Squamous-Cell Carcinoma Developing After an Ileoanal Pouch Procedure: Report of a Case

Abstract

Diligence and vigilance with regard to active follow-up, and a high index of suspicion, are required to prevent this from becoming a more frequently seen problem.

Clinical Features of Ileal Pouch Polyps in Patients with Underlying Ulcerative Colitis

“…17,29 In addition to adenocarcinoma, other cancers may occur in the pouch in patients with underlying UC, including large cell lymphoma 14 and squamous-cell carcinoma. 30 Dysplasia or cancer in the ATZ also can occur but is rare. In a study of 135 patients with stapled IPAA without mucosectomy, no dysplasia or cancer was found in the ATZ, with a median follow-up of 56 months.…”

Perineal Adenocarcinoma Thirty Years After Proctocolectomy: Report of a Case

“…Although medically refractory UC may require proctocolectomy, reconstructive techniques vary, including restorative proctocolectomy, which maintains fecal stream through the anus, continent ileostomy (Kock pouch), and conventional ileostomy (Brooke ileostomy). To date, 21 cases of adenocarcinoma have been reported after restorative proctocolectomy for UC, 1-3 along with one case of squamous-cell carcinoma in an ileal pouch, 4 and 23 cases of adenocarcinoma at an ileostomy site. 5 In these cases, mean latency between restorative proctocolectomy and presentation with neoplasia was 6.4 (standard deviation, 5.7) years.…”

“…5 In these cases, mean latency between restorative proctocolectomy and presentation with neoplasia was 6.4 (standard deviation, 5.7) years. [1][2][3][4] Previously reported tumors have been located in the ileal pouch, at the dentate line, surrounding the pouch, at the anastomosis site, or adjacent to the rectal stump. The case presented is unusual in both the latency to presentation and the location of the tumor free in the perineum without suggestion of attachment to an anastomosis or bowel.…”

Pelvic Cancer Ten Years after Restorative Proctocolectomy in Indeterminate Colitis: Report of a Case

“…This risk seems to extend over many years. The lag time between operation and the discovery of malignancy can extend from 22 months to 25 years in patients who had mucosectomies [7][8][9][11][12][13]16,18,20 and 16 months to 12 years in patients with anal transition zone-sparing procedures. 6,7,10,17,19 When the indication for surgery in long-standing IBD is cancer or dysplasia, especially involving the rectum, arguments can be made for and against mucosectomy, stapled IPAA, and even the wisdom of any pelvic pouch procedure.…”

“…Eighteen cases of postoperative "pouch-related" cancers after restorative proctocolectomy have been reported in the literature. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Most of these cancers were discovered fairly soon after restorative proctocolectomy, and all but two were found in patients with chronic ulcerative colitis. There have been no reports of pouch-related cancer in patients with indeterminate colitis.…”