A case of fistula cancer in Crohn's disease indistinguishable preoperatively from Bartholin's adenocarcinoma

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  • Matsui Mami
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine Department of Obstetrics and Gynecology, Fujita Health University Bantane Hospital
  • Niimi Kaoru
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Yoshihara Masato
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Tamauchi Satoshi
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Yokoi Akira
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Ikeda Yoshiki
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Yoshikawa Nobuhisa
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Nishino Kimihiro
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine
  • Kajiyama Hiroaki
    Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine

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Other Title
  • バルトリン腺癌との鑑別に難渋したクローン病合併痔瘻癌の1例
  • バルトリンセンガン ト ノ カンベツ ニ ナンジュウ シタ クローンビョウ ガッペイ ジロウガン ノ 1レイ

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Abstract

<p>Adenocarcinoma of the vulva is rare. Lesions of the posterior vaginal vestibule are often assumed to be primary lesions of the Bartholin's glands. We report a case where vulvar adenocarcinoma in a Crohn's disease patient was diagnosed as cancer arising from an anal fistula following resection. A 48-year-old woman received treatment for Crohn's disease. Six months prior, she had a tumor of the left vulvar area, close to the vaginal vestibule. Adenocarcinoma was confirmed based on biopsy results. Upper and lower gastrointestinal endoscopy performed was negative. Accordingly, Bartholin's adenocarcinoma was suspected. On the first visit, a 4 cm mass was found in the left Bartholin's gland area. CT revealed mild bilateral inguinal lymph node hypertrophy. We performed simple vulvectomy and bilateral inguinal lymph node sampling for biopsy. The pathological diagnosis was moderately different from adenocarcinoma. A continuity was observed between the colonic mucosal epithelium and the adenocarcinoma. Accordingly, anal fistula cancer was confirmed. The excision margin was positive on the deep exfoliated surface of the left vaginal wall. Subsequently, robot-assisted laparoscopic abdominal perineal resection, vaginal perineal resection, colon stoma construction, and inguinal lymph node dissection were performed. Capecitabine plus oxaliplatin (CAPOX) chemotherapy is currently being administered to the patient. Vulvar adenocarcinoma with Crohn's disease should be scrutinized with suspicion of anal fistula cancer.</p>

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