Atlas of Inflammatory Bowel Disease-Associated Intestinal Cancer : Examining the Macroscopic Images of Small and Large Intestine

This book is structured in three major parts and the first part is a comprehensive overview of IBD-related intestinal cancer. The second and third parts provide rare and important cases on ulcerative colitis (UD) and Crohn’s disease (CD) presenting the macroscopic image of the resected specimen and analyzing the endoscopic and the pathological image to explain how to find the IBD cancer. It also delivers a detailed analysis of the histological structure of cancers. This book tries to clarify the critical but yet to be answered questions such as “Why is it so difficult to find out?”, “Why so flat?” and “How to name superficial lesion with invisible margin?” and so on. Atlas of Inflammatory Bowel Disease-Associated Intestinal Cancer is designed to serve all endoscopists and gastroenterologists managing IBD patients. It also is valuable reading for pathologists who are diagnosing gastrointestinal lesions. This book is designed to assist these medical professionals to find cancers in the early stage and stay up-to-date on image-enhanced endoscopy techniques. This book is a translation of an original Japanese edition. This has been facilitated using machine translation (by the service DeepL.com) followed by editors and authors revising, editing and verifying the translated manuscript. Preface 5 Contents 7 Contributors 8 Part I: Bowel Cancer Associated with IBD: Overview 9 Intestinal Cancer Associated with IBD: Aim and Structure of This Book 10 1 Background 10 2 Aim and Structure of This Book 11 2.1 To understand the clinical and pathological picture of IBD-associated intestinal cancer 11 2.2 Definition of gross image of IBD-associated cancer; depending on endoscopic superficial images or on combination of endoscopic image and pathological invasion 11 2.3 Construction of clinical findings necessary for rational surveillance 11 2.4 The pathological differentiation between sporadic and IBD-related cancers should also be presented and considered 11 References 12 Endoscopic Diagnosis of Neoplastic Lesions in Inflammatory Bowel Disease 13 1 Introduction 13 2 Surveillance Endoscopy in UC 13 3 SCENIC 13 3.1 Creation Method 13 3.2 Main Statements 13 3.3 Impact of SCENIC 14 4 FACILE [12] 14 5 Conclusion 16 References 16 Crohn’s Disease-Associated Lower Gastrointestinal Cancer 17 1 Introduction 17 2 Examination of Cases in Our Institution 17 2.1 Comparison with Conventional Sporadic Lower Gastrointestinal Cancer (Table 1) 17 2.2 Clinical Aspects of CD-Associated Lower Gastrointestinal Tract Cancer (Table 2) 18 3 CD-Associated Small Intestine Cancer 18 3.1 Analysis of Cases in Our Institution (Table 3) 18 3.2 Diagnosis of CD-Associated Small Intestine Cancer 19 4 CD-Associated Colorectal and Anal Cancer 20 4.1 Analysis of Cases in Our Institution (Tables 4 and 5) 20 4.2 Comparison of Rectal and Anal Cancers with and without Cancer-Related Symptoms (Table 6) 21 4.3 Diagnosis of Colorectal and Anal Cancer 22 5 Conclusion 22 References 22 Clinicopathological Features and Pathological Diagnosis of Inflammatory Bowel Disease-Associated Cancer 24 1 Introduction 24 2 Gross Characteristics of Inflammatory Bowel Disease (IBD)-Associated Cancer 24 2.1 Gross Features of Ulcerative Colitis (UC)-Associated Cancer 24 2.2 Gross Features of Crohn’s Disease (CD)-Associated Cancer 25 3 Histopathological Characteristics of Inflammatory Bowel Disease (IBD) (UC, CD)-Associated Cancers 25 4 Conclusion 26 References 26 Development and Course of Inflammatory Bowel Disease-Associated Intestinal Cancer 27 1 A Retrospective Study of UC-Associated Cancer 28 1.1 Early Stage Cancer 28 1.2 Advanced Cancer 30 2 A Retrospective Study of CD-Associated Cancer 32 2.1 Advanced Cancer 32 References 34 Part II: Cases of UC Associated Cancers 36 Early Cancer: 9 Cases with Various Features 37 1 Case 1: Early-Stage Cancer with Extensive Dysplasia 38 2 Case 2: Early-Stage Cancer That Was Difficult to Distinguish from Sporadic Cancer at Preoperative Diagnosis 40 3 Case 3: Early-Stage Cancer with Indistinct Borders 42 4 Case 4: Early-Stage Carcinoma of Sessile Type with Clear Borders 44 5 Case 5: A Case of Early-Stage Carcinoma of Flat Type with Indistinct Borders 46 6 Case 6: Early-Stage Cancer That Was Difficult to Recognize as a Tumor 48 7 Case 7: Early-Stage Cancer Visible with Indigo Carmine Dye Application 50 8 Case 8: Superficial Elevated Early Cancer Treated by ESD 52 9 Case 9: Deeply Submucosal Invasive Carcinoma Preserved Surface Structure 54 Advanced Cancers: 12 Cases with Various Features 56 1 Case 10: Advanced Cancer with Difficulty in Preoperative Diagnosis of Depth of Invasion 57 2 Case 11: Type 2 Advanced Cancer with Surrounding Dysplasia 59 3 Case 12: Advanced Carcinoma Invading the Serosa with Difficulty in Preoperative Diagnosis of Depth 61 4 Case 13: Advanced Cancer with Indistinct Borders 63 5 Case 14: Advanced Cancer Followed Up as an Inflammatory Polyp 65 6 Case 15: Advanced Cancer with Surrounding Flat Early Cancer 67 7 Case 16: Advanced Cancer with Surrounding Flat Early Cancer 69 8 Case 17: Advanced Cancer with Unusual Morphology 71 9 Case 18: Advanced Cancer in a Stenotic Area 73 10 Case 19: Advanced Cancer of the Lower Rectum 75 11 Case 20: Advanced Cancer of the Rectum 77 12 Case 21: Advanced Cancer with Good Extension 79 Part III: Cases of CD Associated Cancers 81 Small Intestinal Cancer: 5 Cases 82 1 Case 1: Early Cancer of the Ileum Diagnosed by Endoscopic Surveillance 83 2 Case 2: Multiple Ileal Carcinomas Diagnosed During Operation for Intestinal Obstruction 87 3 Case 3: Synchronous Quadruple Ileal Carcinomas Diagnosed by Postoperative Pathological Findings of Multiple Stenoses 89 4 CD Case 4: Advanced Carcinoma of the Ileum with Lateral Growth Tumor-Like Morphology 93 5 Case 5: Ileal Cancer Diagnosed from Left Supraclavicular Fossa Lymph Node Metastasis 95 Colorectal Cancer with Various Features: 15 Cases 97 1 Case 6: Carcinoma of the Sigmoid Colon Diagnosed by Preoperative Colonoscopy for Small Bowel Stricture 98 2 Case 7: Ascending Colon Cancer Diagnosed by Scrutiny Endoscopy for Recurrent Abdominal Pain 100 3 Case 8: Intraoperatively Confirmed Transverse Colon Cancer of the Scirrhous Type 102 4 Case 9: Upper Rectal Cancer Diagnosed by Multiple Biopsies 104 5 Case 10: Lower Rectal and Anal Cancer with Extensive Perianal Invasion Diagnosed by an Outpatient Biopsy 108 6 Case 11: Carcinoma of the Lower Rectum and Anus Diagnosed by Anorectal Search Under Anesthesia due to Anal Pain and Mucus Stool 110 7 Case 12: Lower Rectal and Anal Cancer Diagnosed by Retroflexion Endoscopy 20 Months After Detection of Atypical Epithelium in the Anal Canal 112 8 Case 13: Cancer of the Lower Rectum and Anus Diagnosed by Mucus Discharge After 15 Years of Exclusion of the Rectum 114 9 Case 14: Cancer of the Lower Rectum and Anus Diagnosed During Endoscopy for Ileocolonic Anastomotic Dilation Therapy 116 10 Case 15: Cancer of the Anal Canal Diagnosed by Endoscopic Biopsies from a Skin Tag and a Refractory Wound After Resection 118 11 Case 16: Anal Canal Cancer Diagnosed by Biopsy from Aggressive Anal Ulcer 7 Years After Diagnosis of Anal Fissure 122 12 Case 17: Anal Cancer Diagnosed by Surveillance Biopsy of Perianal Fistula 124 13 Case 18: Intramucosal Carcinoma of the Anal Canal Associated with Atypical Epithelium Around Reddish Polyp Lesions 126 14 Case 19: Anal Cancer Diagnosed by a Transanal Biopsy Under Anesthesia Based on Increased Anal Pain and Elevated CEA Level 128 15 Case 20: Cancer of the Anus Diagnosed 2 Months After the Onset of Persistent Anal Pain 130