Rectal adenocarcinoma and ileocecal tuberculosis: A simple coincidence or a pathological co-existence?

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Colon and Rectal Cancer
Cancer Treatment in Patients with Comorbidities
Presenter Jan Michael Jesse Lomanta
Authors J.M.J.C. Lomanta1, C.D.V. Uy2, J. Ignacio3, R. Berba4
  • 1Medicine, University of the Philippines- Philippine General Hospital, 1000 - Manila/PH
  • 2Section Of Medical Oncology, Department Of Internal Medicine, Philippine General Hospital, 1000 - Manila/PH
  • 3Section Of Medical Oncology, Department Of Medicine, University of the Philippines- Philippine General Hospital, 1004 - Manila/PH
  • 4Section Of Adult Medicine, Department Of Medicine, University of the Philippines- Philippine General Hospital, 1000 - Manila/PH

Abstract

Case Summary

The synchronous growth of gastrointestinal tuberculosis and rectal adenocarcinoma is an uncommon occurrence. Here, we report a 66-year-old Filipino male who initially presented with a two-year history of altered bowel habits which eventually progressed to include haematochezia, decreased stool caliber, and constitutional symptoms of unquantified weight loss and easy fatigability. No fever, chills, nor night sweats were reported. Colonoscopy revealed an ulcer with exudate at the ileocecal valve. Moreover, a circumferential, friable, nodular mass partially obstructing the lumen was noted 6 to 10 cm from the anal verge. Biopsy of the rectal tissue was consistent with a well-differentiated rectal adenocarcinoma while that of the ileal tissue showed tuberculous ileitis. Abdominal CT scan with contrast demonstrated an irregular circumferential thickening on the rectosigmoid region and a nodular appearance of the surrounding area, likely due to prominent lymph nodes. The patient was started on anti-TB medications by a private physician and was referred to our institution for further management. After 1 month of TB medications, he was seen at the out-patient clinic of the Medical Oncology Service. He was assessed to have rectal adenocarcinoma stage IIIB (T3, N1M0) with ileocecal TB. He was started on long-course chemoradiotherapy and a low anterior resection with ileostomy will be done thereafter. Although it has been established that chronic inflammation provides an environment that promotes carcinogenesis, the causal relationship between TB and cancer is yet to be elucidated. In this report, it is unclear if the co-existence of both conditions is a predisposing factor for the other or just a mere coincidence.

Editorial acknowledgement

Clinical trial identification