Celiac Disease and Cancers in Morocco

Digestive cancers are the most severe complications of celiac disease (CD), which can lead to death. We can report 12 patients with CD associated with cancer. It is retrospective study of 12 patients with CD complicated by cancers, collected in the department of diseases of the digestive system "Medicine C", from 1995 to 2017. Six patients had lymphoma, three were gastric tumors, two were small intestine tumors, and one had liver tumor. The diagnosis of lymphoma was made at the same time as that of CD in one patient, three months later in two patients, 18 months later in two patients and 8 years later in one patient. Morphological and histological data were in favor of malignant non-Hodgkin's lymphoma with intestinal localization in four patients, with lymph node localization in one patient and one patient with refractory celiac disease type 2 with intraepithelial lymphoma. The treatment consisted of chemotherapy in four patients and corticosteroid therapy with parenteral nutrition in one patient. The evolution was marked by the death of 03 patients and 2 patients were lost without any idea about their evolution. The diagnosis of the gastric tumor was retained after the realization of a upper gastrointestinal endoscopy with biopsies. The histopathologic examination was in favor of a well-differentiated adenocarcinoma in two patients, and of an adenocarcinoma moderately differentiated in one patient. The diagnosis of the well-differentiated neuroendocrine tumor was carried out 30 years after that of CD. The patient underwent a resection of the first two duodenal portions with duodeno-jejunal anastomosis and a colonic resection with termino-terminal anastomosis. The evolution was good with a 2 years follow-up. The second patient with intestinal cancer was a moderately differentiated adenocarcinoma of intestinal origin; the diagnosis was retained after an abdominal CT scan with mass biopsy. The treatment was palliative chemotherapy, with an abdominal scan three months later showed partial response. The hepatocellular carcinoma on healthy liver was diagnosed at the same time as CD on angio-CT scan data and liver biopsy with patient death at the time of diagnosis. Digestive cancers are severe complications of CD requiring early management and follow-up of patients to reduce the rate of death.