Malignancy in Long-Standing Perianal Fistulizing Crohn's Disease: Too Little, Too Late.
Alisha Goyal, Gaurav Syal, Phillip Fleshner et al.
✦ AI-curated · Sources linked
Case in brief
A 71-year-old man with nearly 50 years of untreated perianal fistulizing Crohn’s disease had recurrent abscesses, sepsis, and fistulizing disease. Progressive enlargement of a complex perianal abscess and new pelvic collections raised concern for malignant transformation, but imaging could not reliably distinguish cancer from active inflammation. Examination under anesthesia with drainage and biopsy revealed mucinous adenocarcinoma arising in a chronic fistula. His condition deteriorated rapidly, precluding oncologic treatment, and he was transitioned to hospice.
What made this case unusual
Mucinous adenocarcinoma arose within a chronic perianal fistula after nearly 50 years of Crohn’s disease; progressive abscesses and pelvic collections initially overlapped with inflammatory disease, delaying diagnostic clarity.
Diagnostic / clinical pearl
In long-standing perianal fistulizing Crohn’s disease, persistent or new symptoms and progressive collections warrant evaluation for malignancy; imaging may not distinguish it from inflammation, and examination under anesthesia with biopsy can establish the diagnosis.
Why it matters
The case underscores the diagnostic challenge and poor outcome described for fistula-associated cancer, while formal screening guidelines are lacking.