Multiple studies have demonstrated an increased risk for extra-intestinal cancers, mainly from treatment modalities related to IBD treatment. this includes: lymphoproliferative disorders associated with thiopurine use, hepatosplenic T cell lymphoma in younger male patients on thiopurines and anti-tumor necrosis factor (TNF) agents, non-melanoma skin cancers in patients treated with thiopurines and anti-TNF agents, and melanomas in patients who are on monotherapy with anti-TNF agents. In addition, women with Inflammatory Bowel Disease (IBD) may have higher rates of cervical cancer. Here we report a case of Ewing's Sarcoma in a patient with IBD on Adalimumab.Methods:
This case demontrates a teenage female diagnosed with Crohn Disease at 14 years of age after presenting with severe perianal disease, anemia and hematochezia. She was treated with Adalimumab monotherapy, responded optimally to treatment and was in clinical, biochemical and histologic remission for 5 years. At 19 years of age, she was having complaints of back pain and headaches. Initially, orthopedic physicians recommended x-ray which triggered MRI of lumber spine and concern for bone infarct. Subsequently, a bone scan reported multiple focal areas of abnormal radiotracer uptake in the skull thought to be related to a neoplastic process.Results:
Transitioning care back to her GI group and initial CT of the chest/abdomen/pelvis revealed an indeterminate thoracic anterior paravertebral mass along the posterior aspect of the superior extension into the left T3-4 neural foramen. Given the location, findings may represent ganglioneuroblastoma, neuroblastoma or other neural crest tumor. Multiple mixed lytic and blastic osseous lesions throughout the pelvis, sacrum, and spine were also reported. Patient was taken to OR for surgical left thoracoscopic mediatinal mass excisional biopsy. Pathology report revealed tissue consistent with Ewing's Sarcoma.Conclusions:
This case raises the question of patients with IBD being more at risk for other cancers aside from those associated with treatment modalities or colorectal cancer. Further studies and discussions should be considered.