Intestinal adenocarcinoma in Crohn's disease - A report of 30 cases with afocus on coexisting dysplasia

There are relatively few reports that detail the types of intestinal adenoc arcinoma complicating Crohn's disease and examine associated epithelial dys plasia. We determined the prevalence, grade, and type of dysplasia found ad jacent to and distant from Crohn's-related adenocarcinomas. Thirty cases of resected Crohns-related adenocarcinoma were reviewed, and histologic type, degree of differentiation, TNM stage, and the presence or absence, grade, and location of dysplasia were recorded. Most of the patients were male (70 %). The median ages at diagnosis of Crohns disease and adenocarcinoma were 34 and 49 years, respectively. The extent of Crohn's disease included ileoc olitis in 21 patients, only colonic disease in six, and only small bowel di sease in three. In most cases (67%), carcinoma was found incidentally at su rgery. All carcinomas arose in areas involved by Crohn's disease. Eight (27 %) adenocarcinomas arose in the small bowel, and 22 (73%) arose in the colo n, including two in out-of-circuit rectums. Most carcinomas (63%) were poor ly differentiated. Dysplasia was found adjacent to the carcinoma in 26 (87% ) cases. Of the colorectal carcinomas, 19 (86%) had adjacent dysplasia, and nine (41%) had distant dysplasia. In conclusion, most cases of Crohn s-rel ated intestinal adenocarcinoma have dysplasia in adjacent mucose, and 41% o f those arising in the colorectum have distant dysplasia, supporting a dysp lasia-carcinoma sequence in Crohn's disease.