic and non-neoplastic lesions was unclear. Additionally, a transnasal endoscope was passed through the 1 cm long stenosis, and no other abnormalities were found in the mucosa distal to the stenosis. The patient then underwent a duodenopancreatectomy. Postoperative pathological examination revealed that the lesion was 0-IIc, tub2 > por2, pT1a(M), ly0, v0, pPM0, pRM0, pN0, and p0 (Figure 2). In addition, this examination revealed high-grade adenoma discontinuously adjacent to intramucosal cancer (Figure 3: yellow line), and immunohistochemical analysis detected p53 [removed]Figure 4).

Figure 1: Esophagogastroduodenoscopic image, The descending portion of the duodenum was stenotic, and the surrounding surface mucosa was erythematous.

Figure 2: Histopathological examination of biopsy specimens, (Hematoxylin and eosin stain; original magnification, 40x), This image shown tubular adenocarcinoma with signet ring cell carcinoma, and tumor invasion is confined to the mucosa.

Figure 3: Resection specimen image, The yellow line shown in the image is high-grade adenoma and red line shown intramucosal cancer.

Figure 4: Immunohistochemical examination showed immunopositivity for p53, (Original magnification, 200x).

Discussion

Studies show that the incidence of colorectal and small bowel cancers associated with CD is higher than in the general population due to CD onset at a relatively young age and prolonged duration of the disease[1,2]. Cancer development is often accompanied by chronic active inflammation at the site, and thus it is hypothesized that chronic inflammation of the intestinal tract is closely related to carcinogenesis. Moreover, dysplasia, overexpression of p53 at an early stage, and cancer complications are observed in ulcerative colitis, but the relationship is not clear [3].

Conclusion

The majority of cancers occur in the large intestine, and although the absolute number of small intestinal cancers is small, the relative risk is remarkably high [4]. Upper gastrointestinal tract involvement in CD has been reported to occur in 0.1% of patients with CD [5]. Although the duodenum can be accessed easily during endoscopy, it is challenging to diagnose malignant transformation prior to the surgery because of the presence of chronic inflammation in the background of the cancer site. Many studies report cases of advanced cancer at the time of detection, such as stage IV or lymph node positive cases. Our study suggests that progressive duodenal narrowing and ulceration should be followed up with a careful endoscopic evaluation and biopsy to exclude malignant degeneration of CD. Therefore, early diagnosis of CD-associated cancers is necessary.

Acknowledgements

Author contributions: T. Miyazaki wrote the paper; Y. Sakakibara and

S. Nakazuru contributed to endoscopic diagnosis; T. Miyazaki treated the patient; K. Mori confirmed the pathological diagnosis; and E. Mita supervised the writing of and reviewed the paper.

The lead author: Tetsuro Miyazaki, A Medical Resident.

Disclosure: All authors disclosed no financial relationships relevant to this publication, Informed consent was obtained for this report.

References

Laukoetter MG, Mennigen R, Hannig CM et al. (2011). Intestinal cancer risk in Crohn’s disease a meta-analysis. J Gastrointest Surg. 15:576-583.
Publisher | Google Scholor
Maykel JA, Hagerman G, Mellgeren AF et al. (2006). Crohn’s colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. DIS Colon Rectum. 49:950-957.
Publisher | Google Scholor
Uesugi H, Mitomi H, Sada M et al. (1999). A case of adenocarcinoma of the small intestine in a Japanese patient with Crohn disease a report with immunochemical and oncogenic analyses. Scand J Gastroenterol. 34:1162-1167.
Publisher | Google Scholor
Canavan C, Abrams KR, J Mayberry et al. (2006). Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn’s disease: Aliment pharmacol Ther. 23:1097-1104.
Publisher | Google Scholor
Pimentel AM, Rocha R, Santana GO. (2019). Crohn’s disease of esophagus, stomach and duodenum. World J Gastrointest Pharmacol Ther. 10(2):35-49.
Publisher | Google Scholor

Delia Teresa Sponza

"Journal of BioMed Research and Reports has created a diverse portfolio in peer review process and provides a wide range scientific and medical novel papers to the scientists. This journal publishes high-quality, peer-reviewed content across all levels of professional development and corporate research and development."

Fatema Tashrifwala

I would like to thank the editorial team for their timely responses and consideration in the publication of my paper. They have been very helpful and accommodating, Lastly, being an open access journal, the published work is freely available and accessible to readers at no cost to them. I would encourage other authors to publish their research in BioRes Scientia. I am happy to be a part of BioRes Scientia Publishers.

Dr Nikhil Vitthal Dayama

I would like to thank the editorial team for their timely and prompt responses and consideration in the publication of my case report. Being an open access journal, it will be great help for the readers to learn the new things without any cost. I would encourage the authors to publish their research in BioRes Scientia and I am happy to be part of this journal.

Boubacar Ahy Diatta

I warmly thank the editorial team for the excellent work they do for continuing medical education in Dermatology. I was able to discover with joy their professionalist, their support and above all appreciate their social generosity on the access to the magazines which is free. This allows an update of scientific knowledge to the entire scientific community. I gladly recommend authors for publication in this journal.

Professor Rajko Igic

The editor of JBRR helped me during the whole process, mainly to eliminate some typographical and other errors. It hastened this publication to be published quickly. Although it is a short text, I believe that the content is important for all medical and other scientific disciplines because eventual addition of the iC citations to citation of the paper would lead to proper assessment of the author's contribution.

Dr Tewodros kassahun Tarekegn

I am thrilled to have had the opportunity to publish my research article in this prestigious journal. The entire process of peer review and publication support provided by the editorial office was exceptional, and it fortified my belief in the quality of my research study. The rigorous peer review process ensured that only the highest quality research was published, and the feedback from the reviewers was extremely helpful. I appreciate the journal's commitment to open access publication, enabling my research to reach a wider audience. The easy-to-use online platform streamlined the submission, peer review, and publication process, and I would confidently recommend this journal to any author looking for efficient, rigorous, and high-quality peer-reviewed publication.

Francis Okello Ooko

I was impressed by your author-centred approach whereby you maintained constant and timely communication with us from the time we submitted the manuscript to acceptance, each time providing critical suggestions to improve the manuscript. In addition, we are encouraged by the thoroughness of your editorial team in checking the originality and overall, quality of the work. Which I believe is very encouraging to other researchers and authors who wish to publish their work in your journals. The published work and the information imparted is freely available and accessible to a wide spectrum of readers at no cost to them. I would encourage other authors to publish their research in BioRes Scientia. I am happy to be a part of BioRes Scientia Publishers.

Dr Nidhi Sapolia

I would like to thank the editorial team of their timely response and guidance in the publication of my case report. They have been extremely helpful at all stages. Being an open access journal, it is of great help for the readers to learn new experiences in different fields, I would highly recommend this journal to authors for high quality peer-reviewed publications.

Dwight L Mckee MD CNS ABIHM

I am very impressed by the high quality of the papers published by the International Journal of Clinical and Molecular Oncology. The editors of this journal are a pleasure to work with, as they are highly responsive even to numerous last minute changes in the manuscript that I recently published with them, and the changes are made on-line the same day they are received. I highly recommend this journal to anyone working in the oncology field, and also value it as a source of cutting edge information in the field.

Kyaw Swar Thet

I would like to thank the editorial team for the opportunity to publish our case report in this prestigious journal. I am very impressed by their timely and efficient handling of the submission, peer review, and publication processes. As residents of a developing, low-income country, we greatly appreciate the discount on submission charges. I hope that as an open access journal, it will facilitate easy access for readers to update their scientific knowledge. I highly recommend this journal for high-quality, peer-reviewed publications. I express my sincere gratitude to the editorial team for their excellent work.

Michel Farah

I would like to thank the editorial team for their quick response and support. The publication support and editorial office were excellent and very helpful. I am happy to have my research article published in this prestigious journal. Our previous case report published in this journal was very successful and viewed by many physicians worldwide.