Abstract
Since 1978 we are performing cytologic study of the inflammatory bowel disease (IBD) for the early detection of its malignant change. An adenomatous precancer lesion in a patient of Crohn's disease of 20 year duration was detected by cytologic examination.
A 38-year-old woman was admitted to the Institute of Gastroenterology Tokyo Women's Medical College because of bloody diarrhea and abdominal pain. She has been diagnosed as ulcerative colitis at the age of 20. At the first admission to our institute in 1975. a diagnosis of Crohn's disease in the ileum and distal colon was made. After her discharge medical treatment, chiefly oral administration of SAS, continued. In 1979 a flat mucosal elevation was noticed in the rectum by colonoscopy. Brushing cytology of the focus was evaluated as strongly suggestive of malignancy. Eight months later the focus became more distinct and diagnosed as marked dysplasia by biopsy. In May 1980 the involved ileum and left-side colon were resected. A definitive diagnosis of Crohn's disease was settled. The focus in the rectum was 22×16 mm in size and diagnosed as marked dysplasia of adenomatous type (Riddell).
Cytologic study of the focus was carried out by colonscopic brushing in 3 times and imprinting smear of the surgical material. Papanicolaou and Giemsa staining were applied and the former was used for the measurement of the nuclear size. For the comparison, cytologic specimen of ulcerative colitis (46 cases) and colonic cancer (6 cases) were investigated.
The nuclear size of the cells taken from the focus was 16.7μ in the average and bigger than that of large bland cells or large active cells (Galambos) in ulcerative colitis. Anisonucleosis was more marked. The nucleoli were observed in 78% of the cells and more prominent than that of the latters. The cellular features of the former more resembled to that of the colonic cancer cells.
Since malignant-looking atypical cells are often exfoliated in IBD, the cytologic diagnosis of its malignant change is supposed to be very difficult. However presented case has clearly demonstrated the usefulness of the cytologic examination. Multiple biopsies, more than 10 for each segment of the colon, is recommended for the eraly detection of premalignant lesions in the patients with long-standing IBD. We believe that brushing cytology may be more suitable for this purpose.
