Leiomyosarcoma of the colon

Leiomyosarcoma of the colon, excluding that of the rectum, is extremely rare. We report a case of leiomyosarcoma of the ascending colon with a brief review of literature. The clinical manifestations in our case were typical: abdominal pain, diarrhea, anorexia, and a palpable tumor that was firm, smooth, and mobile inspite of its bulk. Toxic features, cachexia and weight loss were less prominent. Morphologically the tumor was of dumbbell type with intracolic and extracolic components. The microscopic picture, consisting of spindle-shaped smooth-muscle cells with pleomorphism and one to three mitotic figures per high-power field, was characteristic. In the absence of local spread, a hemicolectomy was considered curative, but our patient developed extensive metastasis in 25 months. The correlation between mitotic activity of the tumor and prognosis in our case was consistent with that reported in literature.     

Primary plasmacytomas of the colon

Primary plasmacytomas of the colon are very rare. Six documented cases have been reported, and this article reports the seventh case. Plasmacytomas should be included in the differential diagnosis of a solitary tumor of the colon. They have a better prognosis than carcinomas and secondary plasmacytomas. Address reprint requests to Dr. Campos: Ferguson-Droste-Ferguson Hospital, 72 Sheldon Boulevard, S. E. Grand Rapids, Michigan 49503.     

Surveillance for colitis-associated colon neoplasia

The risk of developing colon cancer is increased in colitis patients, particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. Unfortunately, the natural history of this superimposed neoplastic process in colitis appears to be very heterogeneous and poorly understood. Moreover, there are numerous confounding variables in colitis patients that limit accura...     

Diagnostic performance of two-dimensional versus three-dimensional transesophageal echocardiographic images of selected pathologies evaluated by receiver operating characteristic analysis

The sensitivity and specificity of 2-D and 3-D echocardiographic images for the detection of selected morphological abnormalities were compared using receiver operating characteristic (ROC) analysis. Five experienced clinical echocardiographers blinded to the patients' diagnoses evaluated the 20 original static 2-D image sets and 20 corresponding 3-D reconstructions using a five point categorical scale that ranged from definitely abnormal to definitely normal. The ROC curve for the 3-D images was significantly (P < 0.05) closer to the ideal discrimination function than was the ROC curve for the 2-D transesophageal images (i.e., the sensitivity of the 3-D images was higher than that of the 2-D sequential images at the same specificity). In conclusion: 3-D transesophageal images provided better visual clues for the identification of morphological abnormalities than did serial 2-D echocardiographic images despite the same input information in both image formats. The use of ROC analysis assisted in the comparison of these two imaging techniques.     

Short-term sensitization of colon mechanoreceptors is associated with long-term hypersensitivity to colon distention in the mouse

BACKGROUND & AIMS: Using a mouse model that reproduces major features of irritable bowel syndrome (long-lasting colon hypersensitivity without inflammation), we examined the contributions of 2 proteins, transient receptor potential vanilloid 1 (TRPV1) and acid-sensing ion channel 3 (ASIC3), on development of behavioral hypersensitivity and assessed the function of colon mechanoreceptors of hypersensitive mice. METHODS: Visceral nociceptive behavior was measured as the visceromotor response (VMR) to colorectal distention (CRD) before and after intracolonic treatment with zymosan or saline. Colon pathology was assessed in parallel experiments by quantifying myeloperoxidase activity, intralumenal pH, and tissue histology. Electrophysiologic experiments were performed on na?ve and zymosan-treated hypersensitive mice using an in vitro colon-pelvic nerve preparation. RESULTS: Zymosan, but not saline, produced significant and persistent increases in the VMRs of control mice; zymosan produced nonsignificant increases in the VMRs in TRPV1 and ASIC3 knockout mice. Colon myeloperoxidase activity and pH were unaffected by either CRD or intracolonic treatments. Pelvic nerve mechanoreceptors recorded from zymosan-treated or na?ve mice had similar sensitivity to stretch of the colon. When applied acutely, zymosan sensitized muscular/mucosal mechanoreceptors in both na?ve and hypersensitive mice. CONCLUSIONS: Zymosan produced sensitization of colon mechanoreceptors acutely in vitro and chronic (>or=7 weeks) behavioral hypersensitivity in the absence of inflammation. The behavioral hypersensitivity was partially dependent on both TRPV1 and ASIC3 because deletions of either of these genes blunted zymosan's effect, suggesting that these proteins may be important peripheral mediators for development of functional (ie, noninflammatory) visceral hypersensitivity.     

Microsatellite instability in interval colon cancers

BACKGROUND & AIMS: Colon cancers that develop after a complete colonoscopy may be the result of "failure of colonoscopy" or rapid tumor growth. Tumors that develop via the mismatch repair gene pathway demonstrate rapid tumor growth. The aim of this study was to determine if interval colon cancers were more likely than noninterval cancers to result from the loss of function of mismatch repair genes and hence demonstrate microsatellite instability (MSI). METHODS: We searched our institution's cancer registry for interval cancers, defined as colon cancers that developed within 5 years of a complete colonoscopy. These were frequency matched in a 1:2 ratio by age and sex to patients with noninterval cancers (defined as colon cancers diagnosed on a patient's first recorded colonoscopy). Archived cancer specimens for all subjects were retrieved and tested for MSI. RESULTS: Of the 993 colon cancers diagnosed during the study period, 51 (5.1%) were identified as an interval cancer, and 112 subjects with noninterval cancer served as a comparison group. Study subjects were almost all men. MSI was found in 30.4% of interval cancers compared with 10.3% of noninterval cancers (P = .003). After adjusting for age, interval cancers were 3.7 times more likely to show MSI than noninterval cancers (95% confidence interval, 1.5-9.1). This association was strongest for tumors located in the distal colon (odds ratio, 17.5; P = .008). No difference in TNM stage at diagnosis, histologic type or grade, or 5-year survival was found between groups. CONCLUSIONS: Interval colon cancers were almost 4 times as likely as noninterval colon cancers to be associated with mismatch repair gene dysfunction.     

Pneumatosis coli complicating carcinoma of the colon

The management of pneumatosis coli by oxygen therapy is now well established. In one of five patients treated by this method, routine colonoscopy after such therapy revealed a previously unsuspected carcinoma of the sigmoid colon. The need to thoroughly examine the colon after oxygen treatment to rule out coexistent pathologic conditions is emphasized.     

Multicentric malignant fibrous histiocytomas of the colon

Malignant fibrous histiocytoma is a primitive mesenchymal tumour usually found in the soft tissues of the extremity or torso of adults. Only two previous reports of this lesion in the abdominal viscera are present in the world medical literature. A case is reported of three synchronous tumors in the rectum, colon, and omentum with the pathologic appearance of malignant fibrous histiocytoma. Although resected completely with a transverse colocolostomy and a low-anterior resection, the expected behavior of this tumor is one of aggressive local recurrence followed by distant metastasis. The clinical and pathologic characteristics of malignant fibrous histiocytoma are reviewed.     

Carcinoma of colon and appendix related to fecal stasis

It is widely accepted that carcinoma of the large bowel is common in the Western world because we eat a low-residue diet which causes fecal stasis. The part of the large bowel with the most stasis is the appendix, which has similar mucosa; but the incidence of carcinoma per unit area of appendicular mucosa is four times less than carcinoma per unit area of large bowel. Therefore, fecal stasis is probably not important in the etiology of carcinoma of the appendix.     

Dubin-Johnson syndrome coinciding with colon cancer and atherosclerosis

Hyperbilirubinemia has been presumed to prevent the process of atherogenesis and cancerogenesis mainly by decreasing oxidative stress.Dubin-Johnson syndrome is a rare,autosomal recessive,inherited disorder characterized by biphasic,predominantly conjugatedhyperbilirubinemia with no progression to end-stage liver disease.The molecular basis in Dubin-Johnson syndrome is absence or deficiency of human canalicular multispecific organic anion transporter MRP2/cMOAT caused by homozygous or compound heterozygous mutation（s） in ABCC2 located on chromosome 10q24.Clinical onset of the syndrome is most often seen in the late teens or early adulthood.In this report,we describe a case of previously unrecognized Dubin-Johnson syndrome caused by two novel pathogenic mutations （c.2360₂366delCCCTGTC and c.3258+1G>A）,coinciding with cholestatic liver disease in an 82-year-old male patient.The patient,suffering from advanced atherosclerosis with serious involvement of coronary arteries,developed colorectal cancer with nodal metastases.The subsequent findings do not support the protective role of Dubin-Johnson type hyperbilirubinemia.     

Distribution of malignant polyps in the colon

The purpose of this study was to investigate whether the distribution of malignant polyps of the colon is the same as the distribution of all polyps in general. A consecutive and unselected series of 1226 endoscopically removed polyps was analyzed; the analysis indicated a strong preponderance of malignant polyps to be located in the left side of the colon. Ninety-five per cent of the malignant polyps were taken distal to the splenic flexure, whereas that segment of the colon produced only 72 per cent of all of the polyps in general. It is not possible to determine the reason for this from the present study, but the importance of removing these polypoid lesions continues to be emphasized by these data.     

慢性乙型重型肝炎患者的整合终末期肝病模型短期预后分析

本研究采用整合终末期肝病模型(iMELD)[1]对慢性乙型重型肝炎患者的短期临床预后进行判断,评估该模型的临床应用价值. 一、资料与方法 1.临床资料:收集我院2008年1月-2009年6月的慢性乙型重型肝炎住院患者资料,慢性乙型重型肝炎的诊断符合2000年修订的<病毒性肝炎防治方案>[2]诊断标准,根据患者的病史、临床症状和体征,以及实验室检查、影像学检查结果,按照临床诊断是否存在肝炎肝硬化分为非肝硬化重型肝炎组和肝硬化重型肝炎组.观察患者在整个住院期间直至3个月后的病情转归情况,将病情好转、出院或稳定3个月以上者归人生存组,因病情恶化濒临死亡而自动出院或死亡者归入死亡组.     

Emergency left colon resection with primary anastomosis

Thirteen cases of emergency left colon resection with primary anastomosis are presented. Production of an empty bowel and use of parenteral hyperalimentation, to delay oral intake until healing is evidenced by bowel function, are absolutely necessary, The “elective environment,” assuring primary healing of the left colon anastomosis, consists of several factors: an empty decompressed bowel with adequate lumen, an antibiotic-depressed colon bacterial flora, assured blood supply, healthy bowel wall, and absence of anastomotic tension. The importance of not extraperitonealizing the anastomosis and the danger of long-term drains are emphasized. Read at the meeting of the American Society of Colon and Rectal Surgeons. Orlando, Florida, May 8 to 12, 1977.     

Carcinoma of the colon and rectum complicating chronic ulcerative colitis

Patients with pancolonic chronic ulcerative colitis are at increased risk to develop carcinoma of the colon. Controversy continues, however, as to whether this carcinoma is more “virulent” than “type ordinaire” carcinoma of the colon and as to the best way to manage these patients. This study reviews the characteristics and survival of 70 patients with cancer of the colon superimposed on chronic ulcerative colitis. Patients with carcinoma identified incidentally during prophylactic colectomy for chronic ulcerative colitis fared well (5-year survival of 72 per cent), while those with clinical symptoms or radiographic suggestion of cancer had a poor survival rate (5-year survival of 35 per cent). Patients with panproctocolitis, 10 years of disease, and early onset of disease are most likely to have cancer superimposed on chronic ulcerative colitis. This cancer is likely to have a poorer prognosis than type ordinaire cancer of the colon. Prophylactic proctocolectomy should be considered before evidence suggesting carcinoma develops. Read at the meeting of the American Society of Colon and Rectal Surgeons, Atlanta, June 10 to 14, 1979. This paper received the Harry E. Bacon Foundation Award.     

Single-layer anastomosis of the colon and rectum

A total of 116 one-layer end-to-end anastomoses of the colon and the rectum in 112 patients were studied. Three patients died postoperatively (2.6 per cent). Significant disruption of anastomosis requiring a diverting colostomy occurred in five patients. The study is presented to draw attention to the safety of the single-layer anastomosis.     

Diverticular disease of the colon in a far-eastern community

A 5-year retrospective case review and 6-month clinical observation, in a teaching and general hospital in Bangkok, Thailand, show that colonic diverticular disease is not so common as in the West and has many distinctive features. Solitary cecal diverticula are at least five times more common, accounting for about one-fourth of all diverticula of the large bowel, and show definite male preponderance and occur in younger patients. Their congenital origin is supported by the lack of association with social classes, by the finding of structural relationship with the appendix in one of the patients, and by the presence of the muscular coat. On the other hand, multiple colonic diverticulosis is essentially a disease of those above the age of 40 years and shows slight female preponderance. The diverticula appear segmental and need not originate in the sigmoid colon first. Almost all multiple diverticula show radiologic features of simple massed diverticulosis and seem to be associated with higher social classes. The differences in the pattern of diverticular disease in this series and in the West cannot be readily explained on the basis of the difference in dietary habit or psychologic stress.