Dysplasia Involves Enteritis Cystica Profunda in the Setting of Crohns Disease

Abstract

Enteritis cystica profunda is a rare non-neoplastic condition characterized by misplaced glands deep to the muscularis mucosae of the small bowel, likely as a result of trauma or inflammation such as Crohns disease, a disease with increased risk for small bowel adenocarcinoma. Clinically, enteric cystica profunda and adenocarcinoma can present with obstruction and/or stricture in patients with Crohns disease and should be differentiated from each other. Neoplastic involvement of enteritis cystica profunda by dysplasia has not been reported previously. Herein, we report a case of enteritis cystica profunda involved by high-grade dysplasia of gastric type. High-grade dysplasia and intramucosal adenocarcinoma of gastric type were also present in the overlying mucosa. Additionally, the adjacent mucosa demonstrated marked chronic active enteritis with pyloric gland metaplasia. The neoplastic epithelium showed diffuse and strong nuclear immunoreactivity for p53. The presence of lamina propria deep to the dysplastic epithelium-lined cysts/diverticula supported a non-invasive nature of this lesion. No metastatic disease was noted in 15 nodes identified. All surgical resections were free of neoplasm. The patient was doing well 9 months after surgery without evidence of cancer recurrence or metastasis on abdominal computed tomography.




J Med Cases. 2016;7(6):202-207
doi: https://doi.org/10.14740/jmc2415w