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PubMed2004

The impact on nodal staging of lymphatic mapping in carcinoma of the colon and rectum.

Although the majority of individuals undergoing apparently curative resection for carcinoma of the colon rectum who are found to be without evidence of metastatic disease in the regional lymph nodes will remain free of disease, approximately 20% to 30% of these individuals will develop recurrent disease and die. This may, in part, be due to understaging of the disease. For this reason, there has been increasing interest in approaches to improving staging of all solid tumors, including carcinoma of the colon and rectum. Lymphatic mapping has revolutionized the management of patients with cutaneous melanoma and breast cancer and has been demonstrated to more accurately stage patients with solid tumors. Our investigations as well as others have taken a number of strategies to improving the staging of individuals of colorectal cancer patients with apparently node-negative disease, including the development of a novel ex vivo lymphatic mapping technique. This article summarizes our and other investigations into improved staging of colorectal cancer with an emphasis on the impact of lymphatic mapping on improving the accuracy of staging of apparently node-negative colorectal cancer patients.

Carcinoma↗
PubMed1977

[Preliminary results of preoperative radiotherapy in carcinoma of the rectum (author's transl)].

Preliminary results were evaluated in patients with carcinoma of the rectum of whom 33 had preoperative radiotherapy and 23 were treated by operation only. The tumour stage was T2-4 NX MO in all patients. There was no significant difference between the groups as to postoperative mortality, would healing, and postoperative admission time. However, the recurrence rate was significantly lower in pre-irradiated patients than in those treated by operation only. The combination of radiotherapy and radical operation appears to be a possible means of significantly improving the survival rate of patients with carcinoma of the rectum.

Adult↗
PubMed2001

Cap polyposis of the colon and rectum: an analysis of endoscopic findings.

BACKGROUND AND STUDY AIMS: Because of the rarity of cap polyposis of the colon and rectum, the endoscopic features of this condition have not been specified to date. The aim of this study is to characterize the endoscopic features of cap polyposis. PATIENTS AND METHODS: The diagnosis of cap polyposis was established by histologic findings in specimens obtained endoscopically or surgically from four patients. Colonoscopic findings in the four patients were retrospectively reviewed. RESULTS: The endoscopic features were divided into semipedunculated type (three patients) and flat-topped protruding type (one patient). In the semipedunculated type, the polyps were characterized by reddish protrusions of various configurations with eroded surface in the rectosigmoid colon. In the remaining patient, all the lesions were flat protrusions with a reddish central depression. The polyps of both types became smaller in size and fewer in number at the proximal part of the sigmoid colon. Multiple white specks were observed in the intervening mucosa in all four patients. CONCLUSIONS: The prominence of the polyps at the distal part of the colon and rectum and multiple white specks in the intervening mucosa seem to be the additional endoscopic features suggestive of cap polyposis.

Adult↗
PubMed1982

"The evolution of the solitary ulcer of the rectum"--an endoscopic and histopathological study.

A follow-up study of fourteen out of twenty-seven cases of solitary ulcer syndrome of the rectum was performed at one year's interval from the previous endoscopic and histologic examination. Most of the lesions consistently changed their aspect, resulting in incomplete irregular narrowings, polypoid protrusions or linear ulcers. The symptoms remained unchanged or slightly diminished. A striking difference was found in the histological pattern of the "evolved" ulcer in comparison to the active one, the former showing features of hyperplastic (metaplastic) colonic polyps as well as of the so called "transitional mucosa". It is suggested that chronic ischemia occurring in solitary ulcer of the rectum leads to "transitional mucosa" as an exaggerated regenerative phenomenon, hyperplastic (metaplastic) mucosa representing a later maturative phase. Possibly "transitional" mucosa may undergo dysplastic changes under the influence of environmental factors.

Adolescent↗
PubMed2001

Lymphoepithelioma-like carcinoma of rectum: possible relation with EBV.

Lymphoepithelioma-like carcinoma (LEC) of the colon is very rare. Here we report a case of LEC originating in the rectum that was closely associated with Epstein-Barr virus (EBV) infection. The histologic and immunohistologic features, namely, poorly differentiated adenocarcinoma with lymphoid stroma, showed this tumor to be an LEC. The EBV genome was detected by PCR using DNA obtained from tumor tissue sections. Immunohistochemically, EBV-determined nuclear antigen 2 was detected in the tumor cells, and in situ hybridization using EBV-encoded small RNAs probe showed positive labeling in some tumor cells together with a few stromal lymphoid cells. There are some reports of LEC cases that originated in the colon; however, a relation with EBV was not demonstrated. We report here a case of LEC of the rectum demonstrating a possible relation with EBV.

Aged↗
PubMed2006

In vivo anthelmintic activity of Dorycnium rectum and grape seed extract against Ostertagia (Teladorsagia) circumcincta and Trichostrongylus colubriformis in sheep.

AIM: To assess the in vivo anthelmintic activity of condensed tannins (CT) in the forage species Dorycnium rectum and Medicago sativa, and in an extract from grape (Vitus vinifera) seeds (GSE), against two species of parasite, Teladorsagia (Ostertagia) circumcincta and Trichostrongylus colubriformis, at different stages of their life cycle, in sheep that were parasite-naïve or previously exposed to nematodes. METHODS: In Trial 1, a factorial treatment structure was used to compare faecal nematode egg counts (FEC) and worm burdens in 40 weaned Romney lambs fed either the CT-containing forage D. rectum (12% dry matter; DM) or M. sativa (lucerne; 0.2% DM). Twenty naïve and 20 previously-exposed lambs were drenched free of parasites then reinfected with known species and numbers of parasites, and housed in pens indoors on a diet of lucerne pellets and chaffed hay. Groups of lambs (n=5 lambs per group) were fed one of the forages over one of two time periods within the parasite's life cycle. Six to nine days after the last feeding of fresh forages, faecal samples were collected for FEC, and all lambs were slaughtered and worm counts conducted. In Trial 2, 12 Suffolk x Romney lambs were surgically implanted with an abomasal cannula and then housed indoors in metabolism crates. After infection with parasites, six lambs were infused continuously over a 14-day period with a commercially available CT GSE (96% DM, made up to 34 g/L in water); the remaining lambs were infused with water. During infusion, samples were collected for egg hatch and larval development assays. After infusion, samples were collected for FEC, and all lambs were slaughtered and worm counts conducted. RESULTS: In Trial 1, there was a significant (p<0.001) difference in burdens of O. circumcincta between naïve lambs and those previously exposed to parasites, but no other differences were recorded. In Trial 2, lambs infused with GSE had significantly (p<0.05) fewer T. colubriformis at slaughter and significantly (p<0.001) fewer eggs hatched in the egg hatch assay (EHA) than for lambs infused with water. Overall, the differences attributable to GSE were small in magnitude, being an 11% drop in egg hatch, and an 18% drop in numbers of adult T. colubriformis after 14 days of continuous infusion. No other differences were recorded. CONCLUSION: The results indicate that the in vivo anthelmintic activity of these CT sources is, at best, modest and is unlikely to be of any practical value. Further, these data emphasise that in vitro activity is an unreliable indicator of in vivo efficacy for CT-containing forages and extracts.

Animals↗
PubMed1990

Campylobacter pylori colonizing heterotopic gastric tissue in the rectum.

Campylobacter pylori specifically attaches to gastric epithelial cells and is the etiologic agent for type B gastritis. The authors report the case of a woman with the rare finding of heterotopic gastric mucosa in the rectum that was colonized with C. pylori. Histologic findings of the heterotopic mucosa revealed active chronic gastritis that resolved when C. pylori was eradicated with bismuth subsalicylate and antibiotics. This is the first report of C. pylori in a location distal to the duodenum. The presence of live C. pylori organisms in the rectum suggests that viable organisms are present in the stool and that C. pylori may be spread by the fecal-oral route.

Adult↗
PubMed2006

Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up.

BACKGROUND: The objective of the study is to evaluate the short- and long-term efficacy of complete laparoscopic excision of deep endometriosis, without rectum involvement, with the opening and partial excision of the posterior vaginal fornix. METHODS: Thirty-one patients were included in the study with symptomatic extensive disease including involvement of the cul-de-sac, rectovaginal space and posterior vaginal fornix without rectum involvement. Endoscopic surgery was performed with complete separation of rectovaginal space and in-block resection of the diseased tissue, opening and partial excision of the posterior vaginal fornix and vaginal closure either by laparoscopic or by vaginal route. Patients filled in questionnaires on pain before and 12, 24, 36, 48 and 60 months after surgical treatment. RESULTS: No intraoperative complications were observed; 65% were free of analgesic on post-operative day 2, 38% had total remission of chronic pain and 22% were improved; 38% had total remission of dysmenorrhoea and 22% were improved; 45% had total remission of dyspareunia and 25% were improved. Follow-up improvement of symptoms was statistically significant and was maintained for 5 years without recurrence of the disease or repeated surgery (P < 0.001). CONCLUSION: Complete surgical resection of deep infiltrative endometriosis with excision of the adjacent tissue of the posterior vaginal fornix improves quality of life with persistence of results for long time in patients not responsive to medical treatment.

Adult↗
PubMed1995

A case-control study of physical activity in relation to risk of cancer of the right colon and rectum in men.

BACKGROUND: Epidemiological data suggest that physical activity is modestly or moderately protective against colorectal cancer. Additional data are needed to define better the slope of the dose-response curve and to clarify the types of activities that appear most protective. METHODS: We examined the relation between occupational and vigorous leisure time physical activity and risk of cancer of the right colon and rectum in data from a case-control study conducted in New England from 1986 to 1988. We interviewed 163 cases with cancer of the right colon, 242 cases with cancer of the rectum, and 703 community controls. RESULTS: Vigorous leisure time physical activity was associated with a decreased risk of cancer of the right colon; for men exercising > or = 2 hours per week the odds ratio was 0.60 (95% confidence interval [CI]: 0.35-1.00) compared with those who did not exercise. Adjustment for potentially confounding factors, including diet, had essentially no effect on the association. Self-reported occupational activity was less strongly related to risk of right colon cancer; the odds ratio for heavy work was 0.70 (95% CI: 0.32-1.51). Occupational activity coded according to job title was essentially unrelated to risk of right colon cancer. An association between physical activity and decreased risk of rectal cancer was not present in these data. CONCLUSIONS: Our data add weight to the evidence that physical activity is related to decreased risk of colon cancer.

Adenocarcinoma↗
PubMed1998

A case of giant peritoneal loose bodies mimicking calcified leiomyoma originating from the rectum.

Two giant peritoneal loose bodies were found in the pelvis in a 79-year-old man. These bodies were demonstrated by computed tomography and magnetic resonance imaging to be well circumscribed masses and to have marked calcification in their central portion. Preoperatively, these bodies had been diagnosed as a calcified leiomyoma originating from the rectum; however, surgery revealed these lesions to be detached appendices epiploica. Histological examination showed that these peritoneal loose bodies consisted of thin layers of eosinophilic substance and had no cellular component. Small peritoneal loose bodies are occasionally found during laparotomy, but such large ones measuring 6 cm are very rare. In our case, accurate diagnosis could not be obtained preoperatively, because these loose bodies mimicked calcified leiomyoma of the rectum.

Aged↗
PubMed1999

Transformation of fibrolamellar carcinoma to common hepatocellular carcinoma in the recurrent lesions of the rectum and the residual liver: a case report.

A 21-year-old man had undergone central bisegmentectomy of the liver due to fibrolamellar carcinoma (FLC). Twice, 24 and 30 months after the first operation, lymph node metastases were removed. We have reported this case previously and this is the second report of the same case. Forty-two months after the second operation to remove lymph node metastases, a recurrence occurred in the rectum and was excised. However, the tumor also recurred in the residual liver. The patient underwent hepatectomy for a palliative purpose but died 16 months after the last operation. Histopathologically, the primary tumor was diagnosed as pure FLC, but the lymph node metastases had foci of the common hepatocellular carcinoma (HCC) mixed with FLC. In contrast, the recurrent tumors in the rectum and the residual liver showed the histopathological features of common HCC. Thus, during repeated recurrences, histopathological features changed from pure FLC to common HCC.

Adult↗
PubMed2000

Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02.

BACKGROUND: The conviction that postoperative radiotherapy and chemotherapy represent an acceptable standard of care for patients with Dukes' B (stage II) and Dukes' C (stage III) carcinoma of the rectum evolved in the absence of data from clinical trials designed to determine whether the addition of radiotherapy results in improved disease-free survival and overall survival. This study was carried out to address this issue. An additional aim was to determine whether leucovorin (LV)-modulated 5-fluorouracil (5-FU) is superior to the combination of 5-FU, semustine, and vincristine (MOF) in men. PATIENTS AND METHODS: Eligible patients (n = 694) with Dukes' B or C carcinoma of the rectum were enrolled in National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol R-02 from September 1987 through December 1992 and were followed. They were randomly assigned to receive either postoperative adjuvant chemotherapy alone (n = 348) or chemotherapy with postoperative radiotherapy (n = 346). All female patients (n = 287) received 5-FU plus LV chemotherapy; male patients received either MOF (n = 207) or 5-FU plus LV (n = 200). Primary analyses were carried out by use of a stratified log-rank statistic; P values are two-sided. RESULTS: The average time on study for surviving patients is 93 months as of September 30, 1998. Postoperative radiotherapy resulted in no beneficial effect on disease-free survival (P =.90) or overall survival (P =.89), regardless of which chemotherapy was utilized, although it reduced the cumulative incidence of locoregional relapse from 13% to 8% at 5-year follow-up (P =.02). Male patients who received 5-FU plus LV demonstrated a statistically significant benefit in disease-free survival at 5 years compared with those who received MOF (55% versus 47%; P =.009) but not in 5-year overall survival (65% versus 62%; P =.17). CONCLUSIONS: The addition of postoperative radiation therapy to chemotherapy in Dukes' B and C rectal cancer did not alter the subsequent incidence of distant disease, although there was a reduction in locoregional relapse when compared with chemotherapy alone.

Antimetabolites, Antineoplastic↗
PubMed1996

A solitary Peutz-Jeghers-type hamartomatous polyp of the rectum: report of a case and review of the literature.

A solitary Peutz-Jeghers-type polyp of the rectum in a 64-year-old Japanese man is reported. Barium enema and endoscopic examination revealed a solitary polypoid lesion in the rectum. The polyp was pedunculated, and measured 2 x 1.5 x 1.5 cm. The patient had neither mucocutaneous pigmentation nor a family history of gastro-intestinal polyposis. Histopathologically, this polyp had an arborizing muscular network originating from the muscularis mucosa, and was covered by well organized mucosa with epithelial hyperplasia. The smooth muscle bundles in the polyp were thicker than those seen in Peutz-Jeghers syndrome, but their network was not as complex.

Hamartoma↗
PubMed1997

Metastatic inflammatory carcinoma of the rectum: tumor spread by three routes.

We report a case of a patient with adenocarcinoma of the rectum with inflammatory metastases to the skin who was treated with radiation therapy and subsequently developed lymphatic obstruction with resultant extensive lymphedema of the lower extremities. Histopathologic examination and immunohistochemistry showed intralymphatic, intravascular, and interstitial malignant cells in the dermis. To our knowledge, this is the second reported case of inflammatory carcinoma arising from metastatic carcinoma of the rectum. However, tumor cell spread to the skin by three routes has not previously been demonstrated.

Adenocarcinoma↗
PubMed1998

Metastatic small-cell carcinoma of rectum responding dramatically to combination chemotherapy.

Small-cell carcinoma of the rectum, is very rare with a dismal prognosis that follows a more aggressive course than the pure exocrine counterparts. As a result, survival is usually very poor. A male patient with metastatic disease is presented in this report. After receiving six cycles of combination chemotherapy regimen consisting of cyclophosphamide, adriamycin, and etoposide, he is in complete remission for >3 years. Although it is a single case, it shows that combination chemotherapy may achieve an excellent result even in a metastatic case of small-cell carcinoma of the rectum.

Adult↗
PubMed1976

The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum.

This retrospective series comprises 902 patients who underwent curative resection of the sigmoid colon, rectosigmoid, and upper rectum at the Mayo Clinic during the years 1959 to 1969. Lesions were divided according to the location from the dentate line, with 346 patients having had a lesion located more than 20 cm from the dentate line; in the remaining 556 patients, the lesion was between 6 and 20 cm distant. A thorough analysis was undertaken comparing these two groups of patients on the basis of operative mortality and morbidity, including anastomotic complications, 5- and 10-year survival, and incidence of local recurrence. Overall operative mortality was 1.9%, with an 8.1% incidence of anastomotic complications. The overall 5-year survival rate was 72% and the 10-year survival rate was 55%. The incidence of anastomotic recurrence for anastomosis performed with the use of extraperitoneal rectum was 5.8%; recurrence at the suture line developed in 2.9% of patients who underwent anastomosis to serosa-covered bowel. In addition to the above data, information will be presented which demonstrates the effect of the patient's height and weight on the surgeon's ability to perform a low-anterior anastomosis. Finally, the incidence of anastomotic complications and of local recurrence were analyzed according to the intestinal preparation employed, the use of parenteral antibiotics , and the method of drainage used near the anastomosis.

Adenocarcinoma↗
PubMed1980

Bladder function after abdominoperineal resection of the rectum for anorectal cancer. Urodynamic investigation before and after operative in a consecutive series.

In a consecutive series of 26 patients (10 men and 16 women) undergoing abdominoperineal resection of the rectum, cystometry and pressure-flow-EMG measurements were made preoperatively and three and 6-12 months after operation. Two patients developed neurogenic bladder paresis (7.7%, 95% c.l. 1-25%). Men with even slight complaints of bladder outlet obstruction preoperatively ran a risk of postoperative aggravation demanding surgery. In women no significant changes in micturition patterns were found. It is concluded that urinary flow measurement and cystometry should be available as minimum screening procedures after abdominoperineal resection of the rectum to detect bladder dysfunction at an early stage.

Aged↗
PubMed1982

Surgical experience with carcinoma of the colon and rectum.

From September 1925 through December 1978 at Vanderbilt University Hospital, 1,279 patients with adenocarcinoma of the colon and rectum underwent operations. Reports of this cumulative series have been published previously; the last report in 1970 included 1,022 patients. The current report examines the progress made in our recognition and management of colorectal cancer. During this 54-year period, there has been a relative decrease in the incidence of carcinoma of the rectum and a relative increase in carcinomas elsewhere in large bowel. Resectability rate has steadily increased, culminating in a rate of 98.4% in the recent period (1969-1978). The operative mortality rate fell to 4.3% (1956-1960) but has shown a slight rise to 5.4% in the recent period (1969-1978). This reflects the increased number of patients in the eighth to the tenth decades of life. Five-year survival rates in 99% of 1,218 patients were computed. Absolute five-year survival for the recent period was 43.7%, compared with 17% for the initial period. Five-year survival rates for patients in the recent decade with Dukes A, B, and C lesions were 67%, 58.6%, and 33.3%, respectively. Comparison of survival data in the last two decades shows little improvement. However, in the last 20 years, 78 to 80% of patients had more advanced lesions.

Aged↗