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Extracolonic and synchronous malignancies are rare in colorectal carcinomas. We report a 68-year-old man with complaints of rectal bleeding and hematuria. Endoscopic biopsies revealed synchronous adenocarcinoma of the colon and transitional cell carcinoma of the bladder. The patient was started on chemotherapy, and is alive (with disease) nine months later.
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The situation of detection and treatment of colonic and rectal cancer in the capital of the G.D.R. Berlin is described for the period 1960--1969 and analyzed in comparison to other periods and regions. This study is based on the regional cancer registry and therefore free of the selection bias in clinical statistics. In the ten year period, 3855 new cases were registered (colon 2158, rectum 1697). The proportion of old patients is high, 66 percent were 65 years and older, 28% 75 and more years old. About 41% of patients seek medical advice within four weeks after first symptoms and about 60 percent of cancers were treated within one month after first consultation. The locaized stages I and II amounted to 46 percent of cases. There was only loose relation between duration of history and stage of disease. In nearly 39% of cases radical operation was performed and 27% were not treated by surgery. 5-year survival rates of colonic and rectal cancer in the period 1960--1964 amounted to 12% for all stages irrespeitive of method of treatment and 31% for patients after radical surgery. Survival rates depend on stage, on mode of treatment and on age. In the period from 1955 to 1973, proportion of old patients increased, distribution of stages remained nearly constant but proportion of cases radically operated on increased by 3%. Comparison of the regions of Berlin and Erfurt showed only small differences. Compared with international reports, survival rate is very low in Berlin, presumably due to complete registration of new cases and high number of very old people with colonic and rectal cancer.
The purpose of this study is to review the computed tomography (CT) appearance of infectious and inflammatory diseases, and neoplasms of colon. Forty-five patients with 25 cases of colonic neoplasms and 20 cases of inflammatory and infectious diseases of colon were evaluated based on CT findings of colonic wall thickening (> 5 mm, soft tissue density versus pure wall edema or both), length of the involved segment (short (< or = 5 cm) versus long segment), pericolic infiltration, mesenteric infiltration, lateroconal fascial thickening, mechanical ileus, ascites, contiguous terminal ileum involvement, distribution of the diseased colon, and abscess formation. The results were compared using chi-square test or Fisher's exact test. Our results showed that colonic wall thickening of soft tissue density with or without edema and pure bowel wall edema were the two statistically significant findings in differential diagnosis of colon (p < 0.05). We concluded that CT is a good imaging tool to make differential diagnosis between infectious/ inflammatory diseases and neoplasms.
OBJECTIVE: The purpose of this retrospective study was to determine the frequency and intensity of eosinophilic infiltration (or tissue eosinophilia) in the stroma of colonic adenomas, hyperplastic polyps, and colorectal adenocarcinomas. Eosinophilic infiltration in various malignancies has been reported but has not been evaluated in benign colorectal adenomas and hyperplastic polyps. METHODS: We analyzed 488 colonic neoplasms: 176 tubular adenomas, 55 tubulovillous adenomas, 82 villous adenomas, 15 early carcinomas in polyps, 95 invasive adenocarcinomas, and 65 hyperplastic polyps for the presence of eosinophilic infiltration. The eosinophilic infiltration was graded as negative (< or =5%), mild to moderate (>5-40%), or marked (>40%), depending on the percentage of eosinophils relative to total inflammatory cells in the stroma. RESULTS: Mild to moderate eosinophilia was noted in 75% of all adenomas. The transitional zone in all cases of invasive adenocarcinoma (zone between normal tissue and adenocarcinoma) revealed a high percentage of tissue eosinophilia. There was a striking absence of TE in the stroma of invasive adenocarcinomas. Only 5% of hyperplastic polyps had any eosinophilic infiltration. CONCLUSIONS: These data suggest that, in the spectrum of colonic neoplasms, stromal eosinophilia is most prominent in adenomas and seems to decrease with progression through the adenoma-carcinoma sequence. The ramifications of this study may alter management plans and provide some prognostic information for clinical evaluation.
A retrospective review of 637 consecutive colonoscopies with polypectomy in 526 patients was performed to determine the association of small polyps of the rectum and sigmoid colon with more proximal colonic neoplasms. All colonic polyps were proximal to the sigmoid colon in 117 procedures. Proximal neoplasms were found in 32 percent of patients with a single polyp in the rectum or sigmoid colon. The incidence increased to 83 percent for those with three or more polyps. The occurrence of proximal colonic neoplasms was not affected by the size or histologic type of the rectosigmoid polyps. These findings would suggest that total colonic evaluation be considered in all patients with a polyp in the rectum or sigmoid colon regardless of the size or histologic type of the polyp.
BACKGROUND: Colonic neoplastic lesions can be classified morphologically into polypoid and non-polypoid types. Non-polypoid lesions have a higher malignant potential than polypoid lesions. Removing these lesions and obtaining integral specimen for histopathology evaluation during colonoscopy examination is an important task. Endoscopic mucosal resection (EMR) is an alternative to surgery for removing of non-polypoid lesions of the GI tract. This study assessed the safety, efficacy, and clinical outcomes of EMR. PATIENTS AND METHODS: From October 2000 to October 2003 during the routine colonoscopy performed at one medical center, identified 152 non-polypoid colonic neoplasms in 149 patients (92 males, 57 females) were found. The mean patient age was 57.8 +/- 15.5 yr (range 32-80 yr). EMR was performed for lesions suspected of being neoplastic tumors via magnification colonoscopy with the indigo carmine dye spray method. The lesions were removed via EMR with pure cutting current after which hemoclips were applied to the resected wounds. RESULTS: The study identified 40 flat type lesions, 106 lateral spreading tumors, and 6 depressed lesions that were completely resected. The mean size of lesions was 19.4 +/- 10.3 mm (range 6-60 mm). Histological findings were 4 adenocarcinomas, 59 with high-grade adenoma/dysplasia, and 89 with low-grade adenoma/dysplasia. Two patients experienced bleeding immediately following EMR, while adequate hemostasis was achieved using hemoclips. Neither delayed bleeding nor perforation developed following EMR. CONCLUSION: EMR by using pure cutting current and hemoclip is a useful method for obtaining integral specimen for accurate pathologic assessment. This method provides a safe and minimally invasive technique managing of colonic non-polypoid lesions.
A study was undertaken to compare the age, sex, preoperative diagnosis, and operative findings of patients who had adenocarcinoma of the appendix with patients who had adenocarcinoma of the colon. The study consisted of an analysis of 316 case reports and collective reviews of adenocarcinoma of the appendix that were reported in the literature between 1960 and 1985. The mean age of patients with this disease was 57.1 years and the male-to-female ratio for adenocarcinoma of the appendix was 1.4:1. Only rarely was a malignancy suspected, as 68 percent of the patients presented with signs and symptoms of inflammatory disease of the appendix. The tumor was perforated in 55 percent of patients, making it the most frequently perforating carcinoma of the entire gastrointestinal tract. One half of these perforations were localized as abscesses. The presence of perforation did not necessarily predispose a poor prognosis. Synchronous appendiceal and other colonic neoplasms occurred in 2.7 percent of patients. Pseudomyxoma peritonei occurred as a presenting feature in 5.6 percent of patients and was generally a poor prognostic indicator. Carcinomatosis peritonei was found at initial exploration in 10.3 percent of patients and these patients rarely survived one year.
To investigate whether gonadal hormones are involved in the tumorigenesis of dimethylhydrazine (DMH)-induced colonic neoplasms, the authors measured steroid receptors in the neoplasms. 30- or 60-day-old BD-IX rats were injected with 20 mg of 1,2-DMH per kg of body weight once a week for 20 weeks. Fifty-seven rats were sacrificed at 40 to 45 weeks after the initial injection. Androgen receptor (AR), estrogen receptor (ER), and progesterone receptor (PR) were measured in colonic neoplasms. The total number of colonic neoplasms was 274 among 57 rats, 65.8% in male rats and 34.2% in female rats. The mean number of colonic neoplasms per rat was higher in male rats, i.e., 5.6, compared with 3.5 in female rats. A slightly higher number of colonic neoplasms per rat was seen in the rats that had the initial injection at 30 days of age. The number of large colonic neoplasms with a diameter of more than 1 cm was 77 (28.1%), 74% of which were seen in male rats. Thus, a higher incidence of tumors that were also larger were seen in male rats. Histologic findings showed that 53.6% of the neoplasms were carcinomas. The highest incidence of colonic neoplasms was in the distal colon in both sexes. Most of the well-differentiated adenocarcinoma were seen in the distal colon (82.2%), whereas mucinous carcinoma and undifferentiated adenocarcinoma were prominent in the proximal colon or cecum (56.1%). In rats with a normal colon, low levels of AR and PR were determined; but ER was not found in any regions of the colon. In DMH-induced colonic cancer, the incidence as well as the concentration was higher in male rats (60.6%, 16.9 +/- 3.6 fm/mg protein), compared with female rats (40.0%, 4.6 +/- 0.8 fm/mg protein). Similar incidences and levels of ER and PR were seen in both sexes. There was no relationship between steroid receptors and histologic findings in colonic neoplasms. These results suggest that the gonadal hormones, especially androgens, appear to be involved in DMH-induced colon tumorigenesis in male rats.
BACKGROUND & OBJECTIVE: P27 protein and cyclin E were negative cell cycle regulators. Until the present, the influence of P27 protein and cyclin E on progression of colon cancer was unclear. The aim of this study was to observe the expression features of P27 protein and cyclin E in the tissues of colon neoplasms, and to investigate the relationship between colon neoplasms and tumor special growth factor (TSGF). METHODS: Sixty-nine cases of samples included 23 normal tissues, 28 colon polyps (13 inflammatory polyps and 15 adenomatous polyps), and 18 colon carcinomas. The location and expression of P27 protein and cyclin E were determined using immunohistochemical method in all samples. These samples were diagnosed using formal pathological techniques simultaneously; the relationship between colon neoplasms and TSGF was also investigated. RESULTS: The positive signal of P27 and cyclin E was found mainly in the cytoplasm and extracellular matrix of normal colon tissues, inflammatory polyps, and adenomatous polyps. Less amount of positive expression product of P27 protein and cyclin E was observed in colon carcinoma cells; and the positive signal was only located in the cytoplasm of gland-like cells. The content of TSGF in colon carcinoma tissues was significantly higher than that in normal tissues (117.3+/-57.02 versus 64.16+/-27.5,P< 0.01), but there was no significant difference between colon carcinoma tissues and inflammatory polyp tissues (117.3+/-57.02 versus 92.5+/-47.9,P >0.05). CONCLUSION: P27 protein and cyclin E participate in the adjustment process of colon neoplasm occurrence and progression. The reduced expression of P27 protein and cyclin E may indicate the possibility of colon carcinoma.
BACKGROUND: Stimulation of resting cells by growth factors leads to an increase in the rate of protein synthesis, which is necessary for cell growth and division. Translation initiation factor eIF-2alpha is one of the key translation factors mediating the effects of growth factors on protein synthesis. In normal cells, expression of eIF-2alpha is increased transiently, but its levels are elevated constitutively in oncogene-transformed cells. Overexpression of constitutively active eIF-2alpha in rodent cells makes them tumorigenic. In this article, the authors report their findings on the increased expression of eIF-2alpha in human benign and malignant neoplasms originating from melanocytes and colonic epithelium. METHODS: Immunohistochemistry was used to analyze the expression of eIF-2alpha, eIF-4E, and cyclin D1 in melanocytic nevi and melanomas and the expression of eIF-2alpha in colonic adenomas and carcinomas. RESULTS: The authors found that the expression of eIF-2alpha was increased markedly in both benign and malignant neoplasms of melanocytes and colonic epithelium. CONCLUSIONS: Increased expression of eIF-2alpha took place in both benign and malignant neoplasms of melanocytes and colonic epithelium. These findings suggest that elevated expression of this translation initiation factor may contribute to tumor initiation and progression but that it is not sufficient for establishing a malignant phenotype in the tumors analyzed in this study.
The authors present the case of one male patient, 71 years old, known with serial neoplasia (right colon neoplasm 1983, left colon neoplasm 1987) for which there were performed several interventions. The patient was admitted first time in our Department in 1998 for a non specifically symptomatology; in particular anaemic syndrome. The first intervention was performed in June 1998, without finding anything pathological, despite the presumption of a third tumor on the remaining colonic territory, theory that was partially sustained by the paraclinical examinations. The second intervention was performed in February 2001, when it was found and extirpated a jejunal tumor, under Treitz angle, but after 9 months, when a new intervention was performed, we found a relapse tumor which was not extirpable. The aim of this study is to present the unpredictable versatility of small bowels tumors and the difficulty of establishing an early positive diagnose.
Three women had endometriosis that involved the rectosigmoid colon; their clinical presentation suggested primary colonic malignant neoplasm. Intestinal obstruction, weight loss, and, in two patients, rectal bleeding with radiologic evidence of a mass lesion that involved the rectosigmoid were present at initial evaluation. All patients eventually underwent colonic resection as definitive therapy. Endometriosis of the pelvic colon may mimic primary intestinal disease, mistakenly suggesting malignant neoplasm. Such symptoms in a young woman should prompt a search for endometriosis, which is a more likely diagnosis. Adequate therapy frequently requires surgical intervention.
Although it has been demonstrated that acromegalic patients have an increased risk of neoplasms, especially colon neoplasms, gastric cancer with acromegaly is very rare--only five cases have been reported to date in Japan. We report here a rare case of gastric cancer with acromegaly in a 58-year-old woman, whose acromegalic change began at age 44. This patient showed typical clinical features of acromegaly, with increased concentrations of blood growth hormone (GH) and insulin-like growth factor I (IGF-I); she had four types of neoplasms; gastric cancer, colon tubular adenoma with moderate atypia, pancreatic mucinous cystadenoma, and subcutaneous lipoma. The gastric cancer was macroscopically 0-IIc type, 3.0 x 2.5 cm in size, and histologically diagnosed as a poorly differentiated adenocarcinoma with limited invasion of the mucosal layer. The previously documented stimulatory effects of GH and/or IGF-I on tumorigenesis and cell proliferation may have been responsible for the development of the multiple neoplasms in our patient.
The purpose of this study was to elucidate the purine enzymic programs of human primary colorectal carcinomas. Marked alteration in the enzymology of the human colon neoplasm clearly distinguished it from that of the normal colon mucosa. In the human colon mucosa, the activities of ribonucleotide reductase, inosine phosphate dehydrogenase, formylglycinamidine ribonucleotide synthetase, guanosine phosphate synthetase, and amidophosphoribosyltransferase were 0.042, 5.2, 5.6, 8.2 and 36.0 nmol/h/mg protein, respectively, and in the colon carcinomas the activities increased to 755, 575, 295, 280, and 294% of the normal values. The activities of the salvage enzymes, adenine and hypoxanthine-guanine phosphoribosyltransferases, were 310, 249, and 602 nmol/h/mg protein, respectively, whereas in the tumors, only the activity of adenine phosphoribosyltransferase was increased (2-fold). The markedly higher absolute enzymic capacity for salvage in the tumors accounts, in part at least, for the lack of chemotherapeutic success of inhibitors of enzymes of de novo synthesis that have been used in the clinical treatment of colorectal carcinomas. Combinations of inhibitors of de novo biosynthesis and blockers of the salvage enzymes or of salvage transport (e.g., dipyridamole) should improve the chemotherapy of colon neoplasms. Since in the colon carcinoma the activities of glutamine-utilizing enzymes (guanosine phosphate and formylglycinamidine ribonucleotide synthetase and amidophosphoribosyltransferase) were markedly increased, and the glutamine concentration was decreased (50%), treatment with an antiglutamine agent (e.g., acivicin) should be of relevance. Since the activity of ribonucleotide reductase, the rate-limiting enzyme of nucleic acid biosynthesis, was markedly increased in the colon neoplasms, combination chemotherapy might include drugs against this enzyme.
The effects of low power (1-2 Watts), long exposure (30-400 seconds), interstitial Nd YAG laser therapy on dimethylhydrazine induced rat colonic neoplasms and normal rat colon have been studied. After a single exposure with appropriate laser parameters, dimethylhydrazine induced rat colonic neoplasms underwent coagulative necrosis, sloughed off over a four day period, and left an ulcer which healed within 28 days. Inadequate laser energy resulted in incomplete tumour necrosis whilst excessive laser power or energy increased the likelihood of perforation. Treatment of normal colon with 1 Watt for 30 seconds or longer resulted in coagulative damage which healed by granulation. Mean colonic bursting pressures were significantly decreased one hour after treatment with 1 Watt for 75 or 100 seconds compared with untreated colon (p less than 0.05 and p less than 0.001 respectively) but not in colon treated with 1 Watt for 30 or 50 seconds. In animals treated with 1 Watt for 100 seconds mean bursting pressures were significantly lower than untreated animals when the animals were killed two, four, and seven days after lasering (p less than 0.001 in each case) but not in animals killed at 11, 17, or 21 days. The technique may be of value in the treatment of some inoperable colorectal cancers and sessile polyps in man.
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BACKGROUND AND AIMS: Aberrant crypt foci (ACF) are thought to be preneoplastic lesions and are assessed by magnifying chromoscopy with methylene blue staining. The aim of this study was to evaluate the predictive value of rectal ACF recognized by conventional chromoscopy for colonic advanced neoplasms. METHODS: Total colonoscopy, involving rectal chromoscopy using indigo carmine with standard colonoscopies, was performed on 386 patients. Patients who showed no ACF were classified as Grade 0, and those who had 1-4, 5-9, and 10+ ACF were classified as Grades 1, 2, or 3, respectively. The correlation between ACF grading and the prevalence of colonic advanced neoplasm, any adenoma>or=1 cm in size and/or with villous or tubulovillous morphology, and/or with high-grade dysplasia or invasive cancer, was assessed. RESULTS: Sixty-three patients were classified as ACF Grade 0, 119 as Grade 1, 116 as Grade 2, and 88 as Grade 3. Colonic advanced neoplasm was observed in 4 patients (6.3%) for Grade 0, 43 (36.1%) for Grade 1, 61 (52.6%) for Grade 2, and 57 (64.8%) for Grade 3. As the ACF grade increased, the chance of a patient having a colonic advanced neoplasm increased. For multivariate analyses, compared with patients with Grade 0, those with Grades 1, 2, or 3 had a greater risk of colonic advanced neoplasm (odds ratio [OR] 9.18, 95% CI 3.08-27.33, OR 20.44, 95% CI 6.81-61.42, and OR 32.94, 95% CI 10.49-103.41, respectively). CONCLUSIONS: Chromoscopic assessment of rectal ACF by conventional techniques is useful for predicting colonic advanced neoplasms.