Giant Cyst of the Sigmoid Colon

A case of a giant cyst of the sigmoid colon, believed to be the fourteenth reported, is presented, and some of the features of this condition are discussed.     

Solitary Adrenal Metastasis in a Patient with Sigmoid Colon Cancer; Report of a Case

A 73-year-old man had sigmoidectomy for sigmoid colon cancer in December 2001. Although he was followed regularly with chemotherapy, his serum carcinoembryonic antigen (CEA) increased on August 2002. Abdominal computed tomography and magnetic resonance imaging showed a right adrenal mass and no other abnormality. The preoperative diagnosis was a solitary adrenal metastasis from sigmoid colon cancer; the lesion was removed in September 2002. On pathology, adrenal metastasis was confirmed. Although the patient’s serum CEA normalized soon thereafter, 12 months after adrenalectomy, the CEA again increased; the patient had local recurrence of the resected adrenal lesion and liver metastasis. Therefore, the patient was given systemic chemotherapy, but his condition deteriorated, and he died 38 months after adrenalectomy. Adrenal metastasis from colorectal cancer is not unusual; however, a solitary metastasis is rarely found and resected surgically. As surgical treatment of the metastatic lesion could improve patients’ prognosis to some extent if it is detected early, the possibility of adrenal metastasis should be kept in mind when colorectal cancer patients are followed.     

Obesity and Adenomatous Polyps of the Sigmoid Colon

The relation between obesity and adenomatous polyps of the sigmoid colon was investigated in male self-defense officials who received a retirement health examination at three hospitals of the Self-Defense Forces in Japan between January 1991 and December 1992. Body mass index (BMI) and waist-hip circumference ratio (WHR) were used as indices of obesity. A total of 228 adenoma cases and 1484 controls with normal sigmoidoscopy were identified in 2228 men: cases having small adenomas (<5 mm in diameter) and those with large adenomas (5 mm or greater) numbered 115 and 102, respectively. Smoking, alcohol use, physical activity, rank, and hospital were controlled for by multiple logistic regression analysis. BMI and WHR were classified into four levels using the 30th, 60th, and 90th percentiles of each distribution in the control as cut-off points. There was a significant two-fold elevation in the overall adenoma risk among men at the highest BMI level (≥26.95) compared with those at the lowest level (<22.48), but the risk did not linearly increase: a similar increase was also noted for large adenomas. While WHR was only weakly related to the overall adenoma risk, the risk of large adenomas progressively increased with increasing levels of WHR: odds ratio (OR) 2.9 (95% confidence interval (CI) 1.4–5.9) for the highest (≥0.958) versus lowest (<0.878) levels. BMI was not materially associated with adenoma risk after additional adjustment for WHR, but a positive association between WHR and large adenomas was independent of BMI: OR 3.4 (95%CI 1.5–7.6) for the highest versus lowest levels. These findings suggest that obesity is associated with an increased risk of colon adenomas, probably with adenoma growth.     

Unusual Case of a Sigmoid Mass

Background

Endometrial carcinoma is a relatively common condition which may occur with more than 6,400 new cases diagnosed each year in the UK (Cancer Research UK Statistics http://info.cancerresearchuk.org/cancerstats/types/uterus). It may occur following hysterectomy especially if associated with prolonged hormone replacement therapy.

Case

We report the case of a 63-year-old lady who presented with a tumour in the sigmoid mesentery 13 years after hysterectomy and following 10 years of tamoxifen therapy for a breast carcinoma. This is the first time that endometrial cancer has been reported as a complication of tamoxifen therapy in the absence of a uterus.

Conclusion

We suggest that endometrial carcinoma remains a differential diagnosis of any pelvic or abdominal mass even after hysterectomy, and a history of intake of oestrogen agonists and antagonists needs to be obtained.     

A Huge Ovarian Cyst in a Middle-Aged Iranian Female

A 38-year-old Iranian woman was found to have a huge ovarian cystic mass. Her presenting symptom was vague abdominal pain and severe abdominal distention. She underwent laparotomy and after surgical removal, the mass was found to be mucinous cystadenoma on histology.Key Words: Mucinous cystadenoma, Abdominal masses, Abdominal distention, Ovarian cysts, Ovarian tumors     

卵巢单纯性囊肿83例临床分析

[目的]探讨卵巢单纯性囊肿的诊断和治疗方法.[方法]根据病理结果将卵巢囊肿患者分为两组,单纯性囊肿者为观察组(83例),其他肿瘤者为对照组(111例),对两组囊肿体积、CA125表达、术中出血、术后住院时间及复发情况进行回顾性分析.[结果]与对照组比较,观察组囊肿体积较小、CA125无升高,差异有统计学意义(P＜0.05),而两组术中出血、术后住院时间差异无统计学意义(P＞0.05).[结论]卵巢单纯性囊肿如及时明确诊断,预后良好,可观察或保守治疗.     

Domain-Based Analysis of Colon Polyp in CT Colonography Using Image-Processing Techniques

Background: The purpose of the research was to improve the polyp detection accuracy in CT Colonography (CTC)through effective colon segmentation, removal of tagged fecal matter through Electronic Cleansing (EC), and measuringthe smaller polyps. Methods: An improved method of boundary-based semi-automatic colon segmentation with theknowledge of colon distension, an adaptive multistep method for the virtual cleansing of segmented colon based onthe knowledge of Hounsfield Units, and an automated method of smaller polyp measurement using skeletonizationtechnique have been implemented. Results: The techniques were evaluated on 40 CTC dataset. The segmentationmethod was able to delineate the colon wall accurately. The submerged colonic structures were preserved withoutsoft tissue erosion, pseudo enhanced voxels were corrected, and the air-contrast layer was removed without losingthe adjacent tissues. The smaller polyp of size less than validated qualitatively and quantitatively. Segmented colons were validated through volumetric overlap computation,and accuracy of 95.826±0.6854% was achieved. In polyp measurement, the paired t-test method was applied to comparethe difference with ground truth and at α=5%, t=0.9937 and p=0.098 was achieved. The statistical values of TPR=90%,TNR=82.3% and accuracy=88.31% were achieved. Conclusion: An automated system of polyp measurement has beendeveloped starting from colon segmentation to improve the existing CTC solutions. The analysis of domain-basedapproach of polyp has given good results. A prototype software, which can be used as a low-cost polyp diagnosis tool,has been developed.     

Colonic Perforation Following Polypectomy of a Gastrointestinal Follicular Lymphoma Masquerading as a Colon Polyp

Introduction  

The gastrointestinal (GI) tract is the predominant site for primary extranodal non-Hodgkin lymphomas (NHL), accounting for 5–10% of all extranodal disease.     

An Aneurysmal Bone Cyst of the Mandible: A Case Report

A case of aneurysmal bone cyst on the mandible is presented. A brief review of the literature of aneurysmal bone cyst of the jaw is given, bringing out its rarity at this site. The pathogenesis, clinical and roentgen features have been discussed. The diagnosis of an aneurysmal bone cyst is based on characteristic roentgen, surgical macroscopic and microscopic findings.     

Relationship of Diet to Small and Large Adenomas of the Sigmoid Colon

The relation of dietary factors to the risk of adenomas of the sigmoid colon was examined in men receiving a retirement health examination at the Self-Defense Forces Fukuoka Hospital between October 1986 and 1990. A total of 187 adenoma cases and 1557 controls with normal colonoscopy were identified in the series. Cases were further classified into small-adenoma (<5 mm, n=78) and large-adenoma (≥5 mm, n=67) groups. The consumptions of selected foods and beverages were ascertained before colonoscopy by means of a self-administered questionnaire. After adjustment for smoking, alcohol use, rank and body mass index, low rice consumption and high meat intake were independently associated with an increased risk of large adenomas. The risk of small adenomas was not related to either rice consumption or meat intake. Adjusted odds ratios of large adenomas for the low, intermediate and high consumption levels of rice were estimated to be 1.0 (referent), 0.83 and 0.43, respectively (trend P = 0.08), and the corresponding figures for meat consumption were 1.0 (referent), 1.58 and 2.38, respectively (trend P =0.02). The findings suggest that low rice consumption and high meat intake may promote the growth of colon adenomas, thereby increasing the risk of colon cancer.     

Cigarette Smoking, Alcohol Use and Adenomatous Polyps of the Sigmoid Colon

The relationship of adenomatous polyps of the sigmoid colon with cigarette smoking and alcohol use was investigated in male self-defense officials in Japan. In the comparison between 116 cases and 930 controls, total ethanol intake was not at all associated with the risk of adenomatous polyps, but cigarette smoking was strongly related to adenomatous polyps. After adjustment for total ethanol intake, body mass index and rank, odds ratios (and 95% confidence interval) for the categories of 0, 1–399, 400–799, and 800 or more cigarette-years were 1.0 (referent), 2.3 (1.1–4.6), 2.9 (1.5–5.4) and 3.2 (1.6–6.5), respectively. Among five alcoholic beverages (sake, shochu, beer, whiskey including brandy, and wine), only whiskey consumption was weakly related to the risk of adenomatous polyps. Because the present findings disagree with an earlier observation on self-defense officials, we examined the association with smoking and alcohol use separately for small (<5 mm) and large (≥5 mm) adenomas, combining data from these two studies. Cigarette smoking was more strongly associated with small adenomas while the positive association with certain alcoholic beverages were largely confined to large adenomas. These findings suggest that cigarette smoking and alcohol use may be linked with the development of adenoma at different stages of colon tumorigenesis.     

A Case of Pulmonary Infiltrates in a Patient with Colon Carcinoma

A 31-year-old white male with a known history of colon carcinoma was referred to the Interventional Pulmonary service for right lower lobe infiltrates and mucous plugging on computed tomography with concern for pneumonia. Bronchoscopy was performed revealing a broad based mass completely obstructing the bronchus intermedius. It was possible to pass a probe into the right lower lobe, and subsequent photoablation and mechanical debulking revealed that the mass was arising near the origin of the superior basal segment of the right lower lobe (RB6) and could be resected. Pathology confirmed this was consistent with the patient''s known primary colon carcinoma. The potential for endobronchial metastasis in patients with colorectal carcinoma should be investigated in those patients with new or worsening pulmonary symptoms and signs.Key words: Pulmonary infiltrates, Colon carcinoma, Endoluminal metastasis, Endobronchial colon cancer, Bronchoscopy, Interventional pulmonology     

腹腔镜联合药物治疗卵巢子宫内膜异位囊肿的临床疗效分析

[目的]观察腹腔镜联合药物治疗卵巢子宫内膜异位囊肿的临床疗效。[方法]回顾性分析206例卵巢子宫内膜异位囊肿患者信息,根据术后是否接受药物治疗,将所有患者分为腹腔镜联合药物组(A组)和单纯腹腔镜组(B组),比较两组患者子宫内膜异位囊肿复发率及合并不孕症患者治疗后妊娠率的差异。[结果]A组患者术后联合药物治疗3～6个月,2年复发率2.9%,B组患者术后2年复发率15.61%,两组术后复发率有明显差异(P<0.05)。A组39例合并不孕症的患者术后联合药物治疗,妊娠率60.6%;B组36例合并不孕症的患者术后妊娠率44.8%,无统计学差异(P>0.05)。[结论]卵巢子宫内膜异位囊肿经腹腔镜手术联合药物治疗较单纯腹腔镜治疗2年复发率低,但对合并不孕患者妊娠率无明显差异。     

回肠袢式造口术和结肠造口术治疗老年梗阻性乙状结肠癌的临床观察

目的 探讨回肠袢式造口术和结肠造口术治疗老年梗阻性乙状结肠癌的效果.方法 将70例老年梗阻性乙状结肠癌患者随机分为研究组和对照组,各35例.研究组患者给予回肠袢式造口术,对照组患者给予结肠造口术,观察2组患者的临床疗效及安全性.结果 研究组的治疗有效率为77.14%,对照组为65.71%,差异无统计学意义(P>0.05);研究组的控制率为94.29%,高于对照组的85.71%,差异具有统计学意义(P<0.05).Ⅰ期手术时2组患者手术时间、住院时间差异不大,但研究组患者禁食时间显著少于对照组(P<0.05);Ⅱ期手术研究组患者手术时间、禁食时间、住院时间均显著少于对照组,组间比较差异具有统计学意义(P<0.05).2组患者分期手术过程中并发症的发生率差异不大(P>0.05).结论 对老年梗阻性乙状结肠癌患者使用回肠袢式造口术治疗相对于结肠造口术来说有较大的优势,利于老年患者康复,可推广使用.     

Nasopalatine Duct Cyst: Report of a Case with Review of Literature

The nasopalatine duct cyst is the most common non-odontogenic developmental cysts. Nasopalatine duct cyst also termed as incisive canal cyst, arises from embryologic remnants of nasopalatine duct. Most of these cysts develop in the midline of anterior maxilla near the incisive foramen. This article reports a case and review of literature with respect to epidemiology, etiology, clinical presentation, radiographic and pathological findings, treatment and recurrence rates.     

Colon Polyp Model Use for Educating About Colorectal Cancer Screening in the Iowa Research Network

Providing a model of a colon segment with an adenomatous polyp and cancer can help to educate patients about the adenoma to carcinoma sequence and how this sequence can be interrupted with appropriate testing. The purpose of this study was to assess the use of a three-dimensional colon model with polyps and cancer provided to family physicians or nurses in some Iowa Research Network family physician offices. Colon models were provided to 117 family medicine healthcare providers interested in colorectal cancer screening. Using a mailed survey and follow-up telephone calls to non-responders, 81 (69 %) questionnaires were returned. Thirty-six (44 %) of the respondents reported they had used the model, 33 (41 %) reported they used the model for a mean 16 % of their patients in a month’s time, 31 (38 %) reported using the model to teach patients about the colon and polyps prior to a colonoscopy. Other model use described by respondents included educating staff to promote patient willingness for colonoscopies, demonstrating the need for colon cancer screening, and teaching patients about annual fecal occult blood tests. Respondents agreed that anatomical models are helpful for patient education, the design of the colon model was good, and that it facilitated demonstration of colon polyps. Possible recommendations for an office-wide adoption of an anatomical model would be an in-service for all employees and a standard location for finding the model.