Two Cases of Carcinomas Arising in Anal Fistulas of Crohn's Disease

• Published in: Nippon Daicho Komonbyo Gakkai Zasshi Vol. 55; no. 2; pp. 97 - 102
• Main Authors: Fukazawa, K., Koganei, K., Hoshi, K., Makino, H., Oota, M., Takahashi, M., Kanamura, S., Kitou, F., Fukushima, T.
• Format: Journal Article
• Language: English
• Published: The Japan Society of Coloproctology 2002
• ISSN: 0047-1801; 1882-9619
• DOI: 10.3862/jcoloproctology.55.97

Two cases of mucinous carcinomas arising in anal fistulas of Crohn's disease, are presented as the first case-report in Japan. The first case, A 37-year-old male diagnosed as having Crohn's disease in 1979 because of an anal fistula, was readmitted with anal fistulas and perianal abcesses in June 2000. Magnetic resonance imaging (MRI) of the pelvis revealed-15-cm long intrapelvic spaces filled with a large amount of mucinous substance. Debridement and a fistulectomy were performed, and histological examination of the mucus revealed class V, mucinous adenocarcinoma. In August 2000, abdomino-perineal resection was performed. The second case, a 40-year-old male diagnosed as having Crohn's disease in 1980 because of an anal fistula, was readmitted with anal fistulas, and a fistulectomy was performed. The fistula was filled with mucinous exudates, and cytologic examination revealed mucinous adenocarcinoma. MRI revealed 20-cm-long intrapelvic spaces filled with a large amount of mucinous substance. Abdomino-perineal resection was performed. The diagnosis of cancer is difficult and not infrequently delayed ; prognosis is poor. Risk of anorectal carcinomas should be considerd seriously in the management of patients with fistulas associated with Crohn's disease.