Document Type : Case reports

Authors

Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang, University, Hangzhou, Zhejiang province, China; Inflammatory Bowel Disease Center of Sir Run Run Shaw Hospital, Hangzhou, Zhejiang province, China

Abstract

Background: Anal cancer in patients with Crohn's disease (CD) is rare, and the relationship between infliximab and anal cancer is not clear yet. The present study aimed to report three patients with CD complicated with anal cancer who used infliximab with their basic features.
Case presentation: Three cases were reported, including two females and one male, aged 29-56 years old. All of them developed perianal lesions during the period of Crohn's disease. All three patients had used infliximab for Crohn's disease before the diagnosis of anal cancer, except one patient who stopped using infliximab three times due to allergy; the other two patients had used infliximab until the diagnosis of anal cancer. Two patients had a good prognosis with early therapeutic intervention.
Conclusion: Based on the results, Chinese and Western patients with Crohn's disease who developed anal carcinoma had similar features. Conventional perianal evaluation is important in patients with Crohn's disease. The association between infliximab therapy and anal cancer has not been fully established and needs to be fully evaluated before the use of infliximab in Crohn's disease.

Keywords

  1. Wisniewski A, Flejou JF, Siproudhis L, Abramowitz L, Svrcek M, Beaugerie L. Anal neoplasia in inflammatory bowel disease: classification proposal, epidemiology, carcinogenesis, and risk management perspectives. J Crohns Colitis. 2017;11(8):1011-8. doi: 10.1093/ecco-jcc/jjx035. [PubMed: 28379306].
  2. Egea-Valenzuela J, Belchi-Segura E, Essouri N, Sanchez-Torres A, Carballo-Alvarez F. Adenocarcinoma of the rectum and anus in a patient with Crohn's disease treated with infliximab. Rev Esp Enferm Dig. 2010;102(8):501-4. doi: 10.4321/s1130-01082010000800009. [PubMed: 20670073].
  3. Maejima T, Kono T, Orii F, Maemoto A, Furukawa S, Liming W, et al. Anal Canal adenocarcinoma in a patient with longstanding Crohn's disease arising from rectal mucosa that migrated from a previously treated rectovaginal fistula. Am J Case Rep. 2016;17:448-53. doi: 10.12659/ajcr.897876. [PubMed: 27373845].
  4. Melichar B, Bures J, Dedic K. Anorectal carcinoma after infliximab therapy in Crohn's disease: report of a case. Dis Colon Rectum. 2006;49(8):1228-33. doi: 10.1007/s10350-006-0647-6. [PubMed: 16845561].
  5. Freeman HJ, Perry T, Webber DL, Chang SD, Loh MY. Mucinous carcinoma in Crohn's disease originating in a fistulous tract. World J Gastrointest Oncol. 2010;2(7):307-10. doi: 10.4251/wjgo.v2.i7.307. [PubMed: 21160662].
  6. Lightner AL, Moncrief SB, Smyrk TC, Pemberton JH, Haddock MG, Larson DW, et al. Long-standing Crohn's disease and its implication on anal squamous cell cancer management. Int J Colorectal Dis. 2017;32(5):661–6. doi: 10.1007/s00384-017-2794-8. [PubMed: 28293746].
  7. Buchman AL, Ament ME, Doty J. Development of squamous cell carcinoma in chronic perineal sinus and wounds in Crohn's disease. Am J Gastroenterol. 1991;86(12):1829-32. [PubMed: 1962632].
  8. Benjelloun EB, Abkari M, Ousadden A, Ait Taleb K. Squamous cell carcinoma associated anal fistulas in Crohn's disease unique case report with literature review. J Crohns
  9. Colitis. 2013;7(6):232-5. doi: 10.1016/j.crohns.2012.09.015. [PubMed: 23069004].
  10. Ball CS, Wujanto R, Haboubi NY, Schofield PF. Carcinoma in anal Crohn's disease: discussion paper. J R Soc Med. 1988;81(4):217-9. doi: 10.1177/014107688808100411. [PubMed: 3373467].
  11. Daly JJ, Madrazo A. Anal Crohn's disease with carcinoma in situ. Dig Dis Sci. 1980;25(6):464-6. doi: 10.1007/BF01395512. [PubMed: 7379680].
  12. Barral M, Dohan A, Allez M, Boudiaf M, Camus M, Laurent V, et al. Gastrointestinal cancers in inflammatory bowel disease: An update with emphasis on imaging findings.
  13. Crit Rev Oncol Hematol. 2016;97:30-46. doi: 10.1016/j.critrevonc.2015.08.005. [PubMed: 26315381].
  14. Wisniewski A, Flejou JF, Siproudhis L, Abramowitz L, Svrcek M, Beaugerie L. Anal Neoplasia in Inflammatory Bowel Disease: Classification Proposal, Epidemiology, Carcinogenesis, and Risk Management Perspectives. J Crohns Colitis. 2017 Aug 1;11(8):1011-1018. doi: 10.1093/ecco-jcc/jjx035. PMID: 28379306.
  15. Wisniewski A, Flejou JF, Siproudhis L, Abramowitz L, Svrcek M, Beaugerie L. Anal Neoplasia in Inflammatory Bowel Disease: Classification Proposal, Epidemiology, Carcinogenesis, and Risk Management Perspectives. J Crohns Colitis. 2017 Aug 1;11(8):1011-1018. doi: 10.1093/ecco-jcc/jjx035. PMID: 28379306.
  16. Devon KM, Brown CJ, Burnstein M, McLeod RS. Cancer of the anus complicating perianal Crohn's disease. Dis Colon Rectum. 2009;52(2):211-6. doi: 10.1007/DCR.0b013e318197d0ad. [PubMed: 19279414].
  17. Beaugerie L, Carrat F, Nahon S, Zeitoun JD, Sabate JM, Peyrin-Biroulet L, et al. High risk of anal and rectal cancer in patients with anal and/or perianal Crohn's Disease. Clin Gastroenterol Hepatol. 2018;16(6):892-9. doi: 10.1016/j.cgh.2017.11.041. [PubMed: 29199142].
  18. Ogawa H, Haneda S, Shibata C, Miura K, Nagao M, Ohnuma S, et al. Adenocarcinoma associated with perianal fistulas in Crohn's disease. Anticancer Res. 2013;33(2):685-9. [PubMed: 23393368].
  19. Cohen RB, Dittrich KA. Anti-TNF therapy and malignancy - a critical review. Can J Gastroenterol. 2001;15(6):376-84. doi: 10.1155/2001/403102. [PubMed: 11429667].
  20. Malvi D, Vasuri F, Mattioli B, Gruppioni E, Fiorentino M, Gionchetti P, et al. Adenocarcinoma in Crohn's disease: the pathologist's experience in a tertiary referral centre of inflammatory bowel disease. Pathology. 2014;46(5):439-43. doi: 10.1097/PAT.0000000000000123. [PubMed: 24977730].
  21. Biancone L, Orlando A, Kohn A, Colombo E, Sostegni R, Angelucci E, et al. Infliximab and newly diagnosed neoplasia in Crohn's disease: a multicentre matched pair study. Gut. 2006;55(2):228-33. doi: 10.1136/gut.2005.075937. [PubMed: 16120759].
  22. Biancone L, Calabrese E, Petruzziello C, Pallone F. Treatment with biologic therapies and the risk of cancer in patients with IBD. Nat Clin Pract Gastroenterol Hepatol. 2007;4(2):78-91. doi: 10.1038/ncpgasthep0695. [PubMed: 17268543].