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Case Reports in Pathology
Volume 2017, Article ID 2758769, 6 pages
https://doi.org/10.1155/2017/2758769
Case Report

Newly Diagnosed Colonic Adenocarcinoma: The Presenting Sign in a Young Woman with Undiagnosed Crohn’s Disease in the Absence of Primary Sclerosing Cholangitis and a Normal Microsatellite Instability Profile

Department of Pathology, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA

Correspondence should be addressed to Ann M. Ponsford Tipps; ude.dscu@sppita

Received 1 August 2016; Revised 3 November 2016; Accepted 12 January 2017; Published 31 January 2017

Academic Editor: Hassan Brim

Copyright © 2017 Brett Matthew Lowenthal and Ann M. Ponsford Tipps. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Ulcerative colitis has long been linked with an increased risk for colonic adenocarcinoma, whereas Crohn’s disease (CD) has recently been reported to pose a similar increased risk. We report a 33-year-old healthy female with no family history who presented with abdominal pain and a colon mass. Histopathology revealed a moderately differentiated adenocarcinoma extending through the muscularis propria with metastatic lymph nodes and intact mismatch repair proteins by immunohistochemical expression and gene sequencing. The nonneoplastic grossly uninvolved background mucosa showed marked crypt distortion, crypt abscesses, CD-like lymphoid hyperplasia, transmural inflammation, and reactive epithelial atypia. Additional patient questioning revealed frequent loose stools since she was a teenager leading to diagnosis of a previously undiagnosed CD without primary sclerosing cholangitis (PSC). The adenocarcinoma is suspected to be related to the underlying CD. Newly diagnosed adenocarcinoma in a young female as the presenting sign for CD in the absence of PSC is extremely rare.