PRIMARY ADENOCARCINOMA IN AN ENTEROCUTANEOUS FISTULA ASSOCIATED WITH CROHNS-DISEASE

Increasing numbers of intestinal adenocarcinomas in patients with Croh n's disease have been reported, but the strength of this association s till needs to be elucidated. Adenocarcinoma has also been documented i n different types of fistulous tracts associated with Crohn's disease, The first case of well-differentiated mucinous adenocarcinoma involvi ng only enterocutaneous fistulae is reported in a patient with long-st anding Crohn's disease complicated by persistent abdominal wall fistul ous tracts. The malignant lesion arose from neoplastic transformation of columnar epithelium lining portions of the fistulae occurring as a result of either re-epithelialization of these inflammatory tracts or mural implantation of mucosal tissue secondary to prior ulceration. Th e patient has remained disease-free eight years after surgical resecti on of the tumour. Even though intestinal carcinoma is not as strongly associated with Crohn's disease as with ulcerative colitis, intestinal carcinoma should be considered in the setting of long standing diseas e, previous intestinal exclusion surgeries and complications such as e nterocutaneous or other types of fistulous tracts. The prognosis of su ch patients may be excellent with early diagnosis and treatment.