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PubMed2002

Metastatic renal cell carcinoma involving the rectum.

BACKGROUND AND AIMS: Metastatic spread of a distant tumor to the rectum is extremely rare. To our knowledge, there have been no published reports of hematogenic metastasis from a renal cell carcinoma to the rectum. PATIENTS AND METHODS: A patient with a renal cell carcinoma was initially treated by a radical right nephrectomy. RESULTS: Nine months after the surgery he started to have multiple episodes of hematochezia. Colonoscopy showed a nodular lesion located in the distal rectum, and biopsy revealed an undifferentiated carcinoma. The patient then underwent abdominoperineal resection of the rectum, and histological examination showed metastatic renal clear cell carcinoma. CONCLUSION: This case represents an exceedingly rare condition, which has never been reported before.

Carcinoma, Renal Cell↗
PubMed1982

Postoperative follow-up studies on cancer of the colon and rectum.

We followed up 790 patients with cancer of the colon and rectum treated at our hospital since 1962. The curative resection rate in the rectum and anus was 78 percent but decreased as the distance of the lesion from the anus increased. In the ascending colon the rate was 59.8 percent. The patients undergoing curative resection had a 5 year survival rate of 65 percent and a 10 year survival rate of 45 percent. The closer to the anus, the poorer the prognosis. Prognosis is greatly influenced by the stage at diagnosis. Surgical results have improved annually due to progress in diagnostic and therapeutic procedures. Factors greatly influencing prognosis were the presence of lymph node metastasis, the degree of invasion of the intestinal wall and the site of the primary lesion. Lymph node metastasis was an especially important prognostic factor. In cancer of the rectum primary recurrences were most often found in local sites (66 percent of cases), followed by metastasis to the liver and the lung. However, in cancer of the colon metastasis in both the liver and the peritoneum was observed in 67 percent of the cases. On the basis of these results, methods to prevent local recurrence of cancer of the rectum as well as metastasis to the liver from cancer of the colon must be developed. When extended abdominopelvic wide dissection was performed, the incidence of local recurrence decreased.

Carcinoembryonic Antigen↗
PubMed1996

Predictive value of palpation per rectum for detection of the CL in Zebu cattle as evaluated by progesterone concentrations and ultrasonography.

The main objective of this study was to calculate the predictive value of the positive and negative diagnosis of the presence of a corpus luteum by palpation per rectum in Zebu cattle. Gyr breed (n = 16) heifers were palpated by a veterinarian every 3 d during March and April, and every 5 days during May. The presence or absence of a CL was recorded for 442 examinations. A blood sample was obtained after each examination, and a functional CL was considered to be present if plasma progesterone concentrations were above 1 ng/ml. Progesterone results were used as the reference to calculate the sensitivity and specificity of palpation per rectum for the diagnosis of a functional CL on different months. Predictive values for the positive and negative diagnoses were calculated using different hypothetical rates of the prevalence of CL. To evaluate the morphological basis of an erroneous diagnosis, ultrasonographic scanning of the ovaries was performed in 264 cases and the physical presence or absence of a CL was registered. The calculations were repeated using the ultrasonographic findings as the reference to evaluate the sensitivity and specificity of the diagnosis of a structural CL by per rectum palpation. Several heifers were not cyclic in March but began to cycle during the study. Thus, the prevalence of both functional and structural CL increased with time. As a result, the proportion of palpation diagnoses classified as true positives increased in May, while the proportion of true negatives decreased. Although the values of sensitivity and specificity remained constant from month to month, the predictive values changed markedly in May, when the predictive value of the positive test increased while the predictive value of the negative test decreased. These changes were due to differences in the prevalence of a CL and not to differences in the palpable characteristics of CLs in different months. The prevalence of a structural CL was always higher than that of a functional CL. The Cohen's Kappa test for concordance revealed better correspondence between palpation per rectum and ultrasound (k = 0.82) than between progesterone and either ultrasound (k = 0.68) or palpation (k = 0.66). These results show that a large proportion of the errors imputed to deficient palpation when progesterone concentrations are used as a reference are in fact the result of lack of correspondence between the physical and functional presence of a CL.

Journal Article↗
PubMed2006

Early pregnancy diagnosis by palpation per rectum: influence on embryo/fetal viability in dairy cattle.

The objective was to estimate the effect of palpation per rectum (for early pregnancy diagnosis) on embryo/fetal viability in dairy cattle. A controlled, randomized block-design experiment with two blocks, one by category, and the other by number of embryos, was conducted. Five-hundred-and-twenty pregnant dairy cows and heifers with a viable embryo detected by transrectal ultrasonography (TRUS) between days 29 and 32 after AI were included. The pregnant females were randomly allocated into two nearly equal groups: palpation per rectum (PAL group; n=258) and no palpation per rectum (NPAL group; n=262). The PAL group was submitted to palpation per rectum (PPR) using the fetal membrane slip (FMS) technique once between days 34 and 41 of pregnancy. The fetal membrane slip consisted of compressing the pregnant uterine horn and allowing the chorioallantoic membrane to slip between the fingers. Both groups were submitted to two additional TRUS at days 45 and 60 of pregnancy, to monitor the potential immediate and delayed deleterious effects of PPR on embryo and fetal viability, respectively. A diagnosis of embryo/fetal death was made when there was no embryo/fetal heart beat or the absence of positive signs of pregnancy in an animal previously diagnosed pregnant, or the presence of signs of embryo/fetal degeneration. The overall rate of embryo/fetal death was 14.0% (73/520). Embryonic death (10%; 52/520) was higher than fetal death (4.5%; 21/468; P<0.001). Embryo/fetal mortality was higher in cows (16.4%; 59/360) than in heifers (8.8%; 14/160; P<0.025) and in cattle with twin (25.5%; 12/47) versus singleton pregnancies (12.9%; 61/473; P<0.025), but was not different (P>0.05) between PAL (14.7%; 38/258) and NPAL (13.4%; 35/262). In conclusion, PPR between days 34 and 41 of pregnancy using the fetal membrane slip technique did not affect embryo/fetal viability.

Animals↗
PubMed1993

Sphincter-saving alternatives for treatment of adenocarcinoma involving distal rectum.

In reviewing the results achieved with local treatment of carcinoma of the rectum, it becomes apparent that no single approach to the treatment of carcinoma of the rectum is optimal for all patients. As is true in patients with carcinoma of the breast and other malignant lesions, selection of the appropriate treatment alternatives for a patient with carcinoma confined to the distal rectum requires accurate preoperative staging of the disease. Physicians interested in treating patients with carcinoma of the rectum should have the full spectrum of treatment alternatives available.

Adenocarcinoma↗
PubMed2001

Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature.

OBJECTIVE: To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease. MATERIALS AND METHODS: Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery. RESULTS: Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment. CONCLUSIONS: Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.

Journal Article↗
PubMedDate not supplied

Squamous cell carcinoma of the anus and rectum in homosexual men: CT findings.

OBJECTIVE: Homosexual men are at risk for a variety of infectious and neoplastic diseases of the anus and rectum, many of which have been reported in the radiologic literature. The purpose of this study was to describe the CT findings in homosexual men with squamous cell carcinoma of the anus and rectum, a topic that has received little attention. MATERIALS AND METHODS: Computed tomography examinations of the abdomen and pelvis of nine homosexual men with squamous cell carcinoma of the anus and rectum were reviewed retrospectively. Six HIV-positive men were 28-44 years old (average, 37 years). Three HIV-negative men were 47-61 years old (average, 54 years). RESULTS: In six of the nine patients, CT showed a mass involving the anal canal. In five of these six patients, the tumor extended caudad to involve perianal fat and skin (one patient), cephalad to involve the rectum and perirectal fat (two patients), or both (two patients). In three of the nine patients, the anal canal did not appear to be involved by the tumor; CT showed circumferential rectal wall thickening (one patient), an excavated eccentric rectal tumor (one patient), or a cystic extramucosal rectal mass (one patient). Computed tomography evidence of noncontiguous metastasis was limited to inguinal and iliac lymph node enlargement in two of the nine patients. CONCLUSION: Because CT findings are varied and nonspecific, squamous cell carcinoma should be included in the differential diagnosis of anorectal lesions in homosexual men.

Adult↗
PubMed1987

Long term survival case of small (oat) cell carcinoma of the rectum.

A long term survival case of small (oat) cell carcinoma of the rectum in a 39-year-old female is presented. She complained of anal pain and occasional anal bleeding. The tumor was located at the anterior wall in the lower rectum. Biopsy specimens revealed a carcinoid tumor. She underwent trans-anal local resection for the first time in December, 1980. Macroscopic findings of the resected specimen showed a small nodule, 0.4 by 0.4 by 0.5 cm, with yellowish cut-surface. Microscopically, the tumor deeply invaded the submucosal layer. The appearances were indistinguishable from pulmonary small (oat) cell carcinoma. Since lymphatic permeations were moderately recognized in the tumor, she underwent radical operation (Miles' operation) with lymphadenectomy. Microscopic findings of the resected rectum revealed an intramural metastatic lesion with marked lymphatic permeations in the submucosal layer 2 cm distant from the primary lesion. Up to date, there is no evidence of local recurrence or liver metastasis. Small (oat) cell carcinoma of the rectum easily metastasizes lymphogenously through the lymph system from an early stage of the development. Wide surgical resection will be needed to give a long term survival even if the tumor is extremely small.

Adult↗
PubMed1988

Primary squamous cell carcinoma of the rectum in Denmark.

Only a limited number of cases of primary squamous cell carcinoma (SCC) developed in the colon and rectum have been described in the world literature. This study represents the first population-based study of this rare cancer. Sixteen patients with primary SCC of the rectum diagnosed in the period 1978-1983 were identified from the Danish Cancer Registry. Eleven patients were excluded after revision of the histological specimens because the SCC in these cases were in connection with the squamous epithelium of the anal canal. SCC of the rectum in Denmark in the period 1978-1983 thus constituted 0.06% and 0.11% of the histologically verified rectal tumours in men and women, respectively. Case reports on these cases are given. One of the two males was homosexual and the other had never been married or lived with a woman. It is concluded that our findings support the hypothesis proposed by Austin that there may be an association between the frequency of anal intercourse and occurrence of squamous cell carcinoma of the rectum.

Adult↗
PubMed2005

Synchronous early primary adenocarcinoma of both rectum and gallbladder. Report of a case.

BACKGROUND: Synchronous early primary cancers are rare and in addition synchronous adenocarcinoma of both rectum and gallbladder is extremely rare. CASE REPORT: We report an unusual case of synchronous early primary adenocarcinoma of rectum and gallbladder. The patient was a 72-year-old woman with complaints of bloody stools and constipation. An endoscopy revealed adenocarcinoma of the lower rectum. A through preoperative investigation showed also cholelithiasis. The patient underwent abdominoperineal resection and cholecystectomy. The histopathological diagnosis was well to middle differentiate adenocarcinoma of the gallbladder (T2, N0, M0; stage II) and middle differentiate adenocarcinoma of the rectum (T2, N0, M0; stage II). CONCLUSION: For the cases of extracolonic primary cancer associated with colorectal primary carcinoma, Warren and Gates' diagnostic criteria are used. All patients with colorectal carcinoma, should undergo a throughout preoperative examination to exclude the possibility of synchronous early primary cancers.

Journal Article↗
PubMed1978

Cytological diagnosis of cancer of the colon and rectum.

Results of cytological examination in 120 cases of colon and rectum cancer during the 11-year period ending in 1968 prior to the practical use of fibercolonscope were first studied. At that time, quite favorable results were obtained in cancer of the lower colon and the rectum, but the results were not so satisfactory in cancer of the right side of the colon. After 1969 when the fibercolonscope was introduced into the clinical practice, the range of cytological diagnosis under direct vision was at once expanded to the entire colon. Consequently, diagnosis by the cytological method in 140 cases of cancer of the colon and rectum experienced in 6-year period between 1969 and 1974 revealed favorable results. The results of the cytological diagnosis in cancer of the right sied of the colon, previously not always favorable, improved markedly after the introduction of the cytological method under direct vision through fibercolonscope. When early cancer of the colon and rectum is defined as in early gastric cancer, 40 lesions in 36 patients were detected during the past 19 years. The rate of positive result in cases of early cancer obtained by various diagnostic methods was 83% by the cytological method, 78% by biopsy and 91% by polypectomy. In cases in which both biopsy and cytological method were used, one or both frequently gave positive results. These results would indicate the possibility of correct diagnosis in many cases through the combined use of the cytological method and biopsy, without polypectomy.

Colonic Neoplasms↗
PubMed1979

Diagnosis of early cancer of the colon and rectum.

When early cancer of the colon and rectum is defined as in early gastric cancer, i.e., invasion is limited to the mucosa and submucosa, 38 lesions from 35 patients of early cancer of the colon and rectum were detected during the last 20 years. The macroscopic and histologic findings included cancer-containing adenoma in 35 lesions from 32 patients. When the diagnostic methods were compared in 33 cases of early cancer of the colon and rectum, it was found that positive or suspicious cancer was obtained by an x-ray study in 5 of 18 cases examined (28%), by endoscopy in 19 of 31 cases (61%), by cytologic methods in 18 of 21 cases (86%), by biopsy in 19 of 25 cases (76%) and by polypectomy under direct vision through an endoscope in 13 of 14 cases (93%). When both biopsy and cytologic studies were performed in combination with endoscopy (20 cases), either of them was positive in all cases. These results indicate the possibility of correct diagnosis in many cases through the combined use of the cytologic method and biopsy without polypectomy, if the location is previously checked. On the other hand, 104 polyps from 90 patients were removed by means of the snare-electrocautery technique with the use of coagulation current during the last 4 years. The histologic findings revealed cancer-containing adenoma in 13, even in benign appearing polyps and in small polyps 1.0 cm or less in diameter. These results indicate that diagnosis of early cancer of the colon and rectum is difficult without polypectomy, if cancer is not previously suspected.

Adenoma↗
PubMed1998

A case of giant leiomyosarcoma of the rectum.

A 63 year-old-man was admitted to our hospital with the chief complaint of dyschezia. Digital examination revealed a large solid mass on the posterior wall of the rectum. Endoscopically, the tumor was covered by an intact mucosal layer. Under the diagnosis of rectal leiomyosarcoma, abdominoperineal resection of the rectum was performed. The tumor was 10 x 9 x 8 cm in size, and its cross section showed a gray-white tumor with central necrosis. Microscopically, the large tumor of the rectum was mainly located in the proper muscle layer and adventitia, and showed cellular proliferation of spindle-shaped and mild pleomorphic stromal cells, arranged in interlacing fashion, and focal necrosis. The histologic findings support the diagnosis of leiomyosarcoma. Leiomyosarcoma of the rectum is a relatively uncommon disease. We report our case with reference to the literature.

Humans↗
PubMed2005

Small cell carcinoma of rectum: a case report.

We present a case of a 40-year-old woman with small-cell carcinoma (SCC) of the rectum. She had profuse bleeding in rectum for 5 d. By colonoscopy, polyps were determined in the rectum and biopsies were carried out. Histopathologically, the polyps were adenomatous. Because of the profuse bleeding in rectum, she underwent low anterior resection. After the diagnosis of SCC, she received intravenous chemotherapy with standard doses of siklofosfamid, adriamycin, and vepesid. Nevertheless, intracranial metastases were revealed and she died 6 mo after the operation.

Adult↗
PubMed2006

Management of less common tumors of the colon, rectum, and anus.

The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.

Carcinoma, Squamous Cell↗
PubMed2003

High dose rate intraluminal brachytherapy in combination with external beam radiotherapy for palliative treatment of cancer rectum.

OBJECTIVE: To evaluate the feasibility, efficacy and toxicity of High Dose Rate Intraluminal Brachytherapy (HDRILB) in combination with External Beam Radiotherapy (EBR) used in the palliative treatment of selected patients of adenocarcinoma rectum. DESIGN: A prospective pilot study. PLACE AND DURATION OF STUDY: The study was conducted at the Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar. The study started in April 1996 and the patients accrual was completed in June 1997. PATIENTS AND METHODS: The patients with adenocarcinoma rectum, who refused surgery, had contraindications for surgery or had advanced and/or metastatic disease were treated with HDRILB in combination with external beam radiotherapy (EBR). The apparatus used for HDRILB was Ralstron 20B remote afterloading unit with 60Co stepping source. Indigenously designed rectal applicators were used. The EBR was delivered through Pheonix 60Co teletherapy machine (Theratron AECL). The data for symptom burden and symptomatic relief was analyzed by applying Likert's method of summated scales. RESULTS: Data was analyzed after one week and at the end of the treatment. After one week of treatment, the relief in pain and bleeding per rectum (P/R) was 97%. Excellent palliation was achieved at the end of the treatment when perineal pain and bleeding P/R were relieved in 100%, discharge P/R in 87% and tenesmus in 93% of the cases. CONCLUSION: The use of HDRILB in combination with EBR can provide quick relief of symptoms in selected patients of adenocarcinoma rectum. This combination has an excellent palliative value because of its effectiveness, acceptable toxicity and overall short treatment duration.

Adenocarcinoma↗
PubMed1999

The role of energy and fat in cancers of the breast and colon-rectum in a southern European population.

BACKGROUND: Several uncertainties remain with respect to the role of intake of fat and/or total energy in the etiology of cancer of the breast and colon-rectum. PATIENTS AND METHODS: Between 1991 and 1996, 2569 women with incident breast cancer (median age: 55 years), 1953 subjects with cancer of the colon-rectum (median age = 62), and 5155 hospital controls were interviewed in six Italian areas. The validated food frequency questionnaire included questions on 78 foods and recipes and specific questions on individual fat intake pattern. RESULTS: Significant trends of increasing breast and colorectal cancer risk with increasing intake emerged for bread and pasta, pork and processed meats and potatoes (breast cancer only), cakes and desserts (colon-rectum cancers only), and refined sugar. Most vegetables were inversely associated with cancer of the colon and rectum, whereas only carrots and raw vegetables seemed to lower breast cancer risk. High fruit intake was associated only with a reduction of rectal cancer. Total energy intake was directly associated with all cancer sites. Among macronutrients, high intake of starch and saturated fat seemed to lead to an increase of cancer risk. High intakes of polyunsaturated fatty acids (chiefly derived from olive oil and seed oils) were protective. Among micronutrients, beta-carotene, vitamin E, and calcium showed inverse associations with breast and colorectal cancer risk. CONCLUSIONS: An excess of energy intake, particularly from refined bread and pasta, can be an unfavourable feature of the Mediterranean diet, in the presence of a sedentary lifestyle.

Animals↗
PubMedDate not supplied

Non-Hodgkin's lymphomas with primary localization in large bowel and rectum.

From 1989, at the Department of Medical Oncology of the Institute for Oncology and Radiology in Belgrade, seven patients with primary NHL of large bowel and rectum have been observed and treated, 3 males and 4 females. In 3 patients an urgent laparotomy without previous diagnostic procedures was performed, while 4 patients had laparotomy only after radiographic and endoscopic diagnosis of a tumor. Six patients had radical surgery and 1 palliative only. Five patients had lymphoma localized in cecoascedental part of colon (2 centroblastic, 1 lymphoplasmocytic, 1 Burkitt and 1 Burkitt's like), 1 patient had it in the transversal part of colon (centroblastic), and one in the rectum (diffuse centrocytic). By further investigation, in 2 cases with localization within transversal part of colon and rectum no other sites of NHL were found. They are under regular controls with 45+ and 45+ months disease free survival. Out of 5 patients with localization within cecum or ascendent part of colon, in 2 cases with Burkitt/Burkitt-like histology retroperitoneal lymphadenopathy were found, one female had NHL central propagation, and the other one lymphoma generalization. Both patients had early death from lymphoma. The remaining three patients following chemotherapy with the ProMACE regimen (as they too had a post laparotomy stage II disease) achieved a complete response lasting for 36+, 41+ and 66+ months. Since the median survival in our group of patients is at the moment 41+ months and the median has not yet been reached, our experience does not confirm literature data claiming bad prognosis of primary NHL of the colon and rectum. A long disease free survival can be obtained in these patients either with surgery only or surgery + chemotherapy, depending on disease stage and possibly initial topographic localization.

Adult↗