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PubMed1978

Leiomyosarcoma of the rectum: report of three cases.

Three cases of leiomyosarcoma of the rectum are reported. The first patient underwent palliative surgery and died 18 months after diagnosis; local radiotherapy was not effective and chemotherapy failed as well. The second patient underwent radical surgical treatment but monetheless the tumor recurred and the patient died 37 months after diagnosis. The third patient underwent radical surgery for a tumor that was in an early stage, has been followed for several months without evidence of disease. Review of the literature indicates that leiomyosarcoma of the rectum is the most malignant sarcoma of the gastrointestinal tract, and has a 20 per cent five-year survival rate. Even radical surgical treatment yields disappointing results. Following localized operations, recurrences appear in most cases, and this treatment is not recommended. Should an effective chemotherapeutic combination be found, chemotherapy as an adjuvant to surgery will probably be indicated.

Aged↗
PubMed1975

Suture-line recurrence in carcinoma of the colon and rectum.

Seventy-three patients with adenocarcinoma of the sigmoid, rectosigmoid and rectum were reviewed to determine the incidence of suture-line recurrence. Four patients (5.5 per cent) developed suture-line recurrence despite the use of a number of techniques to reduce this problem. All four recurrences were in patients who had Dukes' C lesions of the rectum. It would appear that such recurrences are not related to implantation factors alone.

Adenocarcinoma↗
PubMed1975

Leiomyosarcoma of the rectum: report of a case.

A case report of a leiomyosarcoma of the rectum recurrent after six years is presented. The diagnostic criteria for determining malignancy are reviewed. The diagnosis of a benign lesion must be supported by the absence of mitoses; mitotic figures are considered proof of malignancy. Abdominoperineal resection is the procedure of choice for leiomyosarcoma of the rectum.

Humans↗
PubMed1976

Benign solid teratoma of the fallopian tube with rupture into the rectum: report of a unique rectal tumor.

Solid teratoma of the fallopian tube is rare. A case of a benign solid teratoma of the fallopian tube that ruptured into the rectum is presented. This is believed to be the first report of this occurrence, which should be included in the differential diagnosis of the rectal mass. Any suspicion of this lesion should mitigate against a posterior approach for resection, as the rectum can be expected to be fixed to other pelvic viscera.

Adult↗
PubMedDate not supplied

Leiomyosarcoma of the rectum: the military experience.

Leiomyosarcoma of the rectum is a rare neoplasm and may behave in a highly malignant manner. Our experience with a single case prompted a review of the Armed Forces Central Medical Registry (AFCMR), where six other cases were found from the total AFCMR population. Four patients were treated with abdominoperineal (AP) resection; three had local excision only. Three patients developed metastatic disease and two of those died. The authors recommend prompt wide excision (AP resection) for any case of leiomyosarcoma of the rectum.

Adult↗
PubMed2005

[Primary linitis plastica of the rectum].

Primary linitis plastica of the rectum is an infrequent and unusual rectal carcinoma. We report a new case that presented clinically as a haemorrhoidal syndrome. We comment on the characteristics--clinical picture and histopathology--of this uncommon presentation of rectal tumour, as well as its clinical history and prognosis taking into account that the literature consulted indicated the unusualness of primary linitis plastica of the rectum.

Adult↗
PubMedDate not supplied

Radiation-induced carcinoma of the rectum.

Carcinomas and sarcomas are known to develop after radiation therapy. A complete review of the literature regarding appearance of carcinoma of the rectum following radiation therapy to the pelvis was undertaken. The average interval between irradiation and diagnosis of the rectal cancer was 15.2 years, the range being from one year, two months to 33 years. We present a case of carcinoma of the rectum arising as two separate primaries 46 years after irradiation for an epidermoid carcinoma of the cervix. There were many pathologic changes related to the radiation therapy.

Adenocarcinoma↗
PubMed2002

[Bilateral adrenal gland hemorrhage after anterior deep rectum resection. Case report with review of the literature].

UNLABELLED: Adrenal insufficiency due to bilateral adrenal hemorrhage is a rare but potentially life-threatening postoperative complication. The difficulty lies in making a timely diagnosis, as the symptoms are often unspecific and similar to those presented by other, more common postoperative complications. We report the case of a 71-year-old patient presenting bilateral adrenal hemorrhage following an otherwise uncomplicated low anterior rectum resection for a villous adenoma of the middle rectum. CONCLUSION: In cases of unexplained postoperative deterioration, surgeons should be aware of acute adrenal insufficiency due to bilateral adrenal hemorrhage. With a high index of suspicion the diagnosis is made easily by CT scan and serum-cortisol measurements and prompt steroid replacement can help to avoid a deleterious outcome.

Adenoma, Villous↗
PubMed2006

Squamous cell carcinoma of the rectum in ulcerative colitis: case report and review of the literature.

The majority of colorectal carcinomas diagnosed are adenocarcinomas. Squamous cell carcinomas (SCC) of the rectum are rare tumors, and were reported as rare complication of inflammatory bowel disease. Surgery is the most effective therapy; and adjuvant chemotherapy and radiotherapy should also be considered. We report two cases of ulcerative colitis-associated SCC of the rectum. The lesions were treated with chemoradiotherapy with complete response.

Antineoplastic Agents↗
PubMed2003

Gasless, video endoscopic transanal excision for carcinoid and laterally spreading tumors of the rectum.

BACKGROUND: The aim of this study is to determine whether gasless, video endoscopic transanal-rectal tumor excision (gasless VTEM) is a valid treatment for rectal carcinoid and laterally spreading tumors (LST). METHODS: Eighty-four patients with an adenoma, adenocarcinoma (Tis/T1), or carcinoid tumor of the rectum were divided into three groups: (i) LST ( n = 17 patients), (ii) carcinoid ( n = 11), and (iii) control with other types of tumors ( n = 56). RESULTS: The LST group had a longer median operating time than in the control group, whereas the carcinoid group had a shorter operating time. Two patients (11.7%) in LST group developed peritoneal entry during the operation, while 2 patients (3.6%) in the control group experienced postoperative complications. During a median follow-up length of 55.2 months, one patient in the LST group developed a recurrence. CONCLUSIONS: Gasless VTEM is a simple, minimally invasive procedure used to treat LST and carcinoid tumors of the rectum. However, resection for the LST group had a high risk of peritoneal entry during operation.

Adenocarcinoma↗
PubMed2005

Usefulness of transanal endoscopic surgery for carcinoid tumor in the upper and middle rectum.

BACKGROUND: This study evaluated the indications and outcome for transanal endoscopic surgery (TES) used to manage rectal carcinoid tumor as compared with those of conventional transanal local resection (TAR). METHODS: The retrospective study subjects were 28 patients with rectal carcinoid tumor treated by TES (n = 17) or TAR (n = 11) between January 1995 and December 2001. Patient and tumor characteristics, operative results, and postoperative outcomes were compared between the two groups. RESULTS: The distance from the anal verge to the distal tumor margin in the TES group (range, 4-12 cm; median, 6.8 cm) was significantly greater than in the TAR group (range, 3-6 cm; median, 4.5 cm) (p = 0.001). The median tumor diameter was 5.5 mm (range, 3-11 mm) in the TES group and 5.0 mm (range, 3-8 mm) in the TAR group, showing no statistical difference. Microscopically, resected specimens in both groups were typical carcinoid tumors restricted to the submucosal layer. No recurrence was noted in either group. CONCLUSION: Whereas TES is useful for patients with small rectal carcinoid tumor of typical histology within the submucosal layer in the upper and middle rectum, TAR is effective for accessing the lower rectum.

Adult↗
PubMed2000

Specific mutation in exon 11 of c-kit proto-oncogene in a malignant gastrointestinal stromal tumor of the rectum.

Gastrointestinal stromal tumor (GIST) in the distal third of the rectum was detected in a 57-year-old man who underwent an abdominoperineal resection of the rectum. Because the tumor expressed CD34 and c-kit gene product, but did not express smooth muscle actin or S-100 protein, it was diagnosed as an uncommitted type of GIST. Moreover, a specific mutation in the sequence coding the juxtamembrane domain in exon 11 of the c-kit proto-oncogene was revealed by a polymerase chain reaction-single-strand conformation polymorphism method. One year after resection, the patient developed multiple liver metastases. It is suggested that a specific mutation in exon 11 of the c-kit proto-oncogene may have played an essential role in the development of the liver metastases.

Exons↗
PubMed2004

Survival and recurrence after a sphincter-saving resection and abdominoperineal resection for adenocarcinoma of the rectum at or below the peritoneal reflection: a multivariate analysis.

PURPOSE: The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival and recurrence after curative surgery. METHODS: This retrospective study included 184 patients who underwent curative surgery achieved by the following two types of operation between 1989 and 1998: (1) SSR ( n = 116 patients) including a low anterior resection with either double-stapling technique ( n = 86) or transanal coloanal anastomosis ( n = 30); (2) APR ( n = 91). The outcome factors evaluated were survival and tumor recurrence. Both univariate and corrected (multivariate Cox's and logistic regression) analyses were used to evaluate the data. The median follow-up was 47.4 months for patients alive at study conclusion. RESULTS: Disease-free and disease-specific survivals, and the frequency and location of recurrence after surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-free survival or in the development of both local and distant recurrences after surgery. In addition, tumor-related factors (stage or histologic grade) were significant predictors of the outcome after surgery. CONCLUSIONS: The type of operation (SSR or APR) did not affect the survival or recurrence after a curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.

Abdomen↗
PubMed1998

Spontaneous perforation of the rectum with possible stercoral etiology: report of a case and review of the literature.

Stercoral perforation of the colon or rectum is a rare cause of acute abdomen, with fewer than 70 cases documented in the literature. We report herein the case of a 60-year-old man who presented with anuria and epigastric pain with physical signs of peritonitis. An abdominal X-ray showed bilateral subphrenic free air accumulation, and an emergency laparotomy subsequently revealed perforation of the rectum, suggestive of a stercoral cause, which was treated by simple closure after debridement. Following an uneventful postoperative course, he was discharged from the hospital 3 weeks after his operation and is now doing well without having suffered any further gastrointestinal problems. The clinical features, diagnosis, and treatment of the disease are reviewed following the presentation of this case. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage because it has a significantly high mortality if not treated early. Conversely, the surgical outcome is satisfactory provided surgery is performed in due time.

Debridement↗
PubMed1998

Arteriovenous malformation of the rectum: report of a case.

We report herein the case of a 38-year-old man found to have a rectal arteriovenous malformation (AVM). The patient was admitted to our hospital for investigation of fresh anal bleeding and general malaise. Barium-enema examination showed a slightly elevated lesion in the rectum, and a selective superior rectal angiogram subsequently revealed an AVM in the peripheral region of the superior rectal artery, which was presumed to be the cause of the anal bleeding. Colonoscopic examination disclosed a submucosal tumor-like lesion in the left posterior wall of the rectum, 3cm above the anal verge. After marking the boundaries by clipping, transanal resection of the lesion was performed. Histological examination revealed an irregularly expanded arteriovenous aggregation in the submucosal layer. The patient had a favorable postoperative course, and no residual AVM was seen on a postoperative selective inferior mesenteric arteriogram. There have been no signs of recurrence in the 2 years since his operation.

Adult↗
PubMed2001

Amelanotic malignant melanoma of the rectum: report of a case.

We describe herein a case of amelanotic melanoma of the rectum. Macroscopically, the tumor was lacking in pigmentation and microscopically, it was found to be deficient in melanin. Moreover, the tumor cells showed positive staining for HMB-45, the antimelanoma antibody, which led to a diagnosis of amelanotic melanoma. The patient died of metastatic tumors in the liver and bone 17 months after undergoing abdominoperineal resection of the rectum and dissection of the bilateral inguinal lymph nodes.

Aged↗
PubMed2004

Pelvic reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts.

BACKGROUND: To find a safe and effective method of pelvic reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. MATERIALS: Prospective, ongoing study examining patients who underwent abdominoperineal resection and pelvic reconstruction with full-thickness skin grafts. METHODS: Nine (9) patients underwent abdominoperineal resection of the rectum and pelvic reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. RESULTS: All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. CONCLUSIONS: Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

Colectomy↗
PubMed2004

Colorectal gastrointestinal mesenchymal tumours. Report of a stromal case of the rectum (GIST) and a leiomyosarcoma of the transverse colon.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. They are positive to C-kit (CD 117), more common in the older males, and mostly in the stomach, less in the colon and rectum and oesophagus. Benign tumours are more common than the malignant ones. Classification of GISTs is based on morphology and immunochemistry. METHODS: We report two cases of colorectal gastrointestinal mesenchymal tumours, one on the transverse colon which was found to be immunohistochemically leiomyosarcoma and the other on the rectum which met the GIST criteria. The patients underwent transversectomy and abdominal perineal resection, respectively. CONCLUSIONS: They did not receive Imanitib postoperatively and two years after there is no evidence of recurrence. Surgery is the treatment of choice for resectable GISTs, and other mesenchymal tumours benign or malignant.

Aged↗