Crohn's disease and ulcerative colitis are well known risk factors of intestinal cancer in relation to the extent and duration of disease. Rarely, small bowel cancer can develop after a longstanding inflammation of Crohn's disease with a relatively higher incidence than the general population. Signet ring cell carcinoma is a rare condition among intestinal cancers, and the diagnosis or detection is more difficult if the cancer originates from the small bowel. We report a case of a 30-year old female in whom signet ring cell carcinoma of ileum was diagnosed after a 15-year history of Crohn's disease.
Adult ; Carcinoma, Signet Ring Cell/*diagnosis/etiology/pathology ; Colonoscopy ; Crohn Disease/*complications/diagnosis/pathology ; Female ; Humans ; Ileal Neoplasms/*diagnosis/etiology/pathology ; Tomography, X-Ray Computed

Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.
Aged, 80 and over ; Bone Marrow Neoplasms/complications/*diagnosis/pathology ; Carcinoma, Signet Ring Cell/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Haptoglobins/metabolism ; Humans ; Immunohistochemistry ; Male ; Necrosis/etiology ; Neoplasm Metastasis ; Positron-Emission Tomography ; Purpura, Thrombotic Thrombocytopenic/*diagnosis/etiology ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.
Aged, 80 and over ; Bone Marrow Neoplasms/complications/*diagnosis/pathology ; Carcinoma, Signet Ring Cell/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Haptoglobins/metabolism ; Humans ; Immunohistochemistry ; Male ; Necrosis/etiology ; Neoplasm Metastasis ; Positron-Emission Tomography ; Purpura, Thrombotic Thrombocytopenic/*diagnosis/etiology ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis