title: Synchronous colonic lymphoma and adenocarcinoma in a patient with Crohn's disease, treated with thiopurine therapy and a TNFα inhibitor: a challenge to Occam's razor.
abstract: A 52-year-old man with Crohn's disease, treated with thiopurine therapy and a tumour necrosis factor (TNF) α inhibitor, attended for surveillance colonoscopy, which revealed a transverse colon mass. Biopsies of this lesion showed a diffuse large B-cell lymphoma. CT scan demonstrated this lesion, an additional caecal mass and multiple metastases. A supraclavicular lymph node was removed and demonstrated metastatic adenocarcinoma, consistent with a synchronous caecal primary. At multidisciplinary oncological, haematological, histopathological, gastroenterological, radiological and palliative care assessment, the metastatic adenocarcinoma was deemed to carry a grave prognosis. Following sensitive discussion, the patient opted for palliative care and died several weeks later. Occam's razor, the principle that 'complexity should not be assumed unnecessarily', is a medical school doctrine. Occasionally, however, dual diagnoses do arise. Recognition, as in this case, may prove critical in informed decision-making, both by doctors and, most importantly, by patients, about prognosis and optimal patient care, especially end-of-life care.
authors.affiliation: Department of Gastroenterology, Royal Bolton Hospital, Bolton, UK.
authors.forename: Rowan Daniel Beaumont
authors.initials: RD
authors.lastname: Bell
authors.affiliation: Department of Gastroenterology, Royal Bolton Hospital, Bolton, UK.
authors.forename: Kieran John
authors.initials: KJ
authors.lastname: Moriarty
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology*; D015897:Comorbidity; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007420:Intestine, Large / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged
chemical_list: D007166:Immunosuppressive Agents