Adenocarcinoma arising at a colostomy site

Primary adenocarcinoma arising at a colostomy or ileostomy site is very rare, and only three cases have been reported following surgical treatment of ulcerative colitis. A 38-year-old man who developed an adenocarcinoma originating at the site of a colonic stoma and producing a large fungating tumor mass in the surrounding abdominal wall is described. This occurred 19 years after Miles' operation for a carcinoma of the rectum     

EEA stapler in low anterior anastomosis

Preservation of the anal sphincter is a goal of all surgeons treating colorectal malignancies. In the hands of many, transsacral and low anterior resections with end-to-end anastomosis have been associated with high morbidity and leakage. The EEA stapler represents an alternative in re-establishing bowel continuity. Fifty-eight patients with adenocarcinoma of the rectum were treated over a three-year period at Roswell Park Memorial Institute. Forty-nine procedures judged to be curative and nine, palliative. All patients had an EEA stapler introduced through the anus. No protective colostomies were needed. No case of clinically significant anastomotic leakage was seen. Minor spotting or bleeding was documented, but no patient required blood transfusions. Two patients developed constipation; 16 patients had temporary soiling, two had prolonged soiling. Frank incontinence was not observed. The EEA stapler is an evolutionary instrument derived from the Russian PKS model. It is safe, reliable, and simple to operate. With adequate training of the surgeon, precious time can be saved. Intraoperative sigmoidoscopies, as well as postoperative barium enema examinations, were not needed. Caps in the stapled anastomotic line (when present) were easily repaired. It is too early to tell whether anastomotic and local recurrence rates will increase, as more sphincter-saving procedures are performed. Five-year follow up is crucial to establish criteria for the use of the EEA stapler.     

Adenocarcinoma of an ileostomy in a patient with ulcerative colitis

A case is reported of adenocarcinoma of the ileum following surgical management of ulcerative colitis. In this patient it seems likely that the carcinoma arose in a pre-existing tubulovillous adenoma of rectal origin. This case report draws attention to the need to exclude any possibility of retention of large-intestinal mucosa in the ileostomy when transecting the ileum, either at primary colectomy or when dismantling an ileorectal anastomosis.     

Irradiation and surgery for primarily inoperable rectal adenocarcinoma

Preoperative irradiation followed by radical surgical removal of the tumor should be attempted in all patients with locally advanced rectal adenocarcinomas, including patients with moderate distant metastases. If the tumor is not operable after half dose of irradiation (3150 rads), the patients should be re-explored for resectability after full irrdiation dose. Resectability can only be adequately determined by exploratory laparotomy and an attempt to resect the tumor-bearing segment by anatomic dissection, and not solely by rectal exploration or palpation of the pelvis at laparotomy.     

Mucinous adenocarcinoma developing in chronic anal fistula: Report of two cases and review of the literature

Mucinous adenocarcinoma developing in a chronic anal fistula is a rare tumor of the anus of which there are less than 150 reported cases. There has been some debate as to whether the fistula is the source of the tumor, or whether the fistula is the presenting feature of a slow-growing, indolent carcinoma. Two recent cases seen at our hospital are presented, along with a review of the literature and what we feel to be strong evidence that the fistula and associated anal glands are indeed the source of this unusual tumor.     

Effect of mucin production on survival in colorectal cancer： A case-control study

AIM： TO investigate the impact of mucin production on prognosis in colorectal cancer, in terms of overall survival （OS） and time to disease progression （TTP） in patients with mucinous compared to those with nonmucinous colorectal cancer （NMCRC）, matched for age, gender, and tumor stage. METHODS： Thirty five patients with mucinous colorectal cancer （MCRC） were matched for age, gender, and tumor stage with 35 controls having NMCRC. OS and TTP were compared among 4 groups divided according to mucin content： group A （50%-75% mucin）, group B （75%-100% mucin）, group C or controls （〈 50% mucin）. Group D consisted of all patients with tumors having 〈 75% mucin （controls and groups A together）. RESULTS： Median survival in MCRC and NMCRC groups was 46.2 and 112.9 mo, respectively （P = 0.26）. OS in groups A and B was 70.1 and 32.8 mo （P = 0.46）, and in groups B and D was 32.8 and 70.1 mo, respectively （P = 0.143）. TTP in MCRC and NMCRC was 50.17 and 44.77 too, respectively （P = 0.795）. TTP in groups A, B, and D was 70.1, 24.8, and 65.5 too, respectively. Twenty-eight percent of patients with MCRC had poorly differentiated adenocarcinoma versus 8.6% in NMCRC patients （P = 0.028）. CONCLUSION： MCRC is associated with a non-significant decrease in median survival and TTP, particularly when mucin content is 〉 75% of tumor volume. However, it tends to be more poorly differentiated. A larger study matching for stage and grade is needed.     

No treatment option for liver metastases from colorectal adenocarcinoma

After an explanation of alternative treatment modalities, 30 patients with unresectable liver metastases from colorectal adenocarcinoma chose to have no treatment. Fourteen patients (47 percent) had synchronous liver metastases and 16 (53 percent) had metachronous lesions. Thirteen of the 30 patients (43 percent) had histologic documentation of liver metastases, with the remaining 17 patients diagnosed by liver scan, ultrasonography, or computerized axial tomography. Twenty-four of 30 patients (80%) had less than 25 percent liver involvement (Stage I), 23 of 24 patients had alkaline phosphatase levels less than twice normal, and 20 of 24 patients were asymptomatic from their liver metastases. The remaining six patients had liver stages II or III at the time of diagnosis. Overall mean survival of the 30 reported patients with untreated metastatic colorectal cancer to liver is 16 months (range, 2 to 58 months; median survival, 12 months).     

误诊为肺结核的42例细支气管肺泡癌患者临床分析

目的 探讨细支气管肺泡癌患者的临床特点、误诊原因及诊治经验。方法 2009年1月至2012年1月西安市结核病胸部肿瘤医院共收治各类肺结核患者22047例,最初误诊为肺结核而后证实为其他病变者203例,其中42例患者经病理组织学证实为细支气管肺泡癌;对42例误诊为肺结核的细支气管肺泡癌患者的临床病理资料进行回顾性分析。结果 细支气管肺泡癌的临床表现以咳嗽、咯痰（31例）、气短（23例）为主,其次为胸闷、胸痛（12例）、咯血或痰中带血（8例）;影像学可分为3类,其中33例为孤立结节型,4例为肺炎型,5例为弥漫结节型;42例患者确诊细支气管肺泡癌前均误诊为肺结核,其中误诊为浸润性肺结核23例,肺结核瘤11例,亚急性血行播散性肺结核5例,肺结核合并浆膜腔积液3例;抗结核治疗症状反复或影像学无明显变化,最终通过手术或肺穿刺证实为细支气管肺泡癌。其中Ⅰ期患者20例。42例患者除2例随访未达到1年而失访外,其余均随访满1年或随访至患者死亡。全组随访1年中1例患者死亡,全组随访1年生存率为97.50%（39/40）。结论 细支气管肺泡癌临床症状及影像学表现特异性不高,极易误诊为肺结核;应综合分析,提高早期诊断率。     

胰腺腺鳞癌的临床诊治分析

目的 总结胰腺腺鳞癌临床诊治经验,以提高对该病的认识和诊治水平.方法 对2002年7月至2008年6月我院收治的5例胰腺腺鳞癌患者的临床资料进行回顾性分析,并结合文献讨论.结果 本组5例胰腺腺鳞癌患者,其中男3例,女2例,平均年龄(64±18)岁.肿瘤位于胰头部者2例,位于胰体尾部者3例;行胰头十二指肠切除术1例,行胰体尾、脾脏切除术3例,行胆肠+胃肠双旁路内引流术并~(125)Ⅰ粒子植入1例.肿瘤平均长径4.5 em,1例侵犯胃后壁、十二指肠降部、门静脉,2例侵犯脾门处包膜,2例合并有神经、血管侵犯,1例伴有淋巴结转移.组织学特征为腺癌和鳞癌成分混杂在一起,呈浸润性生长.5例均获随访,3例死于肿瘤复发和肝转移,术后生存8.5～13.5个月,平均11.2个月,2例已生存6个月和56个月.结论 胰腺腺鳞癌好发年龄60岁左右,临床确诊较困难,恶性程度高,预后差,手术切除结合放、化疗的综合治疗可提高疗效.     

Pharmacological treatment of non-alcoholic steatohepatitis: The current evidence

¹²⁵I-protein-radioiodinated pure pancreatic juice samples from patients with adenocarcinoma of the pancreas, chronic pancreatitis, or intact pancreas were analysed by high-resolution SDS-polyacrylamide gel electrophoresis and subsequent autoradiography. Experiments resulted in the detection of a 180K protein, probably a glycoprotein, in the pure pancreatic juice from pancreatic carcinoma (93%) and chronic pancreatitis (73%) patients, which was completely absent from pancreatic juice from intact pancreas. Sephadex G-200-isolated 18UK protein was found to be different from carcinoembryonic antigen (CEA) when traced by a commercial CEA radioimmunoassay, but it seemed identical in pancreatic juice samples from patients with pancreatic carcinoma and chronic pancreatitis, at least with regard to isoelectric point. In brief, the present results suggest that 180K protein identification in pancreatic juice permits adenocarcinoma of the pancreas and chronic pancreatitis to be differentiated from normal conditions but that distinction between pancreatic carcinoma and chronic pancreatitis is unlikely.     

Natural history of Barrett's esophagus

The natural history of Barrett's esophagus (BE) is difficult to quantify because, by definition, it should describe the course of the condition if left untreated. Pragmatically, we assume that patients with BE will receive symptomatic treatment with acid suppression, usually a proton pump inhibitor, to treat their heartburn. This paper describes the development of complications of stricture, ulcer, dysplasia and adenocarcinoma from this standpoint. Controversies over the definition of BE and its implications in clinical practice are presented. The presence of intestinal metaplasia and its relevance to cancer risk is discussed, and the need to measure the extent of the Barrett's epithelium (long and short segments) using the Prague guidelines is emphasized. Guidelines and international consensus over the diagnosis and management of BE are being regularly updated. The need for expert consensus is important due to the lack of randomized trials in this area. After searching the literature, we have tried to collate the important studies regarding progression of Barrett's to dysplasia and adenocarcinoma. No therapeutic studies yet reported show a clear reduction in the development of cancer in BE. The effect of pharmacological and surgical intervention on the natural history of Barrett's is a subject of ongoing research, including the Barrett's Oesophagus Surveillance Study and the aspirin and esomeprazole cancer chemoprevention trial with interesting results. The geographical variation and the wide range of outcomes highlight the difficulty of providing an individualized risk profile to patients with BE. Future studies on the interaction of genome wide abnormalities in Barrett's and their interaction with environmental factors may allow individualization of the risk of cancer developing in BE.     

Radical external beam radiation therapy for adenocarcinoma of the rectum

External beam megavoltage radiation therapy was used as primary treatment for 123 patients with rectal adenocarcinoma. Surgery was undertaken for some patients who had residual tumor. The overall five-year survival rate was 21 per cent. When patients were separated into those who presented with clinically mobile and those with clinically fixed rectal tumor masses, the survival rates were 38 per cent and 2 per cent, respectively. The primary tumor was controlled by radiation alone in 21 of 56 (38 per cent) patients who had mobile tumors but in only six of 67 (9 per cent) patients who had fixed tumors. Further investigation of high-dose primary radiation, with surgery reserved for patients with residual rectal carcinoma, may allow reduction of the number of patients who require abdominoperineal resection. Secretarial and statistical service support was provided by a grant from the Ontario Cancer Treatment and Research Foundation.     

Mesothelial cysts associated with metastases to ovary from primary colonic carcinoma

The three cases herein reported concern metachronous ovarian metastases from primary adenocarcinomas of the colon associated with mesothelial cysts. Although the etiology of these cysts remains obscure, the cases were of interest because the cysts did not contain tumor cells despite the intimate relationship to the tumor. Metastases were localized to the ovary and were resectable. All signs and symptoms disappeared, affording excellent palliation and an extended survival.     

核糖核酸干扰沉默生长抑制因子1基因表达对胃腺癌AGS细胞凋亡的影响

目的 探讨RNA干扰沉默生长抑制因子1(ING1)基因表达对胃腺癌AGS细胞凋亡的影响。方法人胃腺癌细胞株AGS经常规培养后分为空白对照组、阴性对照组[转染阴性对照小干扰RNA(siRNA)序列]、siRNA组（转染特异性ING1 siRNA序列）。应用免疫荧光、定量PCR和免疫印迹方法检测转染后不同时间的ING1基因表达沉默效果。应用流式细胞技术检测ING1基因表达沉默对AGS细胞凋亡的影响。结果ING1主要在AGS细胞胞质中表达。在荧光定量PCR技术检测中将空白对照组的ING1基因表达量设为1,则转染后24和40 h阴性对照组的ING1基因相对表达量分别为0.88±0.16和0.92±0.13,siRNA组ING1基因相对表达量分别为0.38±0.09和0.17±0.06。空白对照组和阴性对照组比较,P值分别=0.78和0.82。空白对照组和siRNA组比较,P值均=0.01。阴性对照组和siRNA组比较,P值分别=0.02和0.01。免疫印迹技术检测结果显示,转染后40 h AGS细胞中ING1蛋白表达水平明显下调。空白对照组AGS细胞凋亡率为11.06％±0.97％,阴性对照组、siRNA组转染40 h后AGS细胞凋亡率为11.82％±0.69％和 6.70％±0.41％。空白对照组与siRNA组比较P=0.024。空白对照组与阴性对照组比较P=0.76。阴性对照组与siRNA组比较P=0.019。结论ING1在人胃癌细胞凋亡过程中发挥重要作用,可能成为胃癌基因治疗的新靶点。     

结直肠腺癌病理分型的临床意义及预后分析

目的 探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后.方法 收集1994年8月至2007年3月结直肠手术患者2089例,其中黏液腺癌144例,印戒细胞癌25例,乳头状腺癌和管状腺癌1837例,剔除其他类型肠道肿瘤83例.比较三组的临床病理特点.对影响结直肠预后的部分临床病理指标,如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析.对三组进行总体生存分析.结果 黏液腺癌患者发病的中位年龄为(54.20±16.25)岁,印戒细胞癌患者为(40.43±12.88)岁,乳头状腺癌和管状腺癌患者为(58.73±13.62)岁,印戒细胞癌发病年龄最低(P<0.001).三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义(P值均<0.05).经单因素和非条件Logistic回归分析发现,黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素,而印戒细胞癌是预示结直肠癌预后的独立因素.三组总体生存时间和生存率间差异有统计学意义(P<0.001).结论 结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差.黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素.     

An Unusual Presentation of Aggressive Primary Invasive Adenocarcinoma of Lung

Bilateral diffuse infiltrates on chest imaging can present a diagnostic challenge due to a broader differential diagnosis which includes pulmonary and non-pulmonary causes. Malignancy is generally not considered under differential diagnosis at the time of initial presentation. Here we present a case of primary adenocarcinoma of lung manifesting as diffuse bilateral infiltrates on imaging. Our case is unique in regards to its acute presentation, rapid progression to respiratory failure, ultimately leading to the demise of the patient. This indicates the aggressive nature of this malignancy and its variable presentation, like male gender and young age, thus emphasizing the importance of entertaining malignancy in such presentations, especially if there is no response to conventional antibiotic therapy.     

原发性十二指肠球部溃疡型腺癌1例并文献复习

<正> 病例:患者男,74岁,因"反复黑便半年,再发5 d"于2009年1月2日入院。患者半年前无明显诱因下解柏油样稀便共3～4次,大便潜血试验阳性,伴头晕、乏力、心悸,无发热,无腹痛。至本院行胃镜检查示十二指肠球部后壁溃疡,大小约1.2 cm×1.5 cm,胃窦部活检示幽门螺杆菌(H.pylori)(+)。予泮托拉唑40 mg bid对症治疗2周,未予以H.pylori根除治疗(具体原因不详),症状完全缓解。出院后继续予泮托拉唑40 mg qd维持治疗8周。2个月前,患者欲了解溃疡愈合情况,遂于本院复查胃镜示球部溃疡未愈合,大小与第一次胃镜所见相同,胃窦部活检示H.pylori(+)。予泮托拉     

Prognostic factors and patients’ profile in treated stage I and II lung adenocarcinoma: a Hospital’s Cancer Registry-based analysis

BackgroundIt is known that survival from lung cancer can differ between countries and even between different regions of the same country. The variability between hospitals, the age and social profile, and the time when this patient was treated, can influence survival, and these factors are intrinsic to each region. Knowing the profile of patients, hospitals, and other factors associated with the treatment of stage I and II lung cancer in a given region is important to understand outcomes and propose improvements that can be replicated in any region of the world that presents the same profile of patients and care structure. This study evaluates survival and possible predictors in all patients with stage I and II lung cancer adenocarcinoma through the Hospital’s Cancer Registry (HCR), responsible for the State of Sao Paulo’s cancer registry, a geographical area with 40 million inhabitants.MethodsBased on the HCR, an observational study was conducted, including 1,278 patients diagnosed with lung adenocarcinoma at clinical stages (CS) I and II. Sex, age at diagnosis, education, neighbourhood, CS at diagnosis, the time between diagnosis and treatment, 5-year periods in which patients were treated, treatment modality and hospitals where patients were treated were analysed. Cox univariate and multiple regression analyses were used to estimate the hazard ratio (HR).ResultsA total of 1,278 lung cancer patients with clinical lung cancer adenocarcinoma stages I and II were included. About 40.06% of patients did not receive surgery, and only 55.8% started the treatment within 2 months. The majority of the patients were treated in high complexity hospitals, 69%. Five-year overall survival (OS) was 45.6% in CS I and 27.5% in CS II. Patients treated in high complexity centres have lower mortality rates than those treated in Partial Hospital Complexity Centers in Oncology (PHCCO) (adjHR 1.18; 95% CI: 1.00–1.40; P=0.047). Patients diagnosed between 2010–2014 had a protective factor against the risk of death concerning patients diagnosed between 2000–2004.ConclusionsThe 5-year OS has significantly improved as long as the 5-year group analysed. Also, the 5-year OS of the patients treated in high complexity hospitals is higher than those treated in PHCCO.     

Esophageal cancer: Risk factors,screening and endoscopic treatment in Western and Eastern countries

Esophageal cancer is one of the most unknown and deadliest cancers worldwide, mainly because of its extremely aggressive nature and poor survival rate. Esophageal cancer is the 6^th leading cause of death from cancer and the 8^th most common cancer in the world. The 5-year survival is around 15%-25%. There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide. There are areas of high incidence of squamous cell carcinoma (some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas. In Europe and United States the predominant histologic subtype is adenocarcinoma. The role of early diagnosis of adenocarcinoma in Barrett’s esophagus remains controversial. The differences in the therapeutic management of early esophageal carcinoma (high-grade dysplasia, T1a, T1b, N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage. In areas where the incidence is high (China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus.     

Delayed antemortem diagnosis of adenocarcinoma of the cecum presenting as lower extremity gas gangrene

The rare entity of nontraumatic metastatic gas gangrene is commonly associated with occult gastrointestinal malignancies. Normally the patient's course is fulminant, with rapid demise prior to ascertaining the correct etiology at autopsy. An unusual case is presented in that 65 days following hip disarticulation for gas gangrene the diagnosis of colonic cancer was appropriately suspected and then proven.