Mucinous adenocarcinoma arising in rectovaginal fistulas associated with Crohn's disease.
BACKGROUND
Crohn's disease is a chronic inflammatory disorder characterized by focal, transmural inflammation of the intestine. Gynecologic involvement, including rectovaginal fistula formation, is frequent. Case #1. A 53-year-old female with a 30-year history of Crohn's disease and numerous perirectal fistulas developed a foul smelling, purulent drainage from her rectum and a mucopurulent, bloody discharge from her vagina. A lower vaginal lesion biopsy demonstrated a low-grade mucinous adenocarcinoma. Case #2. A 42-year-old female with a 15-year history of Crohn's disease developed drainage from her vagina. Physical examination revealed an enlarging mass involving the posterior wall of the vaginal vault that connected to the anus by a fistula tract. A biopsy revealed mucinous adenocarcinoma.


CONCLUSIONS
Malignant transformation of persistent rectovaginal fistulas is a potential complication of Crohn's disease.
Moore-Maxwell
Crystal A
CA
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA. moore156@mc.duke.edu
Robboy
Stanley J
SJ
D002288:Adenocarcinoma, Mucinous / Q000209:etiology* / Q000473:pathology; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000150:complications* / Q000473:pathology; D014625:Vaginal Neoplasms / Q000209:etiology* / Q000473:pathology