title: Ulcerative colitis associated with nephrotic syndrome after treatment with mesalazine developed into rectal carcinoma: a case study.
abstract: BACKGROUND
  Previous studies reported that nephrotic syndrome is associated with ulcerative colitis (UC) patients treated with mesalazine. Dysplasia associated with UC often develops into colorectal carcinoma.
  
  
  METHODS
  A 17-year-old man was referred to our hospital, complaining of diarrhea and bloody stool. Total colonoscopy (TC) was performed and total-type UC was diagnosed. After treatment with mesalazine for 5 years, a low-grade dysplasia (LGD) was detected in the rectum by histological analysis of a biopsy sample. One month later, he complained of dyspnea and edema. He was diagnosed with nephrotic syndrome and administered steroid and immunosuppressant treatment: cyclosporine and mizoribine. Eight years after LGD was detected, he complained of abdominal distension and pain. Stenosis of the upper rectum by an advanced rectal carcinoma was detected. Abdominal computed tomography showed a rectal tumor with multiple lymph node metastases. Transverse colostomy was performed surgically, followed by two cycles of modified FOLFOX6 and panitumumab. He safely underwent a total proctocolectomy with a stapled ileal pouch anal-canal anastomosis, total mesorectal and bilateral pelvic lymph node dissection, and temporary loop ileostomy. Metastases were observed in 25 lymph nodes microscopically. The pathological stage of rectal carcinoma was pT3N2bM1a. After one cycle of modified FOLFOX6 postoperatively, he was discharged from the hospital.
  
  
  CONCLUSIONS
  A patient with UC associated with nephrotic syndrome was treated with mesalazine. LGD developed into an advanced rectal carcinoma after an 8-year interval. The use of immunosuppressants for the treatment of nephrotic syndrome might affect the development of rectal carcinoma.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  Case report registration #1626.
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan. shinsame@me.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sameshima
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Koketsu
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Okuyama
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Yawara
authors.initials: Y
authors.lastname: Kubota
authors.affiliation: Department of Pathology, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Noie
authors.affiliation: Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Oya
mesh_terms: D000230:Adenocarcinoma / Q000139:chemically induced* / Q000188:drug therapy / Q000556:secondary; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003113:Colonoscopy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D019804:Mesalamine / Q000009:adverse effects*; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology
chemical_list: D000970:Antineoplastic Agents; D019804:Mesalamine
keywords: Carcinoma; Dysplasia; Immunosuppressant; Mesalazine; Nephrotic syndrome; Steroid; Ulcerative colitis