COLONIC-CANCER IN A PATIENT WITH PRIMARY SCLEROSING CHOLANGITIS AND LONG-STANDING ULCERATIVE-COLITIS

A 27-year-old woman with a 9-year history of ulcerative colitis involv ing the entire colon was admitted to our hospital in August 1992 becau se of bloody stools and left lower abdominal pain. She had been treate d with sulfasalazine since 1983 and the colitis had been clinically qu iescent or mild for 7 years. She had also been diagnosed as having pri mary sclerosing cholangitis (PSC) 4 years prior to this admission, bas ed on the clinical, laboratory, and cholangiographic findings. A bariu m enema and colonoscopy showed an irregular mass obstructing the bowel lumen in the distal portion of the descending colon. Biopsy specimens taken from the mass revealed moderately differentiated adenocarcinoma , and a subtotal colectomy was performed. Histologic examination of th e mass lesion showed moderately differentiated adenocarcinoma invading the pericolic adipose tissue. She is currently alive 3 years after su rgery. PSC has recently been reported as a risk factor for colonic neo plasia in patients with long-standing ulcerative colitis. In Japan, ho wever, colorectal cancer associated with PSC and ulcerative colitis ha s rarely been reported. The present case suggests that the risk of col onic cancer is higher in patients with ulcerative colitis and PSC than in patients with ulcerative colitis alone.