Image of the Month—Diagnosis

Mucinous Adenocarcinoma of an IleostomyB iopsy revealed invasive mucinous adenocarci- noma.The patient underwent surgical en bloc resection of the ileostomy and abdominal wall, ileostomy translocation, right inguinal lymph node biopsy, and reconstruction of the abdominal wall.Final pathological findings showed an 8.5-cm, pT3, welldifferentiated, low-grade adenocarcinoma without evidence of microsatellite instability.All surgical margins and lymph nodes were negative for malignancy.She had an uneventful postoperative course.Adenocarcinoma arising from an ileostomy is a rare and late complication.Only approximately 40 cases have been reported in the literature.On average, the interval between the creation of an ileostomy and adenocarcinoma is 27 years (range, 2-48 years). 1,2Most cases have occurred in patients with a history of ulcerative colitis, but it has been reported following colectomy for familial adenomatous polyposis and Crohn colitis. 3,4The most common presentations include bleeding, bowel obstruction, and inability to properly fit the stoma appliance.Physical examination usually reveals an ulcerative or friable polypoid mass at the mucocutaneous junction of the ileostomy.Fifteen percent of patients have associated lymph node metastasis. 1,22][3][4][5] Serial biopsies of suspicious lesions at the mucocutaneous junction of an ileostomy are essential, especially if the ileostomy is up to 15 years old. 3 Surgery is the mainstay of treatment.It entails en bloc surgical resection of the ileostomy, adjoining the mesentery and anterior abdominal wall.The ileostomy should preferably be resited. 1The overall prognosis following resection is good, especially if it is detected early and completely resected.