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Mature cystic teratomas of the ovary with intestinal wall structures harboring intestinal- type epithelial neoplasms.

Mature cystic teratomas of the ovary frequently contain intestinal-type tissues, but these rarely organize into complete intestinal walls, including all layers, and even more rarely develop secondary neoplasms. The present report documents two mature teratomas with formation of complete segments of intestinal wall, one also containing a benign mucinous cystadenoma of the appendiceal type and the other an intestinal-type adenocarcinoma infiltrating into the neoplastic bowel wall but not the surrounding ovarian parenchyma. The latter patient is alive and well 5 years after surgery. These cases expand the repertoire of secondary neoplasms, benign and malignant, developing in mature cystic teratomas.

Adenocarcinoma↗

Surgery of the small intestine.

This article reviews both clinical and scientific advances in surgery of the small intestine that have been reported in the last year. The management of both pediatric and adult intussusception is considered. Multiple studies on the evolving role of ileal pouch-anal anastomosis are assessed. The treatment and epidemiology of a wide variety of intestinal neoplasms are reviewed. Advances in small bowel transplantation are also reported. The cause of small bowel obstruction is considered as well as new strategies to prevent adhesion formation. Finally, a number of diverse topics relating to intestinal surgery, including new data on laparoscopic surgery, treatment of enterocutaneous fistulas, reconstruction after total gastrectomy, intestinal transit after ileocecal segment transposition, and ischemia/reperfusion and anastomotic healing, are reviewed.

Journal Article↗

An inherited form of large bowel cancer: Muir's syndrome.

Three inherited types of large bowel cancer not associated with polyposis were previously proposed. A fourth should also be added to the list, namely, Torre's or Muir's syndrome. This report summarizes the clinical and genetic features of that syndrome in one family. The principle features of the syndrome comprise multiple skin tumors, i.e., sebaceous adenomas, keratoacanthomas, and basal and squamous cell carcinomas occurring with polyps and adenocarcinomas, mainly of the large bowel and also of the small intestine and stomach. Other malignancies occurring with the multiple skin tumors, with or without the involvement of intestinal malignancies, included adenocarcinoma of the uterus, transitional cell carcinoma of the bladder or ureter, squamous cell carcinoma of the larynx, esophagus, or vulva, and cancer of the breast. The syndrome followed a dominant mode of inheritance with high penetrance and variable expressivity, perhaps more variable in females than in males.

Adult↗

Studies on the difference of background mucosa among single advanced carcinoma and benign diseases of the large intestine, and familial polyposis coli.

The entire lengths of fixed specimens from 17 single advanced carcinomas of the colon (Cancer Group), four benign lesions (Benign Group), and four familial polyposis coli (Polyposis Group) were step-sectioned. It was found that the tubules of the basal cells were densely packed with rather a small number of goblet cells in the cancer and benign lesion specimens, but clear and loose with completely differentiated goblet cells in the polyposis coli specimens. Microscopic adenomas that were macroscopically unrecognizable and only microscopically detectable were found in 16 lesions in the Cancer Group, one lesion in the Benign Group, and in numerous lesions in the Polyposis Group. All of them developed from the basal cells. These findings indicate that the colonic mucosa of patients in the Cancer and Benign Groups is similar, but differs from that of the Polyposisis Group, and that microscopic adenomas are not uncommon in the Non-Polyposis Groups (Cancer and Benign Groups), findings which were not previously known.

Adenoma↗

Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma.

The authors studied 51 patients who had small bowel tumors that contained adenomatous epithelium. These rare lesions were identified among 392,000 surgical pathology cases seen during a 62-year period. Grossly and histologically, adenomas arising in the mucosa of the small intestine are similar to the adenomas found in the colon. Of the 51 patients, 18 had adenomas, and 33 had tumors that contained both adenoma and carcinoma in the same lesion, including five intramucosal and 28 invasive carcinomas. The location of the tumor usually determined which clinical problems were produced. The data indicate that adenomas originating in the small bowel mucosa probably are premalignant lesions and that many primary adenocarcinomas of the small intestine arise in adenomas. Of the authors' 130 apparently primary small bowel carcinomas (including the papilla of Vater), 33 (25%) histologically demonstrated adenomatous epithelium in the same lesion. Factors associated with an increased chance of finding carcinoma in an adenoma include adenoma type, size of lesion, location, and multicentricity. Carcinomas appear to develop more frequently in papillary (villous) adenomas than in ordinary adenomas. The larger the lesion is, the more likely carcinoma will be identified. Adenomas involving the ampulla contain carcinoma more often than do lesions found elsewhere in the duodenum and small intestine. Three patients had multiple adenomatous polyps of the small bowel; two of these individuals also had duodenal carcinomas. Various problems in pathologic diagnosis and clinical management are discussed.

Adenocarcinoma↗

Atrophic chronic gastritis and intestinal metaplasia in gastric carcinoma. Comparison with a representative population sample.

The occurrence of chronic gastritis and intestinal metaplasia (IM) was studied in 257 patients with gastric carcinoma (GC). In all cases biopsies were available from the benign mucosal area adjacent to the tumor, and in 139 patients from the antrum and/or body mucosa outside the tumor. The results were compared with endoscopically and bioptically examined noncancer controls representing a large Finnish population sample. For every GC patient, a control subject was matched by age and sex. In addition, a mean age-adjusted score (AAS) of chronic gastritis, which expresses the progression of gastritis in GC patients as compared with that in the general population, was calculated for GC patients. The prevalences of chronic and atrophic gastritis in the antrum and body mucosa were similar in GC patients and controls when carcinoma cases were not more specifically classified according to histologic type or location of tumors. On the other hand, the location of the tumor showed a significant relation to gastritis: the progression of gastritis was more rapid (high mean AAS value) and the prevalence of atrophic gastritis was higher in the tumor-affected area (i.e., in the antrum in patients with antral [distal] tumors; in the body in patients with body [proximal] tumors), than in the general population, but were similar in the tumor-free area in both GC patients and controls. In the intestinal type of GC (IGC), the prevalence of chronic gastritis was higher and its progression was more rapid than in controls. In the diffuse type of GC (DGC), these correlations were less distinct. In GC patients, the IM adjacent to and outside the tumor area was significantly more common and extensive than in the corresponding area of controls, and a significant positive correlation was present between the location of the tumor and the distribution of IM. Like gastritis, the IM showed a closer relationship to IGC than to DGC. In all cases of GC and particularly of IGC, the antral mucosa tended to be more severely affected by gastritis and IM than the body mucosa, i.e., the prevailing type of gastritis found in this GC series was that morphologically corresponding to the so-called B-type of chronic gastritis.

Age Factors↗

A 10-year survey of large bowel carcinoma at Groote Schuur Hospital with particular reference to patients under 30 years of age.

In a 10-year survey of large bowel carcinoma at Groote Schuur Hospital 926 cases were studied retrospectively. A marked difference was seen in both the age of presentation and histological differentiation in two different racial groups. All patients who were 29 years of age or less at the time of presentation have been studied in detail. Predisposing factors, symptomatology, treatment, pathology and prognosis are discussed. It is apparent that large bowel carcinoma in the young has a very poor prognosis.

Adolescent↗

Malignant change in enterocystoplasty: a histochemical assessment.

Increasing numbers of cases of malignant tumours occurring in enterocystoplasties are being reported. Material from five cases of adenocarcinoma arising in such patients were studied using standard mucin and carbohydrate lectin staining methods. Sections from the tumour and adjacent and distant mucosa were stained to determine the pattern of histochemical changes. The abnormal staining patterns seen suggest that the adenocarcinomata arising at the enterovesical anastomosis are of intestinal origin. A hypothesis is advanced to explain the pathogenesis of these tumours.

Adenocarcinoma↗

Adenocarcinoma complicating Crohn's disease.

We report on 14 cases of intestinal adenocarcinoma complicating Crohn's disease, seven occurring in the small bowel and seven in the large bowel. In both locations, two-thirds of patients were male. The average ages at the time of diagnosis of Crohn's disease and of cancer were similar between the two groups of patients: 28 and 48 years, respectively. The diagnosis of cancer was suspected or obtained preoperatively in only four cases of large bowel cancer; in two patients with large bowel cancer and five with small bowel cancer, the diagnosis was made at laparotomy. In the remaining cases, only careful histologic examination revealed the carcinoma. Six small bowel cancers were located in the ileum, and five colonic cancers were distal to the splenic flexure. Two small bowel and one large bowel cancer were multifocal and had surrounding mucosal dysplasia. All tumors, except one small bowel cancer, underwent resection. Survival correlated with stage of tumor at resection; no patient with regional or distant metastasis survived five years, in comparison with an 83 percent five-year actuarial survival rate of patients with tumor confined to the intestinal wall. Mean survival was six months for patients with small bowel cancer in comparison with 65 months for patients with large bowel cancer, reflecting a tendency toward more advanced lesions in the small bowel cancer group.

Adenocarcinoma↗

Clinical involvement of mesenteric and antimesenteric borders of small bowel loops. II. Radiologic interpretation of pathologic alterations.

Many small bowel abnormalities selectively involve the mesenteric or antimesenteric borders of small intestinal loops solely or predominantly. This report documents the roentgen localization and diagnosis of a variety of intraabdominal disease states by their effects specifically on the mesenteric or antimesenteric margins of small bowel loops. The conditions with selective or predominant involvement of either the mesenteric or antimesenteric borders include diverticulosis, Meckel's diverticulum, intestinal duplication, seeded metastases, hematogenous metastases, regional enteritis, lymphoma, and intestinal ischemia and intramural bleeding.

Crohn Disease↗

Inflammatory pseudotumor of the mesentery and small intestine.

Three cases of abdominal inflammatory pseudotumor or inflammatory myofibroblastic tumor of the small intestinal mesentery are presented with additional examples from the literature. An abdominal mass was detected in three preadolescent children who presented with fever, growth failure, hypochromic anemia, thrombocytosis and polyclonal hypergammaglobulinemia. The radiographic findings confirmed the presence of a mass. Following surgical resection, the systemic manifestations dramatically resolved. The solid mesenteric mass was composed of spindle cells with the features of myofibroblasts and mature plasma cells and small lymphocytes. Clinical follow-up confirmed the benign nature of this lesion with no signs of recurrence in any patient from 3 to 6 years after the initial surgery.

Child↗

Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery.

In the Melbourne (Monash) series reviewed here the development of apparently isolated incisional scar tissue recurrences after curative excisions for large-bowel cancer proved unusual. Eleven patients with such a recurrence all died of disseminated disease within four years, and most within 12 months, of its development. This suggests that an incisional recurrence is a manifestation of disseminated cancer rather than isolated implantation.

Abdominal Muscles↗

Prophylactic oophorectomy in surgery for large-bowel cancer.

From 1968 to 1975, 201 women had prophylactic oophorectomy at the time of definitive large-bowel resection, while in 134 patients oophorectomy was not performed. Oophorectomy was performed more commonly in women with cancer of the rectum and rectosigmoid. More patients undergoing oophorectomy had Dukes' C primary carcinoma. Four patients undergoing synchronous oophorectomy (2.0 per cent) had ovarian involvement or metastases from large-bowel cancer. Three patients (2.2 per cent) developed subsequent ovarian disease: two cases of ovarian carcinoma and one case of ovarian metastases from primary breast cancer. No late ovarian recurrences of large-bowel cancer were seen during this study. No patient with ovarian involvement or metastases from large-bowel cancer survived five years nor was the overall survival of the group of women undergoing oophorectomy materially affected. While stage and site significantly influenced survival, oophorectomy, menopausal status, preoperative irradiation, tumor size, and degree of differentiation had no influence. The prevention of primary ovarian cancer in postmenopausal women is considered to be the main benefit of bilateral prophylactic oophorectomy. Selective recommendations for oophorectomy under other circumstances are discussed.

Adenocarcinoma↗

Malignant fibrous histiocytoma of the abdominal cavity: report of a case.

Malignant fibrous histiocytoma (MFH) is a soft-tissue sarcoma originating from fibroblast cells, characterized by a high rate of metastasis or recurrence. This tumor rarely develops in the gastrointestinal tract, with no more than 30 cases described in the literature. We report a case of MFH of the abdominal cavity in a 45-year-old woman who presented with epigastric pain, anorexia, and weight loss. A computed tomography (CT) scan of the abdomen revealed multiple solid tumors in the peritoneal cavity. We performed exploratory laparotomy and found at least 15 solid whitish tumors attached to the wall of the small intestine, as well as to the parietal peritoneum. There were three metastases in the liver. All of the tumors were excised, most of which were about 10 cm in diameter. Histopathological findings indicated a stromal tumor consisting of spindle cells, and immunohistochemical examination of the resected specimens established the definite diagnosis of a pleomorphic MFH. The patient had an uneventful postoperative course and was given adjuvant chemotherapy. She is currently well 2 years after her operation. We review the clinical picture of this tumor in the abdominal cavity, and discuss its diagnosis, pathogenesis, and treatment.

Female↗