Unusual manifestations of non-Hodgkin's lymphoma.

Two patients with biopsy proven lymphomatous infiltration of uncommon sites are presented. One had histiocytic lymphoma, involving the true vocal cord with a squamous cell carcinoma on the opposite vocal cord. The other had diffuse well-differentiated lymphocytic lymphoma, presenting with nodal and periorbital disease. After local radiation therapy and while clinically free of other lesions, he developed hemotochezia due to several polypoid lesions throughout the entire colon and prostatic infiltration with symptoms of lower urinary tract obstruction. Both problems were solved after specific treatment.     

Occult blood testing in asymptomatic patients previously resected for colorectal cancer

Hemoccult testing was carried out in 100 patients who had previously undergone surgical resection for colorectal cancer. Of the 15 Hemoccult-positive patients detected, endoscopic examination revealed polypoid formations in six (one with invasive carcinoma) and local recurrent tumors in three. Eighteen polypoid lesions were endoscopically detected in 10 Hemoccult-negative patients. Patient acceptance was good (above 90%) for Hemoccult testing especially when compared to the significantly lower compliance to endoscopic examination (66% in Hemoccult-negative patients). The results suggest that a significant number of lesions may be missed if the Hemoccult test is heavily relied upon exclusively for follow-up of patients previously resected for colorectal cancer.     

Ganglioneuromatosis with carcinoid foci in the large bowel

A rare case of a 27-year-old man who suffered from ganglioneuromatosis with five carcinoid foci arising from the colon and underwent subtotal colectomy is reported. There was no malignancy. The tumors extended to the mucosa and/or submucosa, and in most parts, tumors created polypoid lesions protruding into the intestinal lumen. In the rectum the tumors showed circumscribed extension around the wall. In the sigmoid and descending colon, polypoid lesions were seen on the side opposite from the attachment line of the mesocolon. In one of five carcinoid foci, a transitional pattern between carcinoid and neuroma was investigated.     

基质金属蛋白酶-2及其组织抑制因子在原发性胆囊癌的表达及意义

目的:探讨MMP-2、TIMP-2蛋白在原发性胆囊癌的表达及意义.方法:应用免疫组化SABC法结合图像分析技术,定量检测45例胆囊癌和15例胆囊息肉样病变的MMP-2和TIMP-2蛋白表达.结果:胆囊癌MMP-2表达量显著高于胆囊息肉样病变(P=0.002);MMP-2表达与胆囊癌组织学类型、分化程度、浸润深度、淋巴结转移及肝脏浸润等均无相关性,但不同分期的MMP-2表达量差异显著;胆囊癌TIMP-2表达虽与胆囊息肉样病变无差异(P=0.295),但不同Nevin分期间、浸润深度不同、有无局部淋巴结转移及肝脏浸润的胆囊癌,TIMP-2表达量有显著差异.结论:TIMP-2表达能较准确地反映胆囊癌的生物学特点,在胆囊癌的早期诊断、浸润转移和患者预后有重要的意义.     

胆囊癌发病的相关因素分析及其处理

目的 :探讨胆囊癌发病的高危因素及其处理。方法 :对 1990年 1月— 2 0 0 2年 6月经手术和病理证实的 4 0例胆囊癌病例资料进行回顾性分析。结果 :4 0例胆囊癌病例 ,伴发胆结石 2 9例 ,无胆结石者 11例。 4 0例中伴有萎缩性胆囊炎 6例 ,胆囊腺癌伴腺肌瘤增生 3例。结论 :胆囊癌发病与胆囊结石、萎缩性胆囊炎、胆囊息肉样病变有一定关系 ,对胆囊癌的高危因素应有足够的认识并予以处理 ,这样才能降低胆囊癌的发病率 ,改善预后。     

Evolution of carcinoma in the extrahepatic bile ducts

The histopathology of 43 cases of carcinoma in the extrahepatic bile ducts was reported. All four cases of noninfiltrating carcinoma were papillary or polypoid in gross shape. Only one of the eight cases of papillary or polypoid cancers penetrated beyond the fibromuscular layer of the bile ducts, while most cases of nodular or flat cancers spread deeper than the fibromuscular layer. Adenomatous residue was found in 9 (21.4%) of the total 43 cases, and was particularly frequent in papillary or polypoid cancers (6 [75.0%] of 8 cases). It is likely that early cancers were usually polypoid or papillary in gross shape and that most carcinomas arose from a pre-existing adenoma. Carcinoma associated with a choledochal cyst was found in two cases. Multiple carcinomas were seen in one case. Three cases of carcinoma in the extrahepatic bile ducts were associated with carcinoma of the gallbladder.     

Synchronous and metachronous colon lesions in squamous cell carcinoma of the anal canal

The charts of 79 patients with a histologic diagnosis of squamous cell carcinoma of the anal canal were reviewed to determine the incidence of synchronous and/or metachronous colon lesions. Forty-six patients underwent an adequate preoperative evaluation of the colon and rectum. Ten patients underwent colonoscopy, 33 patients underwent a barium enema, and three patients underwent colonoscopy and a barium enema. In this group six adenomatous polyps and three hyperplastic polyps were discovered. An adenocarcinoma of the sigmoid colon was found in another patient six months prior to the diagnosis of a squamous cell carcinoma of the anal canal. Twenty-three patients had follow-up evaluation of the large bowel for metachronous lesions following treatment of the squamous cell carcinoma of the anal canal. Ten patients underwent colonoscopy, three patients had a barium enema, and ten autopsies were available for analysis. In this group metachronous lesions consisted of two adenomatous polyps and one hyperplastic polyp.     

A case of early gastric carcinoma which disappeared with treatment of low dose 5-FU

A 60-year-old male with early gastric carcinoma of Ha type, had received colectomy for his carcinoma in transverse colon. He was treated after operation with 5-Fluorouracil (5-FU) orally at 200 mg per day. One and a half month after operation at a total dose 8.4 g 5-FU, the patient was examined on his stomach by endoscope and barium enema. The polypoid tumor in the stomach was not recognized there. No lesion has been noticed in his stomach endoscopically in the following 1 year.     

Early colorectal carcinoma with special reference to its development de novo

The growth type of early colorectal carcinoma was classified into two types. The first type is intramucosal polypoid growth (PG-Ca) and the second type nonpolypoid growth (NPG-Ca) which shows mainly massive infiltration of tumor cells below the submucosal layer. The incidence of adenoma-carcinoma sequence was 72 of 75 lesions (96.0%) in pedunculated polypoid carcinoma, and 61 of 71 lesions (85.9%) in sessile and broad-based polypoid carcinomas. Their average sizes were 15.0 and 18.7 mm, respectively. Submucosal invasive carcinoma (SM-Ca) showed a low incidence. They were detected as microscopical or scattered lesions with a few lymphatic and venous permeation. The NPG-Ca contained 32 lesions. Intramucosal carcinoma without adenoma showing slight depression consisted of ten lesions of which the average size was 5.1 mm. The other 22 lesions showed massive submucosal invasion with marked lymphatic and venous permeation. The average size was 10.3 mm being smaller than PG-Ca. Histologically, NPG-Ca was not accompanied with adenoma. The NPG-Ca arose from de novo carcinoma less than 10 mm in diameter and invaded into the submucosal layer. In advanced carcinoma, the PG-Ca showed a low incidence (21.8%), and almost all cases were of the NPG type (78.2%). The NPG advanced carcinomas increased in those over the size of 20 mm. It is concluded that nonpolypoid early colorectal carcinomas easily progress to advanced carcinoma, and de novo carcinoma occupied about 80% of colorectal carcinoma.     

Colon cancer in Iceland—A nationwide comparative study on various pathology parameters with respect to right and left tumor location and patients age

Increasing evidence suggests genetic, biological and demographical difference between right and left colon cancer. Studies have also indicated age differences in the pathology of colon cancer. There is a scarcity of large‐scale studies that closely examine the pathological differences regarding age and tumor location. The aim of our study was to do an extensive comparison of right‐ and left‐ sided colon cancers as well as comparing patients <50 years with older patients. A retrospective, population‐based study was carried out on all patients with colon cancer in Iceland between 1955 and 2004. A total of 2293 cases were analyzed (1148 men, 1145 women). All histopathology material was re‐evaluated. Differences in tumor characteristics between right and left location and younger (<50) and older (≥50) patients was evaluated in particular. Higher TNM‐stage, larger tumors, vessel invasion, mucinous type, high grade and expanding tumor border occurred more frequently in right‐ versus left‐sided lesions while annular and polypoid tumors were more common in left‐sided tumors (p < 0.05). Young patients had more frequent lymph node metastases, vessel invasion, nonpolypoid lesions and infiltrating tumor border (p < 0.05). Right‐sided lesions show more aggressive features, reflected in morphology and stage. Younger patients present more frequently with adverse features than do older patients. Frequency of right‐ and left‐sided colon cancer differs by age with pronounced age‐location differences in females. This supports the assumption of differences in etiology and carcinogenesis of right‐ and left‐sided colon cancer, and between young and old patients.     

Development of colonic neoplasms and expressions of p53 and p21 proteins in experimental colitis of mice induced by dextran sulfate sodium.

The mechanisms underlying the frequent development of colorectal carcinomas in patients with ulcerative colitis (UC) are still not understood. This study was conducted to investigate whether p53 and p21 protein expressions contribute to carcinogenesis in an experimental model with dextran sulfate sodium (DSS) treatment, and to establish if this colitis model is suitable for study of cancer development in UC. A total of 40 mice were subjected to four administration cycles of 4% DSS for 7 days followed by plain water for the subsequent 14 days. The 33-surviving mice were sacrificed to examine the malignant transformation of colonic mucosa morphologically and to determine p53 and p21 expressions immunohistochemically. After DSS treatment periods, there were marked irregularities in the mucosal layer, the thickness of the entire bowel wall and the shortness of the colon. Histologically, tumors were found in 13 out of 33 (39.4%) mice. These 13 cases included 9 with a solitary lesion and 4 with double tumors. There were occurrences of invasive carcinomas in 8 lesions, high-grade dysplasia in 3 lesions and low-grade-dysplasia in 6 lesions. One presented with a polypoid tumor, 5 mm in diameter, while 16 had small flat lesions. There were 13 tumors on the left-sided colon, as opposed to 4 on the right-sided colon. Histological differentiation of invading carcinomas revealed that 6 out of 8 lesions were comprised of well differentiated adenocarcinomas, while 2 were moderately differentiated adenocarcinomas. Overexpression of p53 protein was found in 4 out of 8 invasive carcinomas, 2 out of 3 high-grade dysplasia cases and 2 out of 6 low-grade dysplasia cases, whereas only 1 out of 8 with invasive carcinoma was positive for p21. This experimental colitis model suggests that p53 and p21 protein expressions may contribute to carcinogenesis in DSS-induced colitis in mice and appears suitable to study cancer development in UC.     

Colonic metastasis of a renal carcinoma. A case report.

A 64 year-old man with a metastatic clear-cell renal carcinoma experienced low intestinal bleeding. The endoscopy revealed a polypoid mass in the left colon which proved to be a metastasis of the renal carcinoma. This is an uncommon cause of intestinal hemorrhage, and a rare localization of metastatic deposits.     

Etiology of solitary extrapulmonary positron emission tomography and computed tomography findings in patients with lung cancer.

PURPOSE: The aim of this prospective study was to assess the incidence and the nature of solitary extrapulmonary [18F] fluorodeoxyglucose (FDG) accumulations in patients with non-small-cell lung cancer (NSCLC) staged with integrated positron emission tomography and computed tomography (PET/CT) and to evaluate the impact on management. PATIENTS AND METHODS: A total of 350 patients with NSCLC underwent whole-body PET/CT imaging. All solitary extrapulmonary FDG accumulations were evaluated by histopathology, further imaging, or clinical follow-up. RESULTS: PET/CT imaging revealed extrapulmonary lesions in 110 patients. In 72 patients (21%), solitary lesions were present. A diagnosis was obtained in 69 of these patients, including 37 (54%) with solitary metastases and 32 (46%) with lesions unrelated to the lung primary. Histopathologic examinations of these 32 lesions revealed a second clinically unsuspected malignancy or a recurrence of a previous diagnosed carcinoma in six patients (19%) and a benign tumor or inflammatory lesion in 26 patients (81%). The six malignancies consisted of carcinoma of the breast in two patients, and carcinoma of the orbit, esophagus, prostate, and non-Hodgkin's lymphoma in one patient each. Benign tumors and inflammatory lesions included eight colon adenomas, four Warthin's tumors, one granuloma of the lower jaw, one adenoma of the thyroid gland, one compensatory muscle activity due to vocal chord palsy, two occurrences of arthritis, three occurrences of reflux esophagitis, two occurrences of pancreatitis, two occurrences of diverticulitis, one hemorrhoidal inflammation, and one rib fracture. CONCLUSION: Solitary extrapulmonary FDG accumulations in patients with newly diagnosed lung cancer should be analyzed critically for correct staging and optimal therapy, given that up to half of the lesions may represent unrelated malignancies or benign disease.     

A case of sigmoid carcinoma successfully treated with endoscopic topical infusion of OK-432 and UFT oral treatment

A 78-year-old man had a tumor of Borrmann type II affecting about one third the circumference of sigmoid colon, which was diagnosed as well-differentiated adenocarcinoma from biopsy. Although surgical intervention was recommended and the radical operation seemed possible from preoperative examination, the patient first refused it. Of necessity, systemic administration (s.c) and single endoscopic topical infusion of OK-432 and oral treatment of UFT were performed for 1 month. Since the patient agreed to receive an operation later, sigmoidectomy and lymph node dissection (R 2) were performed, resulting in the disappearance of tumor cells histologically. One week before endoscopic infusion, oral UFT and subcutaneous OK-432 were initiated. Although no macroscopic change was found during the topical infusion as compared with the time of first examination, the bulging disappeared, showing a polypoid change and IIc-like findings after 3 weeks. The operation was performed after an additional week, after which a benign tumor was found macroscopically and the disappearance of tumor cells histologically. Although many reports have dealt with the effect of endoscopic treatment for gastric carcinoma, there have been fewer reports describing the endoscopic treatment performed in patients with colon carcinoma, making it difficult to evaluate its therapeutic effect. However, this endoscopic therapy was suggested to be capable of becoming a useful treatment for inoperable colon carcinoma from the present case, whereas chemotherapy was found to have almost no effect on colon carcinoma in general.     

Flow cytometric DNA ploidy pattern in dysplastic mucosa, and in primary and metastatic carcinomas in patients with longstanding ulcerative colitis

Eighty-nine fresh tissue samples from flat colonic mucosa, polypoid lesions, macroscopically evident carcinomas, and metastatic carcinomas from ten patients with longstanding ulcerative colitis (greater than or equal to 8 years duration) were analysed by DNA flow cytometry and light microscopy. Of a total of ten carcinomas found in six patients, six showed DNA aneuploidy. Three patients developed metastatic carcinomas, all with aneuploid cell populations with similar DNA indices as in the primary carcinoma. Furthermore, aneuploid cell populations with similar DNA indices often occurred, both in separate mucosa samples, as well as in mucosa and carcinoma samples, from the same patient. DNA aneuploidy was found in flat mucosa in five of the six patients with carcinoma, and in one of the four patients without carcinoma (P greater than 0.1). High grade dysplasia was found in only four of the six cases with carcinoma, indicating that high grade dysplasia is insufficient as marker for malignant development. DNA aneuploidy was found in 24% of the dysplastic mucosa samples, and in 18% of the non-dysplastic mucosa samples (n.s., both with regard to high and low grade dysplasia). Since abnormal DNA ploidy pattern was not confined to dysplastic epithelium only, DNA aneuploidy in flat mucosa may constitute an additional marker in the identification of patients at increased cancer risk who could benefit from a closer surveillance.     

Clinical and pathological studies of multiple primary carcinoma of the colon and rectum

During a 5-year period from 1976-1981, we clinicopathologically studied 21 patients with 45 lesions of multiple primary colorectal carcinomas and compared our findings with those made in 288 single carcinomas of the large intestine. The frequency of multiple primary colorectal carcinoma was 6.8%. The pathological findings suggested an interrelationship between colorectal adenoma and carcinoma. Patients with multiple carcinomas of the large bowel had coexisting adenomas more than patients with single carcinoma. We suggest that it is necessary to do a thorough preoperative examination of cancer of the large intestine to detect double cancers or other adenomatous polypoid lesions with synchronous association.     

Induction of Aberrant Crypt Foci and Flat-type Adenocarcinoma in the Colons of Dogs by N-Ethyl-N'-nitro-N-nitrosoguanidine and Their Sequential Changes

Sequential endoscopic observation of dog colons was performed during colon carcinogenesis. Two beagle dogs were given suppositories containing N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG) every day for five months. In month 3, aberrant crypt foci (ACF), a putative preneoplastic lesion, were found in the colons of both dogs, but not in an untreated dog. The frequency of ACF increased until month 10, and then decreased. In month 9, very small lesions, less than 1 mm in diameter, which were similar to human early flat tumors, were first noticed. One of these lesions grew to about 7 mm in size without a change in its shape for 10 months. There were more than ten flat-type tumors in the two dogs, but such lesions were not found in the untreated dog. By biopsy, two of the lesions were proved to be well-differentiated adenocarcinomas histologically. Four polypoid lesions were found in one of the carcinogen-treated dogs. Thus, flat-type adenocarcinomas were induced in the dog colon by ENNG, and their development was followed by magnifying endoscopy.     

Depressed adenoma of the duodenum in patients with familial adenomatous polyposis: endoscopic and immunohistochemical features.

BACKGROUND: Depressed neoplastic lesions of the colorectum have been specified in patients with familial adenomatous polyposis (FAP). The aim of this study was to characterize endoscopic, histologic, and immunohistochemical features of depressed adenoma of the duodenum in patients with FAP. METHODS: Duodenoscopy was performed on 25 patients with FAP, and the neoplastic nonampullary lesions were classified as polypoid or depressed adenomas. The grade of dysplasia, the proliferative activity determined by Ki-67 labeling index (LI), and the grade of p53 expression were compared between polypoid and depressed neoplasia. RESULTS: Ten subjects had depressed nonampullary adenoma, whereas polypoid adenoma was found in the remaining 15 subjects. Moderate dysplasia was more frequent in depressed adenoma than in polypoid adenoma (70% vs. 27%, P = 0.04). Whereas p53 expression was not different between the two adenoma groups, the LI was significantly higher in depressed adenoma than in polypoid adenoma (59.7 +/- 9.5 vs. 47.5 +/- 10.7, P < 0.01). CONCLUSIONS: Depressed adenoma of the duodenum is a distinctive phenotype of duodenal neoplasm in patients with FAP. The high proliferative activity of depressed adenoma suggests that there may be a need to survey FAP patients with such lesions intensively.     

Breast cancer in Cowden's disease: a case report with review of the literature

We report a case of invasive breast cancer in a 62-year-old female patient with Cowden's disease. A left modified radical mastectomy was performed and histopathology of the tumor showed invasive ductal carcinoma, histological grade 3, without lymph node metastasis. The patient had a past history of endometrial cancer at 55 but did not have a family history of malignant disease. Goiter was palpable but aspiration cytology revealed no malignancy. There were several papillomas on the oral mucosa and multiple papillomatous lesions on the right femur. Barium X-ray and endoscopic examination revealed multiple, small, hyperplastic polypoid lesions on the esophagus, stomach and rectum. Histopathology of the biopsy specimens from the esophagus and stomach showed acanthotic squamous epithelium and foveolar hyperplastic polyps. The patient was followed up closely to monitor the thyroid lesions and polyposis of the digestive tract. A total of 12 breast cancer patients who also had Cowden's disease have been reported in Japan and these cases are reviewed in this report.      

20例食管癌肉瘤的诊断与治疗分析

目的食管癌肉瘤是一种罕见病,通过回顾分析本组较大样本食管癌肉瘤的病理及临床特点,探讨其诊断治疗.方法对20例食管癌肉瘤病人的临床资料进行回顾性分析.结果食管癌肉瘤多为覃伞样、息肉样腔内生长,个别呈浸润生长.光镜下肉瘤与癌两种成份共存,瘤体以肉瘤成分为主,表面及蒂多分布癌组织,活检常显示为鳞癌,故术前多不能明确诊断.20例患者中9例侵犯粘膜层,1例浅肌层,4例深肌层,6例侵犯外膜.4例出现淋巴结转移,淋巴转移率20%,转移成分3例鳞癌,1例肉瘤.手术切除率100%.1、3、5年生存期分别为85%、68%、68%.结论食管癌肉瘤是一种低侵袭性,低淋巴转移率,预后尚佳的肿瘤.X线表现为食管腔内息肉样的充盈缺损,轮廓较为光滑整齐,粘膜显示"涂抹征".食管镜活检多显示鳞癌或低分化癌,术前难以确诊.治疗以手术切除为主,必要时辅以放化疗.