Author of 1 Presentation
SS 6.6 - Early detection of mucinous adenocarcinoma within fistulating peri-anal Crohn’s disease (ID 1014)
Abstract
Purpose
Development of peri-anal fistula mucinous adenocarcinoma (MA) is a presumed rare but recognised event in patients with fistulating peri-anal Crohn’s disease. The true incidence is unknown with a lack of robust registry data. Fistula mucinous cancers may evade early diagnosis, often necessitating morbid exenterative surgery. This study aimed to improve early detection of these cancers.
Material and methods
We performed a retrospective analysis of 8 cases of biopsy-proven MA that had developed within Crohn-related anal fistula. MRI studies pre-dating the diagnosis of malignancy were reviewed to establish whether there are early predictive features of MA. Demographic, disease and surgical history were collected.
Results
The median time to histological diagnosis of MA from the time of diagnosis of Crohn’s disease was 426 (96-480) months and from diagnosis of fistulating disease 66 (24-156) months. On review of MRI, characteristic “budding” appearance within the T2 high-signal “sepsis”/fistula tract is noted in all of our MA fistula cancers. This finding pre-dates the histological diagnosis of MA by a median of 42 months (12-156). Metastatic disease was not detected in any of the 8 cases. Potentially curative pelvic exenteration was possible in 7 patients.
Conclusion
There is an opportunity for early detection of the development of MA in anal fistula by recognition of “budding” within the tract. Earlier diagnosis may lessen the magnitude of subsequent radical surgery following prolonged growth of these lesions. Long-standing Crohn’s anal fistula should be surveyed with MRI and any finding of “budding’ within the tract on T2 sequences should prompt urgent examination under anaesthetic and biopsy.