Case Report

Ileal Adenocarcinoma with Liver Metastasis in Patient with Crohn’s Disease: A 9-Year Survival

Table 1

Treatment summary and clinical outcome.

DateTreatment (medical, surgical)CEA (ng/ml) and CA 19-9 (U/ml) range during treatment periodOutcomeComplications

1996Ileocolic resection for obstructive disease, maintained on 6-MPTolerated procedure well(i) Was well until June 2008, when noted to have two areas of small bowel dilation along with two hypodense liver lesions
September 2008Underwent resection of strictures was found to have SBACEA: 0.1-0.9Tolerated procedure well(i) PET scan showed nine metastatic liver lesions
October 2008Chemotherapy with FOLFOX (leucovorin calcium, fluorouracil, and oxaliplatin) for 12 cyclesCEA: 0.1-0.9PET scan in December 2008 showed interval resolution of majority of the liver mets except 2 enhancing lesions on the left liver lobe with the stable appearance of small bowel thickening(i) Weight loss, fistulae, failure to thrive, and bone marrow suppression
January 2009Left hepatic lobe resection for isolated liver metastasis
Received 4 additional cycles of chemotherapy with FOLFOX
Tolerated procedure well(i) Patient had treatment response until December 2011 when noted to have widespread disease progression to the peritoneal LNs, liver, and lung
(ii) In April 2012, he was hospitalized with obstructive symptoms. He underwent resection of the large mesenteric mass of matted LNs resulting stricture
April 2012-May 2015Gemcitabine, 5-flourouracil, irinotecan, leucovorin, and oxaliplatin (GFLIO)CEA: 0.1 to 2.7
CA 19-9: 13 to 32
Stable disease without evidence of recurrence on PET scan in May 2015 and September 2015(i) Continued fistulizing CD requiring mesenchymal stromal cell (MSC) infusion in December 2013
(ii) PET scan in November 2015 showed progression of the tumor
November 2015-May 2016Cetuximab + (GFLIO)CEA: 0.3 to 2.9
CA 19-9: 28 to 71
After May 2016: CEA: 0.3 to 21
CA 19-9: 91 to 567
Clinically stable without progression(i) May 2016: disease metastasized to the lungs and thoracic spine requiring laminectomy and resection of the extradural tumor and radiotherapy to spinal metastasis in March 2017
July 2017–February 2018Trastuzumab was added for HER2+ with Cetuximab + (GFLIO)CEA: 9.5 to 41
CA 19-9: 398 to 1338
Clinically stable(i) Patient remained clinically stable
March 2018(i) Recurrence of tumor at fistula site with bleeding
June 2018(i) Died due to complication from metastatic SBA

6-MP: mercaptopurine; CEA: carcinoembryonic antigen; CA 19-9: cancer antigen 19-9; CD: Crohn’s disease; HER2+: human epidermal growth factor receptor 2; PET: positron emission tomography.