Origin of multiple "primary" colon carcinomas. A retrospective flow cytometric study

Multiple, synchronous, apparently primary carcinomas of the colon are a relatively common occurrence. The DNA ploidy in 23 colon carcinomas from 10 patients was determined to see if this parameter supported common or independent origins for such synchronous lesions. Paraffin blocks of each tumor were prepared for flow cytometry, then analyzed for nuclear DNA content. In 3 of the 10 cases, the tumors within each colon differed with respect to DNA ploidy; in four cases all tumors were diploid; and in three cases both (all) tumors within each colon had identical aneuploid DNA indices. Tumors from the same colon with identical DNA histograms often had dissimilar histology. The replicate aneuploid DNA indices strongly suggest a common origin for the multiple tumors within these colons; tumors in the other groups are compatible with either single or multiple origins. These findings suggest that multiple "primary" colon carcinomas may, in some cases, arise as translumenal metastases from an initial single lesion.     

A case of multiple liver metastases from colon cancer successfully operated after intraarterial chemotherapy performed in home

A 60-year-old male patient had unresectable multiple liver metastases from a sigmoid colon cancer that had been resected, and thus hepatic arterial infusion therapy was planned. A heparin coated catheter was inserted from the left thoracoacromial artery to the proper hepatic artery. 5-fluorouracil (1,000 mg) was administered via the catheter 24 hours/week using an implantable vascular device and a small disposable pump in his home. After 59 weeks, the metastatic liver tumors had decreased remarkably in size, and all tumors could be resected completely through surgery. Three weeks after the operation, the same intraarterial chemotherapy was restarted to prevent the recurrence in the liver. However, the patient died of lymph node recurrences. The intraarterial chemotherapy is thought to be useful for neoadjuvant therapy in patients with inoperable liver metastasis from colon cancer.     

A case of multiple peripheral pulmonary carcinoids showing a diffuse lung disease synchronously associated with sigmoid colon cancer

Reported is a rare case of a multiple peripheral pulmonary carcinoids showing a diffuse lung disease synchronously associated with a sigmoid colon cancer. An abnormal chest shadow was detected in a 75-year-old male by X ray during a periodic health examination. After admission to hospital for a more thorough examination he was found to have a sigmoid colon cancer. A CT scan of his chest suggested sarcoidosis, but the results of a bronchofiberscopic examination appeared normal. Subsequently, a TBLB specimen revealed typical carcinoid tumors. Thus, the diagnosis of diffuse multiple peripheral carcinoids was made. A surgical resection of the sigmoid colon cancer was performed successfully, but five months later, the patient died of acute pneumonia. An autopsy was not permitted. Also discussed are multiple pulmonary carcinoids and a double cancer.     

Non-simultaneous primary cancers in five different organs in a case of cancer family syndrome

Non-simultaneous primary malignant tumors in five different organs were detected in a case of cancer family syndrome, and the patient's offspring were found to have colorectal cancers during follow-up. The first cancer in the patient was found in the transverse colon at the age of 47, and partial colectomy was carried out. The second and third were cancers of the cecum and gallbladder which were found concurrently at the age of 61, and ileocecal resection and cholecystectomy were carried out simultaneously. The fourth was cancer of the urinary bladder which was found at the age of 66, and partial cystectomy with interstitial irradiation using a radon seed in the residual urinary bladder was carried out. The fifth was cancer of the stomach at the age of 72, and subtotal gastrectomy was carried out. All of the resected specimens were demonstrated to be different carcinomas histologically. The father and 5 of the 7 siblings of this patient suffered from gastrointestinal or uterine cancers. Furthermore, two daughters of this patient were affected with cancer; the younger with cancer of the descending colon at the age of 47, and the elder with cancers of the transverse colon and rectum at the age of 54. Thus, familial clustering of cancer was shown. Genetic characteristics may have contributed to the development of multiple primary cancers in this family.     

Multiple hepatic metastases and ovarian metastases of colon cancer responding to combined therapy with S-1 and CPT-11--a case report

We report a patient with multiple hepatic metastases and ovarian metastases of transverse colon cancer treated by combination of S-1 and CPT-11. The patient was a 51-year-old woman with cancer of the transverse colon and multiple hepatic metastases. She had undergone surgery. Resection of the transverse colon and left ovary was performed because left ovarian metastases were found during the operation. After the operation, the patient was given chemotherapy with S-1 (120 mg/body on days 1-14) and CPT-11 (150 mg/body on day 1). After completion of 11 courses of chemotherapy, abdominal CT scans revealed that the LDAs of the liver had disappeared, so the patient was judged to have achieved CR. No adverse event was observed. This case suggests that the combination of S-1 and CPT-11 may be an effective regimen for advanced colon cancer with multiple hepatic metastases.     

A patient with recurrent sigmoid colon cancer in whom pleural effusion and ascites resolved after FOLFOX 4 therapy

We performed combination therapy with oxaliplatin/l-LV/5-FU (FOLFOX 4) in a patient with recurrent colorectal cancer (a 58-year-old man) who had pleural effusion and ascites. This resulted in disappearance of the pleural effusion and ascites, as well as negative tumor markers. Surgery was performed for sigmoid colon cancer on September 29, 2004. In February 2006, abdominal swelling was observed, and CEA increased to 15 ng/mL with multiple intraabdominal tumor nodules. The patient was diagnosed as having peritonitis carcinomatosis associated with recurrent sigmoid colon cancer, and was treated with FOLFOX 4. CEA was 134.9 ng/mL before treatment, but became negative after six courses, while his pleural effusion and ascites disappeared after 10 courses of treatment. This treatment also appeared to be useful for recurrent colorectal cancer with peritoneal dissemination.     

A case whose lung metastasis was detected and resected eleven years after resection of primary colon cancer

In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.     

A case of recurrent colon cancer with complete response to modulation chemotherapy using low-dose leucovorin and 5-fluorouracil]

We experienced a case of lymph node recurrence from colon cancer with complete response to modulation chemotherapy using low-dose leucovorin and 5-FU. The patient was a 68-year-old male. He underwent sigmoid colon resection for sigmoid colon cancer in October 1993. In June 1994, he complained of left lower abdominal pain. Swelling of retroperitoneal lymph node was detected by CT scan and cytology revealed cancer cells in urine. He was diagnosed as having lymph node recurrence. He then was given modulation chemotherapy of 30 mg of leucovorin and 500 mg of 5-FU that were bolus injected intravenously for 5 days. After 2 cycles of this regimen, the recurrent mass disappeared completely for further examination. Until May 1998, he had received 14 cycles. Since this regimen started, his survival period has been 46 months, and his response duration 42 months.     

Submucosal Invasive Micropapillary Carcinoma of the Colon with Massive Lymph Node Metastases: A Case Report

Micropapillary carcinoma was originally reported to be an aggressive variant of breast carcinoma, and it is associated with frequent lymphovascular invasion and a dismal clinical outcome. It has subsequently been found in other organs; however, at present, only a limited number of cases of colorectal micropapillary carcinoma have been reported. We present a case of early colon cancer with extensive nodal metastases in a Japanese patient. An 82-year-old man was found by colonoscopy to have a 20-mm pedunculated polyp in his sigmoid colon. Endoscopic resection of the sigmoid colon tumor was performed, and pathological examination of the resected specimen revealed a poorly differentiated adenocarcinoma component and a micropapillary component. Despite the tumor being confined within the submucosa, massive lymphatic invasion was noted. Thereafter, the patient underwent laparoscopic sigmoidectomy with lymph node dissection, and multiple lymph node metastases were observed. Our case suggests that when a micropapillary component is identified in a pre-operative biopsy specimen, even for early colorectal cancer, surgical resection with adequate lymph node dissection would be required because of the high potential for nodal metastases.Key words: Lymph node metastases, Micropapillary carcinoma, Submucosal colonic cancer     

A case of asbestosis complicated with double cancer of the stomach and colon

A case of a double cancer, a stomach and a colon cancer, in a 84-year-old man is reported. The patient had an occupational history of asbestos exposure while working at two shipyards. His chest X-ray revealed typical, pleural plaque with calcification. Further, a significant number of asbestos bodies in his autopsied lung tissue was detected. In spite of failure to detect asbestos bodies in the stomach and the colon, our findings suggest that these two cancers may have been induced by asbestos exposure.     

A Report of Disseminated Carcinomatosis of the Bone Marrow Originating from Transverse Colon Cancer Successfully Treated with Chemotherapy Using XELOX plus Bevacizumab

A 61-year-old male, who had been admitted to another hospital due to disseminated intravascular coagulation (DIC), was referred to our hospital. Total colonoscopy, abdominal dynamic CT and positron-emission tomography revealed bone metastasis and multiple lymphocytic metastases from transverse colon cancer in addition to disseminated carcinomatosis of the bone marrow (DCBM). We immediately performed chemotherapy with XELOX + bevacizumab and denosumab against DCBM from transverse colon cancer in order to avoid radical surgery. In addition, we initiated the administration of recombinant human soluble thrombomodulin for 1 week to treat DIC. The patient was able to tolerate and receive 4 cycles of chemotherapy without any severe side effects. After receiving the 4 cycles of treatment, he recovered from DIC, and the bone and multiple lymphocytic metastases disappeared.Key words: Disseminated carcinomatosis of bone marrow, Chemotherapy, Transverse colon cancer, Disseminated intravascular coagulation     

Atypical identification of Lynch syndrome by immunohistochemistry and microsatellite instability analysis on jejunal adenocarcinoma

As we learn more about the etiology and cancer risks associated with Lynch syndrome (LS), the phenotypic spectrum of this condition and its genotype-phenotype correlations are being elucidated. We report a patient with past history of multiple cancers including colon and kidney cancer, and recently diagnosed with jejunal adenocarcinoma. The patient had microsatellite instability and immunohistochemistry (MSI/IHC) testing performed on his small bowel cancer in order to evaluate his risk for LS. The MSI/IHC results on his tumor tissue were reported as abnormal and subsequent blood draw revealed the presence of a germline MSH6 mismatch repair gene mutation. This case highlights the phenotypic variability of LS and complications it may present in evaluation for diagnosis and appropriate surveillance and management recommendations. To our knowledge, this is the first report of MSI/IHC being done on small bowel cancer to evaluate for this condition and subsequently confirmed via molecular analysis.     

A case of liver metastases of sigmoid colon cancer treated effectively by oral UFT/LV

The patient was a 77-year-old woman with multiple liver metastases of sigmoid colon cancer. She underwent low anterior resection for sigmoid colon cancer. After surgery, she selected oral administration of UFT and LV for liver metastases and multiple lymph node metastases. After two courses, the liver metastases had markedly diminished. Thirty-two months later, liver metastases had disappeared on computer tomography. This therapy was continued for five years, and recurrences are no longer shown. Severe adverse effects were not observed. Oral anti-cancer drugs can serve as effective therapy for advanced colorectal cancer of old patients.     

Deletion of chromosome 4q predicts outcome in Stage II colon cancer patients

Background

Around 30% of all stage II colon cancer patients will relapse and die of their disease. At present no objective parameters to identify high-risk stage II colon cancer patients, who will benefit from adjuvant chemotherapy, have been established. With traditional histopathological features definition of high-risk stage II colon cancer patients is inaccurate. Therefore more objective and robust markers for prediction of relapse are needed. DNA copy number aberrations have proven to be robust prognostic markers, but have not yet been investigated for this specific group of patients. The aim of the present study was to identify chromosomal aberrations that can predict relapse of tumor in patients with stage II colon cancer.

Materials and methods

DNA was isolated from 40 formaldehyde fixed paraffin embedded stage II colon cancer samples with extensive clinicopathological data. Samples were hybridized using Comparative Genomic Hybridization (CGH) arrays to determine DNA copy number changes and microsatellite stability was determined by PCR. To analyze differences between stage II colon cancer patients with and without relapse of tumor a Wilcoxon rank-sum test was implemented with multiple testing correction.

Results

Stage II colon cancers of patients who had relapse of disease showed significantly more losses on chromosomes 4, 5, 15q, 17q and 18q. In the microsatellite stable (MSS) subgroup (n?=?28), only loss of chromosome 4q22.1-4q35.2 was significantly associated with disease relapse (P?

Conclusion

In the present series of MSS stage II colon cancer patients losses on 4q22.1-4q35.2 were associated with worse outcome and these genomic alterations may aid in selecting patients for adjuvant therapy.

     

Expression of MDR1 and glutathione S transferase-pi genes and chemosensitivities in human gastrointestinal cancer.

The relationship was analyzed between drug resistance and MDR1 (with MDR signifying multiple drug resistance) and glutathione S transferase-pi (GST-pi) gene expression in four stomach and four colon cancer cell lines. Northern blot analysis by pmdr1 probe showed that stomach cancer cell lines had no detectable level of MDR1 mRNA expression. By contrast, some levels of MDR1 mRNA expression were found in two colon cancer cell lines, indicating doxorubicin resistance. To examine the MDR1 mRNA in each cell level, in situ hybridization was used. It was found that all colon cell lines and two stomach cell lines had more silver grains per cell than KB cells (a human KB kidney epidermoid carcinoma cell line). However, the number of silver grains in each cell was heterogeneous in the colon and stomach cell lines. Low-level MDR1 mRNA expression could be detected even in cell lines without MDR1 mRNA expression by northern blot hybridization. These results suggest the possibility that all gastrointestinal cell lines can acquire multiple drug resistance. In addition, all examined gastrointestinal cell lines had high GST-pi mRNA expression. This GST-pi gene expression shows cisplatin resistance in the examined cell lines. Heterogeneity of GST-pi mRNA expression also was shown at the cellular level.     

A case of advanced colon cancer responding to treatment with levofolinate combined with 5-fluorouracil

The patient was a 70-year-old man who had sigmoid colon cancer with multiple lung and paraaortic lymph node metastases. Sigmoidectomy was performed on August 3, 2001. After the operation, combined l-Leucovorin (LV) + 5-fluorouracil (5-FU) was carried out. As a result, lung and lymph node metastases were reduced markedly and CEA level decreased. It is suggested that this combination therapy may be useful for advanced colon cancer patients.     

A surgical case of descending colon cancer with abdominal wall abscess after drainage of abscess

We report a surgical case of descending colon cancer with abdominal wall abscess. A 72-year-old man was admitted to a hospital because of left lower abdominal mass with slight pain. An abdominal CT showed a left lower abdominal wall abscess adjacent to the descending colonic wall thickening. We diagnosed an abdominal wall abscess due to descending colon cancer or colon diverticulitis. The abscess was drained under local anesthesia releasing foul-smelling pus and air. After abscess drainage and general improvement in his condition, we conducted subtotal colectomy with lymph node dissection and excision of abdominal wall abscess cavity. Pathological findings indicated moderately differentiated adenocarcinoma of the descending colon (pT4, pN0, sH0, sP0, sM0, fStage II). The carcinoma had invaded the abdominal wall and transverse colon, but the cancer cells were not shown in the abdominal wall abscess cavity. In abdominal wall abscess treatment, colon cancer should be considered as a potential underlying cause. CT proved useful for assessing the status of the tumor and the abscess. We conducted a radical operation for descending colon cancer after the drainage for abdominal wall abscess.     

Synergistic effects of valproic acid and mitomycin C in adenocarcinoma cell lines and fresh tumor cells of patients with colon cancer

Valproic acid has been demonstrated to mediate cytotoxic effects against tumor cells by acting as a histone-deacetylase inhibitor. However, to date, there are only limited data on the effects of valproic acid in colon cancer. Moreover, information regarding combinations of the drug with chemotherapeutic agents is very limited. The latter is of interest as there is increasing evidence for synergism between so-called "molecular targeting drugs" and chemotherapy. We first demonstrated that valproic acid dose-dependently reduced the viability of adenocarcimona cell lines. After co-incubation with a variety of chemotherapeutic agents, only valproic acid in combination with mitomycin C consistently induced synergistic growth inhibition in all cell lines. To confirm these results in an ex vivo situation, five samples of fresh colon cancer cells were studied. Again, the effect of valproic acid on the viability of the fresh tumor cells was dose dependent. In four of five samples of freshly isolated colon cancer cells, the synergistic effect of valproic acid and mitomycin C on the inhibition of cell growth was confirmed by calculation of the combination index by multiple drug effect analysis. In conclusion, this is the first demonstration that valproic acid as a model substance for histone-deacetylase inhibitors is effective in tumor cells freshly isolated from patients with colon cancer and that the combination of mitomycin C and valproic acid synergistically decreases viability of colon cancer cells.     

Cancer of the colon in California, 1945-1966: the California Tumor Registry experience

Appropriate data from the California Tumor Registry (1945–1966) and the Alameda County Tumor Registry were analyzed with specific reference to colon cancer (excluding rectal cancer) I.C.D.A. No. 153. The high incidence of colon cancer in the Chinese population (33.8 per 100,000) requires further epidemiologic study to ascertain its significance. The sigmoid colon is the location of the highest percentage of colonic tumors. The 5-year relative survival rate for all stages of colon cancer has increased from 24% in 1945 to 43.2% in 1966. For cases localized at the time of diagnosis, the 5-year relative survival rate was 71.3%. An inverse relationship between age and survival was noted for both sexes, except for those under 45, who had a poorer survival experience. An appreciable difference was seen in the lessened survival of patients with upper colonic versus lower colonic lesions. Part of the increase in survival over time appeared to be due to an increasing percentage of patients who received surgery in contrast to other modalities. Part of the female's better survival experience was due to the fact that more women in proportion to men with colon cancer underwent surgery. The physician should take these characteristics, among others, into account when advising his patient on his chances of survival (and when considering treatment modality), and be alert to the high risk of this entity in certain racial, sex, and age groups as noted.     

Marked response to oral administration of UFT and leucovorin for liver metastases from colon cancer in an elderly patient

A83 -year-old man was admitted to our hospital for the treatment of advanced ascending colon cancer with liver metastases. He had initially undergone an ileocecal resection for ascending colon cancer. Subsequently, we started oral administration of UFT/LV(UFT 400mg/day, LV 75 mg/day, and 4 weeks of therapy followed by a week suspension of treatment). After 3 courses, his tumors responded well to treatment, and CT showed marked regression of liver metastases. After 10 courses, liver metastases had almost disappeared. Two years passed without any adverse events since UFT/LV therapy was started. These findings suggest that UFT/LV therapy is very safe and effective for elderly patients with unresectable colorectal cancer.