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PubMed1978

Value of the mandibular radiograph in familial polyposis coli.

Familial polyposis coli and Gardner's syndrome have identical colonic manifestations. Recent evidence has shown that both conditions are associated with occult osteomatous lesions in the mandible. We present 3 patients from 2 families with familial polyposis coli who, in addition to the colonic lesions, also had occult osteomatous mandibular lesions. The value and practical application of radiography of the mandible as an additional diagnostic aid in familial polyposis coli are emphasized.

Adolescent↗
PubMed1994

Clinicopathological study of anorectal mucosa in total colectomy with mucosal proctectomy and ileoanal anastomosis.

OBJECTIVE: To find out whether the extent of inflammation of the anorectal mucosa affects the quality of the mucosectomy and postoperative function in patients undergoing total colectomy with mucosal proctectomy and ileoanal anastomosis. DESIGN: Prospective study. SETTING: University hospital. SUBJECTS: 33 patients with ulcerative colitis and 17 with familial adenomatous polyposis. INTERVENTIONS: With the patient in the prone jackknife position, the anorectal columnar mucosa above the dentate line was removed transanally by the forceps coagulation technique. MAIN OUTCOME MEASURES: Score of histological appearance on light microscopy. RESULTS: All the patients with ulcerative colitis had moderate (n = 17, 52%) or severe (n = 16, 48%) inflammation, and their mean histological score was 12 (range 7-16). The patients with polyposis had little or no inflammation, and a mean histological score of 0.4 (range 0-2). The mucosectomy became more difficult as the severity of the inflammation increased, but there were no significant differences between the two groups in operating time, blood loss, or bowel function postoperatively. CONCLUSION: Though mucosectomy is technically more difficult in the presence of severe inflammation, there were no adverse effects on bowel function postoperatively.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Colorectal cancer in patients younger than forty years of age.

The records of the General Surgery Department of the Cerrahpasa Medical Faculty of 10 years duration (1981-1991) were studied retrospectively to determine prognostic factors in colorectal cancer patients younger than 40-year old. Fifty patients between the ages of 10-39 were identified. The family history was positive in 7 of the 50 patients. We found Hematochezia (60%), abdominal pain (64%), alterations in bowel movements (60%) among the presenting symptoms. The pathologic examination revealed no patients in Dukes Stage A, 14 patients in stage B (28%), 36 patients in stage C and D (72%). Distant metastases were present in 10%. Mucinous adenocarcinoma was found in 40% of the patients in whom an histological differentiation could be made. The 5-year survival rate was 25.7% and the 5-year disease free survival rate was 17.1% in the patients who were followed up. The mean survival was 30 months. Poor prognostic factors were Dukes Stages C and D, sex, age, mucinous/nonmucinous histology, tumour differentiation and grade. Patients presenting with one or more of the symptoms above should be carefully examined for colorectal cancer regardless of age because of the importance of delay and presentation with progressive disease on survival. Colorectal cancer is the second leading cause of cancer in the U. S. A. Although colorectal cancer is a disease of older group of patients, the incidence of colorectal cancer in younger patients is being increasingly reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenomatous Polyposis Coli↗
PubMed1993

[Single-stage proctocolectomy and ileo-anal anastomosis: benefits and risk factors].

A collective experience of restorative proctocolectomy with "J" pouch over seven and a half years is presented comparing 63 patients with covering ileostomy and 122 patients with no ileostomy. There was no postoperative mortality in either group, and permanent failure resulted in four (6.3%) and one (0.8%) of patients with and without covering ileostomy, respectively. Total number of postoperative complications was slightly more in the ileostomy group (38 vs. 30%), and significant ileostomy related complications or anastomosis leakage were more common in patients with covering ileostomy (24%) than anastomosis leakage needing later covering ileostomy in the no ileostomy group (14%). There was a median saving of 12 hospital days and 30 sick-leave days in favor of no ileostomy. Severe active ulcerative colitis and male sex (indicating technically difficult anastomosis) emerged as significant risk factors of anastomosis leakage in the no ileostomy group, while steroid use as such seemed not to be a special risk. It was concluded that one stage restorative proctocolectomy suits well for most patients in good general condition when a technically sound anastomosis without tension can be done.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Proliferative activity of normal and neoplastic colonic mucosa in population groups with high and low risk for colorectal carcinoma.

Europeans have a high incidence of colorectal cancer in comparison to Africans. Lack of detectable sequence adenoma-colorectal carcinoma in Africans may suggest the development of adenocarcinoma is de novo. The aim of this study is to assess colonic mucosal proliferative activity in various pathological conditions of diverse population groups. Materials included routinely processed tissue specimens from consecutively resected well- and moderately differentiated colorectal adenocarcinomas from 32 rural Africans (South Africa) and 27 urban Europeans (Poland) and from apparently normal rectal mucous membrane from the age and sex matched each population group (28 and 25 samples respectively). In addition, 32 resected adenomatous polyps were examined in Europeans as well. The MIB 1 monoclonal antibody was used to assay the expression of Ki67 antigen in routinely processed tissue specimens. Proliferative activity in colonic carcinomas was scored by the percentage of positively stained cells. Labelling indices were estimated in 5 crypt compartments in apparently normal colonic mucosa adjacent and distant to the tumour, in mucosal samples of controls from both population groups and in adenomatous polyps from Europeans. The mean age of African patients with adenocarcinoma was markedly lower than in European counterparts (48.6 yrs vs. 66.4 yrs). The overall proliferative activity in cancerous tumours of Africans was higher than in Europeans. The labelling indices were lower in all compartments in normal colonic mucosa in Africans. Overall increase of the labelling indices in adjacent and distant to the tumour mucosa noted when compared to the mucosa of healthy individuals. No such differences were detected between indices in the mucosa adjacent and the mucosa distant to the tumour. Proliferative activity in the mucosa adjacent to adenoma was also higher than in normal mucosa from healthy individuals. Adenomas with marked dysplasia showed higher and diffuse proliferative activity, when regular adenomas shown superficial labelling only. Relatively young age, lack of detectable evidence of adenoma-carcinoma sequence and low proliferative activity in all compartments of mucosa from healthy individuals indicate different etiopathogenesis of colorectal carcinoma in rural Africans.

Adenocarcinoma↗
PubMed1995

Flow cytometric analysis of DNA synthetic phase fraction of the normal appearing colonic mucosa in patients with colorectal neoplasms.

DNA synthetic (S) phase fractions of normal appearing colonic mucosa in Japanese and British patients with colorectal neoplasms were compared with those in patients without colonic neoplasms. Normal crypts were isolated from fresh surgical specimens of the large intestine by the use of EDTA. After fixation with 70% ethanol, isolated crypts were digested with pepsin into single nuclei suspensions. These were stained with propidium iodide and examined by flow cytometry. S phase fraction was calculated from the flow cytometry DNA histogram using Baisch's method. S phase fractions of normal appearing crypts in Japanese and British patients with colorectal tumours were not significantly different and analysed together. S phase fraction of normal appearing colonic crypts in 14 patients with familial adenomatous polyposis (FAP) was 10.23 (2.59%) (mean SD)) ranging from 5.8 to 18.8. S phase fraction of background normal mucosal in patients with large adenomas (over 2 cm) and adenocarcinomas were 9.74 (3.76%) (range, 2.7-16.1) and 8.93 (3.54%) (range, 2.9-18.9) respectively. In normal mucosa of patients without any colorectal neoplasms, S phase fraction was 8.99 (3.94)% (range, 3.9-17.7). There was no statistically significant difference in S phase fractions of normal mucosa in the four groups. Our results show that an increase in proliferative activity of background colonic crypts is not necessary for tumour development.

Adenocarcinoma↗
PubMed1999

Dysregulated expression of beta-catenin marks early neoplastic change in Apc mutant mice, but not all lesions arising in Msh2 deficient mice.

We have analysed the pattern of beta-catenin expression by immunohistochemistry in mice singly or multiply mutant for Apc, p53 and Msh2. We observed increased expression of beta-catenin in all intestinal lesions arising on an ApcMin+/- background. In all categories of lesion studied mosaic patterns of beta-catenin expression were observed, with the proportion of cells showing enhanced expression decreasing with increasing lesion size. p53 status did not alter these patterns. We also show that beta-catenin dysregulation marks pancreatic abnormalities occurring in ApcMin+/- and (ApcMin+/-, p53-/-) mice. In these mice both adenomas and adenocarcinomas of the pancreas arose and were characterized by increased expression of beta-catenin. We have extended these analyses to intestinal lesions arising in mice mutant for the mismatch repair gene Msh2. In these mice, increased expression of beta-catenin was again observed. However, in contrast with ApcMin+/- mice, a subset of lesions retained normal expression. Taken together, these findings show that increased expression of beta-catenin is an efficient marker of early neoplastic change in both murine intestine and pancreas in Apc mutant mice. However, we also show that dysregulation of beta-catenin is not an obligate step in the development of intestinal lesions, and therefore that genetic events other than the loss of Apc function may initiate the transition from normal to neoplastic epithelium.

Adenomatous Polyposis Coli Protein↗
PubMed2006

Smad4 signalling in T cells is required for suppression of gastrointestinal cancer.

SMAD4 (MAD homologue 4 (Drosophila)), also known as DPC4 (deleted in pancreatic cancer), is a tumour suppressor gene that encodes a central mediator of transforming growth factor-beta signalling. Germline mutations in SMAD4 are found in over 50% of patients with familial juvenile polyposis, an autosomal dominant disorder characterized by predisposition to hamartomatous polyps and gastrointestinal cancer. Dense inflammatory cell infiltrates underlay grossly normal appearing, non-polypoid colonic and gastric mucosa of patients with familial juvenile polyposis. This prominent stromal component suggests that loss of SMAD4-dependent signalling in cells within the epithelial microenvironment has an important role in the evolution of intestinal tumorigenesis in this syndrome. Here we show that selective loss of Smad4-dependent signalling in T cells leads to spontaneous epithelial cancers throughout the gastrointestinal tract in mice, whereas epithelial-specific deletion of the Smad4 gene does not. Tumours arising within the colon, rectum, duodenum, stomach and oral cavity are stroma-rich with dense plasma cell infiltrates. Smad4(-/-) T cells produce abundant T(H)2-type cytokines including interleukin (IL)-5, IL-6 and IL-13, known mediators of plasma cell and stromal expansion. The results support the concept that cancer, as an outcome, reflects the loss of the normal communication between the cellular constituents of a given organ, and indicate that Smad4-deficient T cells ultimately send the wrong message to their stromal and epithelial neighbours.

Adenomatous Polyposis Coli↗
PubMed1986

Crypt production in normal and diseased human colonic epithelium.

New crypts are added continuously to the adult mouse intestinal epithelium by a process of crypt replication. Branching crypts found in the epithelium represent a stage in the process of crypt replication. In "normal" human colonic epithelium we found a small but definite percentage of branching crypts, 0.44 +/- 0.16, indicating that new crypts are being produced at a low rate in this epithelium. Significantly higher (P less than .001) percentages of branching crypts, 30.4 +/- 5.75, 15.1 +/- 1.08, and 13.2 +/- 1.05, were found in diseased colonic epithelium from patients with ulcerative colitis, Crohn's disease, and multiple polyposis, respectively. These results may be interpreted as suggesting that the rate of crypt production in human colonic epithelium is increased in a number of disease states. We concluded that, as in the mouse intestinal epithelium, the rate of the crypt replication process in human colonic epithelium is plastic and may respond to a variety of conditions.

Aged↗
PubMed2006

Possible involvement of hyperlipidemia in increasing risk of colorectal tumor development in human familial adenomatous polyposis.

BACKGROUND: Familial adenomatous polyposis (FAP) results from germline adenomatous polyposis coli (APC) gene mutations and many affected patients die from colorectal cancers which arise from colorectal polyps. We previously reported that two strains of Apc gene-deficient mice developing multiple intestinal polyps exhibit a hyperlipidemic state. The triglyceride (TG) levels were approximately 10-fold higher than the levels observed in wild-type mice. METHODS: To examine whether a positive relationship might exist between hyperlipidemia and colorectal tumor development in FAP patients, as with Apc gene-deficient mice, a pilot experiment was performed using readily available clinical data such as ages, serum lipid levels, number of colorectal polyps and cancer development in 28 FAP patients from the National Cancer Center Hospital, Japan. RESULTS: The overall prevalence of hyperlipidemia in FAP cases was 58%. Average TG levels in the 40-60 year age groups of FAP patients were > or =150 mg/dl (the defined threshold level of hyperlipidemia). Moreover, there was a tendency for higher serum TG levels in patients who developed colorectal cancer, as compared with those without colorectal cancer. CONCLUSIONS: These results show that a hyperlipidemic state occurs in FAP patients. Although it is weaker than that in Apc gene-deficient mice, it may be linked to colon tumor development. These data warrant further studies for wider populations of FAP patients.

Adenomatous Polyposis Coli↗