Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation

Philippe Soyer, Lora Hristova, Frank Boudghène, Christine Hoeffel, Xavier Dray, Valérie Laurent, Elliot K. Fishman, Mourad Boudiaf

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The aim of this study was to analyze the clinical, pathological, and CT-enterography findings of small bowel adenocarcinomas in Crohn disease patients. Materials and methods: Clinical, histopathological, and imaging findings were retrospectively evaluated in seven Crohn disease patients with small bowel adenocarcinoma. CT-enterography examinations were reviewed for morphologic features and location of tumor, presence of stratification, luminal stenosis, proximal dilatation, adjacent lymph nodes, and correlated with findings at histological examination. Results: The tumor was located in the terminal (n = 6)or distal (n = 1) ileum. On CT-enterography, the tumor was visible in five patients, whereas two patients had no visible tumor. Four different patterns were individualized including small bowel mass (n = 2), long stenosis with heterogeneous submucosal layer (n = 2), short and severe stenosis with proximal small bowel dilatation (n = 2), and sacculated small bowel loop with irregular and asymmetric circumferential thickening (n = 1). Stratification, fat stranding, and comb sign were present in two, two, and one patients, respectively. Conclusion: Identification of a mass being clearly visible suggests strongly the presence of small bowel adenocarcinoma in Crohn disease patients but adenocarcinoma may be completely indistinguishable from benign fibrotic or acute inflammatory stricture. Knowledge of these findings is critical to help suggest the diagnosis of this rare but severe complication of Crohn disease.

Original languageEnglish (US)
Pages (from-to)338-349
Number of pages12
JournalAbdominal Imaging
Volume37
Issue number3
DOIs
StatePublished - Jun 1 2012

Keywords

  • Adenocarcinoma
  • Computed tomography
  • Crohn disease
  • Imaging
  • Intestinal neoplasm

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology

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