levoleucovorin and Cholangitis--Sclerosing

A case is presented of a 36-year-old male with primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD) and two synchronous stage 1 adenocarcinomata of the colon, who was initially treated with a subtotal colectomy with ileostomy. One year later, the patient presented with extensive intra-abdominal lymphadenopathy and peritoneal carcinomatosis, as well as a markedly elevated serum level of alpha-fetoprotein (AFP). Fine needle aspiration biopsy of a porta hepatis lymph node revealed a metastatic hepatoid adenocarcinoma. Subsequent review of the previous colectomy specimen showed that one of the previously identified adenocarcinomata had features suggestive of a hepatoid colonic adenocarcinoma. The patient was subsequently treated with a cytotoxic regimen of FOLFOX (oxaliplatin, leucovorin, 5-fluorouracil) and bevacizumab, with stable results being achieved after six months. This case presents the first known report of PSC-IBD associated with synchronous typical and hepatoid adenocarcinomata of the colon and highlights the importance of considering hepatoid adenocarcinoma as a differential diagnosis in patients with an increasing serum AFP level.

Topics: Adenocarcinoma; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Biopsy; Cholangitis, Sclerosing; Colectomy; Colitis, Ulcerative; Colonic Neoplasms; Fluorouracil; Humans; Ileostomy; Jejunostomy; Leucovorin; Male; Middle Aged; Neoplasm Staging; Neoplasms, Multiple Primary; Organoplatinum Compounds; Oxaliplatin; Peritoneal Neoplasms; Risk Factors; Time Factors; Treatment Outcome

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cholangitis, Sclerosing; Colectomy; Colonic Neoplasms; Crohn Disease; Cytoprotection; Edetic Acid; Fluorouracil; Humans; Leucovorin; Male; Palliative Care; Pyridoxal Phosphate; Young Adult

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cholangitis, Sclerosing; Colonic Neoplasms; Combined Modality Therapy; Fatal Outcome; Fluorouracil; Humans; Leucovorin; Lung Diseases, Interstitial; Lung Neoplasms; Male; Prednisolone