Korean J Gastroenterol.  2012 Dec;60(6):373-376. 10.4166/kjg.2012.60.6.373.

A Case of Squamous Cell Carcinoma of the Breast in a Patient with Crohn's Disease Taking Azathioprine

• Park KC
• Ju DU
• Heo SW
• Ryu JI
• Cho JY
• Kim EJ
• Oh HK
• Kim EY

• KMID: 1773074
• DOI: http://doi.org/10.4166/kjg.2012.60.6.373

Abstract

Azathioprine (AZA) treatment in transplant or autoimmune patients and subsequent appearance squamous cell carcinomas at various sites, particularly skin and cervix, has shown a close relationship. However, it remains uncertain whether this is true for the patients with Crohn's disease. We report a case of squamous cell carcinoma of the breast occurred in a 35-year-old female with Crohn's disease taking AZA. She was first diagnosed with Crohn's disease 10 years ago and has taken AZA with 5-aminosalicylic acid (5-ASA) on regular follow up in gastrointestinal department for 9 years. She had no family history of breast cancer. She visited breast cancer clinic due to incidentally found right breast mass. A mastectomy on the right breast was performed and 6.3x5.5 cm mass was removed. The mass was microscopically proven to be poorly differentiated squamous cell carcinoma with focal keratin pearl formation. At age of 25, she was first diagnosed with active Crohn's disease. 5-ASA and corticosteroid induced remission. Then, steroid was tapered off and AZA was maintained at 1 mg/kg due to leukopenia at higher dose. She stopped taking AZA at her discretion during her two pregnancies and reported total of 67 months of AZA medication on her breast cancer diagnosis.

Keyword

Crohn's disease; Azathioprine; Breast cancer; Squamous cell carcinoma

MeSH Terms

Adult
Azathioprine/*therapeutic use
Breast Neoplasms/*diagnosis/pathology/therapy
Carcinoma, Squamous Cell/*diagnosis/pathology/therapy
Colonoscopy
Combined Modality Therapy
Crohn Disease/*drug therapy
Female
Humans
Immunosuppressive Agents/*therapeutic use
Mesalamine/therapeutic use
Positron-Emission Tomography
Immunosuppressive Agents
Azathioprine
Mesalamine

Figure

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  Fig. 1 Finding of positron emission tomography. In the right breast, intense FDG uptake (max SUV>21.32) was seen.

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  Fig. 2 Pathology finding. Microscopic finding revealed poorly differentiated squamous cell carcinoma with focal keratin pearl formation (H&E, ×400).

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  Fig. 3 Initial colonoscopy finding. There were multiple shallow ulcers and longitudinal ulcers with edematous hyperemic mucosa at the descending colon.

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  Fig. 4 Follow up colonoscopy finding. There were scars with pseudodiverticuli at the ascending colon after 6 years.

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