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P-016 Endometrial Carcinoma Mimicking Crohn’s Disease: A Rare Case Report

BACKGROUND:We report a case of endometrial carcinoma mimicking Crohn’s Disease. A 55 year old female underwent surveillance colonoscopy for a history of colon polyps in September 2009. The exam revealed moderate colonic diverticulosis and mild erythema at the ileo-cecal valve orifice. The terminal ileum was normal. Biopsies from the valve orifice showed acute cryptitis with preserved crypt architecture. She was next seen in April, 2013 with a 1½ year history of progressive lower abdominal pain without associated diarrhea. Physical examination revealed fullness and tenderness in the RLQ without a discrete mass. Routine laboratory studies showed a normal metabolic profile except for mild hypokalemia. CBC was normal. Computed tomography scan of the abdomen and pelvis demonstrated a cecal mass with associated wall-thickening of the terminal ileum. Colonoscopy revealed a polypoid mass at the ileo-cecal valve orifice. The ileum could not be intubated. Biopsies revealed mildly active colitis with prominent eosinophils and reactive lymphoid aggregates. Therapy with budesonide 9 mg daily was initiated for presumed Crohn’s Disease.After 3 weeks of treatment, she noted marked improvement in symptoms. Her pain had diminished and her appetite was improved but she still noted some early satiety and fullness. CRP was normal and a Prometheus sgi profile revealed a pattern not consistent with inflammatory bowel disease. In light of persistent symptoms, a small bowel series was done and showed thickening, narrowing, and irregularity of the terminal ileum “consistent with Crohn’s Disease.” QuantiFERON Gold TB testing was negative and HBsAg was negative with a positive HBsAb.In July, 2013, therapy with infliximab 5 mg /kg was initiated. She completed the induction regimen and began maintenance therapy. During this time, she noted near complete resolution of symptoms and normalization of bowel function. Budesonide was tapered and discontinued. She was able to travel overseas without difficulty.She returned in January, 2014 with recurrent episodes of abdominal bloating and soreness despite infliximab therapy. She was averaging 2 stools daily. Her weight was slightly increased. An infliximab level was > 34 micrograms/mL and no antibodies to infliximab were detected. MR enterography was consistent with terminal ileal Crohn’s Disease. There was a small inflammatory mass suspicious for a localized perforation. She underwent exploratory laparotomy in February, 2014. A firm mass was noted in the terminal ileum/cecum and this was resected. Pathology revealed adenocarcinoma with squamous features consistent with endometrial origin. Of note, the patient had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis 20 years ago. Discussion:Early diagnosis and treatment of Crohn’s Disease is critical. However, there are other diseases that can mimic small bowel Crohn’s Disease, including Mycobacterium tuberculosis, Yersinia, NSAID or ARBS induced enteritis, Celiac Disease, lymphoma, small bowel adenocarcinoma, and autoimmune enteritis. Endometrial carcinoma arising in the setting of remote endometriosis is a rare condition mimicking Crohn’s Disease. We report this case to illustrate that it is necessary to place endometrial carcinoma as a rare “mimic” of ileal Crohn’s Disease even after prior total abdominal hysterectomy, bilateral salpingo-oophorectomy. METHODS:N/A. RESULTS:N/A. CONCLUSIONS:N/A.