P0304 SARS-COV-2 in Colorectal Cancer of IBD Patients
Authors: Boscá Watts M M , Navarro S , Rosello S , Varela J M , Gonzalez S , Fernández U , Sanahuja A , Mongort C , García T , Suria C , Tosca J , Antón R , Merino V , Ponce M , Villagrasa R , Pla V , Moro D , Casado D , Navarro D , Pascual I 
Published: January 2025

Abstract

Background
It has been hypothesized that inflammation related to SARS-CoV-2 infection can affect cancer cell proliferation, without having a direct oncogenic effect. SARS-CoV-2 infection is associated with the ACE2 receptor. ACE-2 over-expression has been found in many kinds of malignancies, including rectum adenocarcinoma (ADC) and in IBD patients. IBD-associated CRC (colorectal cancer) arises from a specific carcinogenic pathway involving chronic inflammation which is distinct from the traditional pathways.
IBD patients characteristically had right colon cancer and a higher incidence with respect to the general population, which had declined over time.

Methods
We observed a sudden increase in CRC incidence. Between June 2022 and May 2024, 6 of our patients presented with ano-rectal cancer (4 in the lower rectum and two in the anal canal). Biopsies were reviewed as usual and an extra study searching for coronavirus protein was also performed. Immunohistochemical analysis was performed using OMNIS Automated System (AGILENT), and monoclonal antibody anti-SARS-COV-2 clone 1A9 from Gene Tex. Inc (USA) at 1:100. All patients had signed consent.

Results
They were male, ages 38-62, one smoked and one was an ex-smoker, duration of the disease 3-31 years, two were overweight. 3 Crohn’s Disease (CD) and 3 Ulcerative Colitis (UC). CD: A3L1B2, A2L2B1 and A1L3B3p. UC: 2 extensive and one distal. All on different treatments: adalimumab and azathioprine, azathioprine and steroids, filgotinib, two were on vedolizumab and one was only on oral mesalamine (never biologics). 5/6 were in endoscopical remission. They were diagnosed of ADC of distal rectum and two of perianal ADC. Four of them were mucinous ADC (including the two perianal ones), one conventional low grade infiltrant ADC (pT1) in distal rectum-anus, and the sixth with rectal intramucous ADC. 100% had received COVID vaccines (variable type) and had had COVID infections. Biopsies: all frequent viruses were negative, whereas coronavirus was found in all cases, with a diffuse cytoplasmic and granular pattern. See figures 1 and 2.

Conclusion
The incidence of CRC in our patients in the past two years is relevant. The type of tumour and its locations also calls our attention, as well as the fact that all tumours have SARS-COV-2 protein abundance. Whether an epiphenomenom, part of the cause or a trigger for CRC of this specific type, will have to be dilucidated in prospective studies. We do not know if coronavirus stays longer in the bowel mucosae of our IBD patients (long covid) or maybe just in a subpopulation. It is of clinical relevance no matter whether the coronavirus is a mere spectator or an actor. Many questions arise with just these six patients, which we hope to answer in the future.

References
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