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P299. Mucinous adenocarcinoma in perianal Crohn's disease after biological therapy: A four cases report

L. Gentilini, M. Coscia, S. Laureti, P. Gionchetti, F. Rizzello, C. Calabrese, G. Poggioli

University of Bologna, Bologna, Italy

Aim: Malignant transformation in perianal Crohn's disease has rarely been reported. In this paper we report 4 cases of mucinous adenocarcinoma of anus arisen on chronic perianal Crohn's disease in patients previously treated with biological drugs. All these patients have been submitted to a radical proctectomy subsequently. In this article we evaluate patients' characteristics, disease activity, surgical treatment and medical therapy that have been used.

Materials and Methods: A total of 226 patients with perianal Crohn's disease submitted to surgery in our surgical unit between 2002 January and 2010 June were reviewed retrospectively. All patients have been treated with biological drugs after surgery with a median of 9.6 (range 2–40) infusions for infliximab and 15.4 (range 2–80) injections for adalimumab.

Results: We report 4 cases of carcinoma arisen in this court (1.8%): 2 patients with Crohn's colitis and ano-rectal involvement and 2 patients with ileocolonic and perianal Crohn's disease. Three patients were male and one female with a median age of 49 years (range 42–55). All patients had a longstanding disease (more than 10 years of perianal disease) and had been submitted to macro-biopsies for recurrent fistulas without diagnosis of neoplastic disease. All patients have been submitted to a radical proctectomy for persistent perianal disease and surgical-medical therapy's failure. The diagnosis of neoplastic disease was occasional during surgical procedures. Histological diagnosis has been in all cases of mucinous adenocarcinoma.

Conclusions: Cancer in Crohn's chronic perianal fistulas is rare but a high suspicion for malignancy should be maintained in all patients with persistent or recurrent symptoms also in spite of negative biopsies. Our data suggest that biological drugs could increase the risk for malignant degeneration in long standing perianal Crohn's disease. Therefore in persisting fistulizing perianal Crohn's disease a more aggressive follow up is recommended including surgical biopsy.