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Inflammatory pseudotumor of the liver.

Inflammatory pseudotumor of the liver (IPL) is a rare benign neoplasm. It often masquerades as a malignancy, either primary or metastatic. We describe the case of a 71-year-old man who presented with fever and malaise. Workup revealed a cecal mass, as well as a lesion in the left lobe of the liver. Pathologic examination showed a cecal neoplasm and a hepatic inflammatory pseudotumor. The patient recovered uneventfully. This case highlights the ability of IPL to masquerade as a malignant hepatic neoplasm, and emphasizes the difficulties in diagnosis.

Aged↗

[The biological behavior of colorectal carcinoma in young patients].

Patients of the Instituto Nacional de la Nutrición Salvador Zubirán under 40 years of age with colorectal carcinoma were compared with similar patients above 40 in a retrospective and longitudinal study. Patterns of presentation, stage at diagnosis, degree of tumor differentiation and survival were analyzed. Abdominal pain, rectal bleeding and weight loss were the most frequent clinical manifestations in both groups. Constipation was more common in the young adults (60.5% vs 34.2%; p less than 0.05). In both groups, rectosigmoid was the most frequent location of the neoplasm. Cecal carcinoma was found in 2.6% of patients under 40 years and in 11.8% (p less than 0.05) in older patients. There was a higher frequency of mucinous tumors in the young patients (26% vs 13%; p = NS). Colon cancer in both groups were in advanced stage at presentation. The survival rate for young adults was 30%, and 21% for the other group (p = NS). The degree of tumor differentiation did not affect survival in both groups. Dukes stage was the only prognostic factor identified. The need for early recognition of colorectal cancer in young adults is emphasized by the greater incidence of advanced disease and poor prognosis.

Adult↗

Genetic mechanisms in cancer predisposition: report of a cancer family.

A family is described in which four children developed cancer affecting different organs:lymphoma, meningeal sarcoma, osteogenic sarcoma, and adenocarcinoma of the cecum. Since there was only one other case of cancer in previous generations of this family, an hypothesis is put forth to explain this unusual aggregation on the basis of recombination of common genes. It is postulated that each parent carried a different combination of genes which, though not associated with increased cancer predisposition in the combinations in which they were present in the parents, due to independent assortment resulted in a combination producing cancer susceptibility in half of the offspring. Such genetic loci could include factors similar to an oncogene which is normally held in control by genes at another locus; thus the dominant oncogene without the dominant controlling genes would make for cancer susceptibility, while the controlling genes without the oncogene would be associated with cancer resistance since two mutations would then be required for malignant development. To explain the occurrence of lymphoma in one of the children in this family, a third set of genes is included in this model--genes affecting immunocompetence, in which the normal allele is dominant. This three locus model has the advantage of being able to explain not only the occasional cancer family, but also the distribution of cancer susceptibility and resistance in the general population.

Adenocarcinoma↗

Effects of tumour necrosis factor on human tumour xenografts in nude mice.

Recombinant human tumour necrosis factor (rHuTNF) when injected intraperitoneally into nude mice bearing subcutaneous tumour xenografts (breast and bowel) had no significant antitumour activity (six different tumours were tested). The same dose administered locally at the tumour site resulted in complete regression and cure of the majority of tumours. Macroscopic evidence of tumour necrosis was rarely seen but microscopically a peritumoral cuff of host inflammatory cells surrounded the dying tumour cells within four days of the start of therapy. The combination of rHuTNF (i.p.) with recombinant human gamma-interferon (rHuIFN-gamma) (i.p.) led to significant tumour inhibition in only one of three xenografts tested. Combination of rHuTNF (i.p.) and HuIFN-alpha (s.c.) resulted in significant inhibition in all of three xenografts tested. Human ovarian tumours were grown in the peritoneal cavity of nude mice. The biological behaviour of this cancer closely resembled the human disease, the xenografts growing as solid tumours and/or ascites. When rHuTNF or rHuIFN-gamma were given intraperitoneally at the time of tumour cell injection most mice survived, whereas control mice died in 4-8 weeks. Once the disease was established (seven days or more after injection) either agent alone was ineffective. In the combined results of three experiments with one xenograft, with a total of 21 mice in each group, cumulative survival at 154 days was 0% for control mice and 5% and 15% for mice treated with 1 microgram/day rHuTNF or 5 X 10(4) U/day rHuIFN-gamma, respectively, when therapy was started seven days after tumour cell injection. Combining the two agents led to a cumulative survival of 85%. This combination cured 40% of mice by 21 days after tumour cell injection. With a further two ovarian cancer xenografts, the combination of rHuTNF and rHuIFN-gamma produced a significant survival advantage.

Animals↗

Generation of a unique strain of multiple intestinal neoplasia (Apc(+/Min-FCCC)) mice with significantly increased numbers of colorectal adenomas.

The relevance of the Apc(+/Min) mouse model in the study of human colorectal cancer remains uncertain due to the predominance of small intestinal adenomas and few, if any, colorectal adenomas. A new strain of Apc(+/Min) mice (Apc(+/Min-FCCC)) with significantly greater numbers of colorectal adenomas has been generated and characterized. Male C57BL/6J-Apc(+/Min) mice (the Jackson Laboratory, Bar Harbor, ME) were crossed with wild-type (Apc(+/+)) C57BL/6J females from an independent colony at this institution (offspring=Apc(+/Min-FCCC)) and 233 animals were evaluated over 20 generations. In order to determine the contribution of genetics to the enhanced colorectal adenoma phenotype, breeding pairs (Apc(+/Min) male x wild type female C57BL/6J) were purchased from the Jackson Laboratory and offspring (Apc(+/Min-JAX)) were maintained in our facility under identical conditions (n=98). Animals were fed Purina Rodent chow (#5013) diet containing 5% fat. The entire intestinal tract was examined histopathologically in both strains. Both the Apc and Pla2g2a (candidate for Mom1) genes were sequenced and found to be identical for both the Apc(+/Min-FCCC) and Apc(+/Min-JAX) mouse strains. The multiplicity of colorectal adenomas in the Apc(+/Min-FCCC) mice was much higher than reported in the literature and significantly greater than the multiplicity of colorectal adenomas in Apc(+/Min-JAX) mice maintained in our facility (P=0.01). Apc(+/Min-FCCC) had a significantly greater incidence of rectal prolapse (P = 0.02) and small intestinal adenocarcinomes (P=0.001), and multiplicity of small intestinal adenocarcinomas (P=0.001) compared to Apc(+/Min-JAX) mice. Male Apc(+/Min-FCCC) mice had significantly greater numbers of colorectal adenomas compared to female Apc(+/Min-FCCC) mice (P=0.0002), as did male Apc(+/Min-JAX) mice vs. female Apc(+/Min-JAX) mice (P< 0.0001). These results allow us to conclude: (1) Apc(+/Min-FCCC) mice are unique in that they develop significantly greater numbers of colorectal adenomas and small intestinal cancers, and a significantly greater incidence of small intestinal cancers and rectal prolapse than Apc(+/Min-JAX) mice. (2) This study represents the first report of a significant gender difference in multiplicity of colorectal adenomas. (3) Differences between Apc(+/Min-FCCC) and Apc(+/Min-JAX) mice in currently undefined genetic modifiers may contribute to the enhanced colorectal phenotype. (4) The Apc(+/Min-FCCC) strain is highly suited for the investigation of colorectal neoplastic disease and chemoprevention studies.

Adenoma↗

CT abnormalities in right lower quadrant inflammatory disease: review of findings in 26 adults.

Abnormal abdominal computed tomographic (CT) examinations, performed on 26 adults who presented with clinical evidence of right lower quadrant inflammatory disease, were retrospectively studied. Final diagnoses, established surgically in each case, included complicated appendicitis (15 patients), diverticulitis of the ileum or right colon (4), previously undiagnosed Crohn's disease (3), perforated cecal neoplasm (2), right tuboovarian abscess (1), and paracolic abscess of unknown cause (1). The CT features in each diagnostic group are presented in detail. Solid or ring calcification within a pericecal inflammatory mass was specific for appendicitis, occurring in 40% of the 15 patients. Without calcification, the differentiation of complicated appendicitis from Crohn's disease or diverticulitis, based on CT features alone, may be difficult in some cases.

Adolescent↗

Femoral neuropathy: unusual presentation for recurrent large-bowel cancer.

PURPOSE: The recurrence of colon or rectal cancer may be signaled by serial carcinoembryonic antigen assays, patient symptoms, or radiologic tests such as abdominal and pelvic computed tomographic scans. There are unusual clinical presentations of recurrent disease. METHODS: Retrospectively, six patients with recurrent appendix, colon, or rectal cancer had a femoral neuropathy. Their clinical features and results of reoperative surgery were reviewed. RESULTS: All six patients had thigh weakness and atrophy, and four complained of leg pain. Each of the six patients underwent a reoperation, with a complete cancer resection in four. Pain control was excellent, but only one of the six patients, a patient with appendix cancer, demonstrated prolonged survival. CONCLUSIONS: Leg pain, thigh weakness, and atrophy are compatible with femoral neuropathy and are symptoms and signs compatible with recurrent large-bowel cancer. These findings may alert the clinician to the need for further investigation and treatments.

Adenocarcinoma↗

Superficial spreading adenocarcinoma of appendix, cecum, and terminal ileum.

A case of superficial spreading adenocarcinoma involving terminal ileum, appendix and cecum is presented. The tumor might primarily arise from the proximal part of the appendix with extension to the cecum and terminal ileum, although multicentric origin of the tumor cannot be excluded. The mechanism underlying superficial infiltration of the tumor is through close contact and intramucosal lymphatic spread.

Adenocarcinoma↗

An unusual presentation of colon cancer in a young individual.

Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. CT scan of the abdomen and pelvis usually reveals the diagnosis of intussusception in adults. Surgical resection of the intussusception without reduction is the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy. However, the choice and timing of operation will depend on the clinical condition of the patient and the status of the invaginating tumor. Colon cancer in young individuals is usually aggressive, with a dismal prognosis.

Adenocarcinoma↗

Second primary tumor in anti-Ma1/2-positive paraneoplastic limbic encephalitis.

Memory loss can be a symptom of paraneoplastic limbic encephalitis (PLE) a neuropsychiatric disorder associated mostly with small-cell lung cancer and anti-Hu antibodies or with testicular tumors and anti-Ma2 antibodies. We present the case of a patient with temporal coincidence of beginning cognitive decline and diagnosis of a carcinoma of the prostate in whom we diagnosed anti-Ma1/Ma2-positive PLE. The tumor had been completely resected but memory impairment further deteriorated. As the effective treatment of the cancer is considered as the most efficient treatment of a paraneoplastic neurological syndrome (PNS) a second neoplasia was suspected in the patient. By the aid of whole body positron emission tomography with 18-fluorine fluoro-2-deoxy-glucose (FDG-PET) an adenocarcinoma of the cecum could be detected. Two months after surgery anti-Ma antibodies were negative. We conclude that a second neoplasia should be considered, if effective cancer treatment does not lead to improvement or stabilisation of a PNS. Tumor search should be exhaustive and include PET when conventional imaging fails to show a malignancy.

Adenocarcinoma↗

Thymosin alpha 1 does not promote growth or oncogenic transformation.

Thymosin alpha 1 (T alpha 1) is an immune modulatory peptide which has been evaluated in a variety of clinical trials. Although no in vivo adverse effects, including enhancement of tumor growth, have been noted, in vitro studies suggesting a role for T alpha 1 in cell growth have been reported. The studies presented in this report evaluated both exogenously added T alpha 1 and endogenously expressed T alpha 1 as factors which could either promote growth of tumor cells or induce transformation. No effect of exogenous T alpha 1 on cell growth was found. NIH-3T3 cells transfected with cDNA for the precursor ProThymosin alpha (Pro T alpha) expressed elevated levels of authentic T alpha 1 but did not demonstrate either enhanced proliferation in liquid culture or transformation as defined by the loss of contact inhibition or anchorage independent growth in soft agar. Thus these studies argue against the hypothesis that T alpha 1 is either an intracellular or extracellular growth promoter.

3T3 Cells↗