Ulcerative colitis - carcinoma
This 68-year-old male was first diagnosed with ulcerative colitis 19 years ago. From time of first onset, disease involvement was limited to the left side of the colon. No inflammatory changes were observed from the cecum to the middle of the transverse colon. Patient’s clinical course was complicated by numerous flares characterized by bloody diarrhea. Despite treatment with prednisolone, tacrolimus, apheresis and, most recently, TNF-? antibodies, lasting remission was never achieved during these 19 years. The patient consistently refused surgical treatment despite the fact that stepped biopsies three years earlier had already shown low-grade dysplasias. The patient repeatedly developed anemia requiring transfusion. Responsible for the bleeding were numerous large pseudopolyps with erosive surfaces. The current endoscopy was performed with the objective of excising these polyps. Endoscopic findings, however, resulted in the need to rethink this strategy.
The video clip begins in the distal sigmoid colon just prior to reaching the changes suspicious for malignancy. First, one sees pseudopolyps. The suspicious lesion is itself flat and about 2 × 4 cm in size. Near the middle of the lesion, one sees two depressed sites. The endoscope is then advanced into the descending colon. Here, one recognizes numerous pseudopolyps of varying form with a “frosting-like” surface. The suspicious lesion was biopsied during the withdrawal of the endoscope.
The histological examination revealed a mucinous adenocarcinoma, partially of signet-ring-cell type (G2-3) with adjacent lesions characterized by high-grade epithelial dysplasia.<br />Malignant changes can be expected in patients with a multi-year history of ulcerative colitis even when disease involvement is restricted to the left-side of the colon. This is especially true in cases in which remission has never been achieved despite many years of treatment. Malignant changes are initially flat and difficult to detect.