Ureterosigmoidostomy followed by carcinoma of the colon.

Adenocarcinoma of the colon developing as a late complication or ureterosignoidostomy has been reported with increasing frequency. A patient is presented who developed adenocarcinoma of the colon 28 years after ureterosigmoidostomy for bladder exstrophy and 13 years after conversion of the ureterosigmoidostomy to an ileal conduit. The colonic tumor was documented at postmortem examination to be at the ureterosigmoidostomy site. Because of the potential late development of adenocarcinoma of the colon, careful follow-up of patients with ureterosigmoidostomies, particularly those performed in children many years ago, is indicated.     

Tubular adenoma with squamous metaplasia of the sigmoid colon: A case report

A case of tubular adenoma with squamous metaplasia of the sigmoid colon in a 44-year-old female is reported. The tumor was a pedunculated polyp with a size of 1.2 × 1.7 × 1.7 cm. Histologically, the tumor showed tubular adenoma with focal squamous metaplasia. Borderline atypia was noted in a part of adenoma without squamous metaplasia and squamous component. It is supposed that squamous epithelial polyp, squamous cell carcinoma, adenosquamous carcinoma, and mucoepidermoid carcinoma may be derived from colonic adenoma with squamous metaplasia. Only six cases of the adenoma with squamous metaplasia of the large intestine have been reported previously in the literature.     

The Relation of Smoking, Alcohol Use and Obesity to Risk of Sigmoid Colon and Rectal Adenomas

We conducted a case-control study, using 429 cases with histologically confirmed sigmoid adenoma, 75 cases with rectal adenoma, and 3101 controls showing normal colonoscopy at least up to 60 cm from the anus. The subjects were male Self-Defense Forces personnel aged 48–56 who received a retirement health examination including a routine sigmoid- or colonoscopy. Lifestyle characteristics were ascertained by a self-administered questionnaire. Smoking in the recent past (ġ 10 years preceding the colonoscopy) and smoking in the remote past (>10 years before the colonoscopy) were both significantly associated with risk of sigmoid adenoma but not with rectal adenoma as a whole. After reciprocal adjustment for smoking in the two periods, only smoking in the recent past was associated with both sigmoid colon and rectal adenomas. Odds ratios (OR) of sigmoid adenoma (and 95% confidence interval) for the categories of 0, 1-150, 151-250 and ġ251 cigarette-years were 1.0 (reference), 1.9 (1.3-2,8), 2.1 (1.4-3.0) and 3.0 (1.9-4.7), respectively ( P for trend < 0.01), and those for rectal adenoma were 1.0 (reference), 1.2 (0.4-3.2), 3.5 (1.4-8.5) and 2.0 (0.6-6.7), respectively ( P for trend = 0.03). Alcohol use was significantly positively associated with sigmoid adenoma, and insignificantly associated with rectal adenoma. Body mass index was significantly positively associated with sigmoid adenoma, especially large ones. No such association was found for rectal adenoma. These findings suggest that smoking, especially in the recent past, and alcohol use are common risk factors for sigmoid colon and rectal adenomas while obesity may be exclusively related to the growth of sigmoid adenoma.     

Colon carcinoma associated with ureterosigmoidostomy

A patient developing a colonic adenoma 38 years following ureterosigmoidostomy is presented. The mechanisms of neoplastic transformation associated with ureterosigmoidostomy is now better understood. This knowledge is being applied to develop modifications both of the surgical technique and the management of patients with this form of urinary diversion, and is a subject of discussion.     

Meat, meat cooking methods and preservation, and risk for colorectal adenoma

Cooking meat at high temperatures produces heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs). Processed meats contain N-nitroso compounds. Meat intake may increase cancer risk as HCAs, PAHs, and N-nitroso compounds are carcinogenic in animal models. We investigated meat, processed meat, HCAs, and the PAH benzo(a)pyrene and the risk of colorectal adenoma in 3,696 left-sided (descending and sigmoid colon and rectum) adenoma cases and 34,817 endoscopy-negative controls. Dietary intake was assessed using a 137-item food frequency questionnaire, with additional questions on meats and meat cooking practices. The questionnaire was linked to a previously developed database to determine exposure to HCAs and PAHs. Intake of red meat, with known doneness/cooking methods, was associated with an increased risk of adenoma in the descending and sigmoid colon [odds ratio (OR), 1.26; 95% confidence interval (95% CI), 1.05-1.50 comparing extreme quintiles of intake] but not rectal adenoma. Well-done red meat was associated with increased risk of colorectal adenoma (OR, 1.21; 95% CI, 1.06-1.37). Increased risks for adenoma of the descending colon and sigmoid colon were observed for the two HCAs: 2-amino-3,8-dimethylimidazo[4,5]quinoxaline and 2-amino-1-methyl-6-phenylimidazo[4,5]pyridine (OR, 1.18; 95% CI, 1.01-1.38 and OR, 1.17, 95% CI, 1.01-1.35, respectively) as well as benzo(a)pyrene (OR, 1.18; 95% CI, 1.02-1.35). Greater intake of bacon and sausage was associated with increased colorectal adenoma risk (OR, 1.14; 95% CI, 1.00-1.30); however, total intake of processed meat was not (OR, 1.04; 95% CI, 0.90-1.19). Our study of screening-detected colorectal adenomas shows that red meat and meat cooked at high temperatures are associated with an increased risk of colorectal adenoma.     

A case of multiple colorectal cancers repeatedly resected 5 times

A case of successive metachronous colorectal cancers repeatedly resected 5 times during an 8-year period is reported. The 1st cancer was found in the sigmoid colon when the patient (male) was 32 years old. The 2nd was a mucosal carcinoma of the rectum which was locally excised. The 3rd was found in the ascending colon, and there was detected yet another small cancer in the adenoma in the resected specimen. The 4th and 5th cancers were found in the transverse colon and rectum, respectively. This case is considered to be highly associated with genetic factors. Long-term and careful surveillance is mandatory for early detection of recurrent or additional tumors.     

结肠癌前病变的临床研究──271例结肠腺瘤分析

对我院１９８７～１９９６年经结肠镜检出的２７１例结肠腺瘤进行了分析。提示以远侧结肠、大小＜１ｃｍ、表面光滑者及管状腺瘤多见。特别讨论了与癌的关系，证实了其是一种癌前病变。本组癌变平均年龄为５３．７岁，较腺瘤平均检出年龄长１０年。腺瘤恶变多见于绒毛状腺瘤，尤＞２ｃｍ，广基无蒂及外形呈颗粒菜花状者。恶变多发于直肠及乙状结肠。腺癌患者多表现为便血，处理以内镜下治疗为宜。     

纤维结肠镜检查诊断结直肠癌的评价──附106例分析报道

 本文报告1430例纤维结肠镜检查结合镜下活检及手术病理确诊为大肠癌者106例,均为进展期癌(肿块伴狭窄型58.5％,溃疡伴狭窄型41.5％)。。肿瘤位于直肠62例(58.5％),乙状结肠19例(17.97％),降结肠、脾曲结肠11例(10.4％),升结肠、肝曲结肠13例(12.3％),多部位(升结肠、乙状结肠、直肠同时存在)1例(0.9％)。全部病例以手术切除后病理结果为标准,106例均经手术检查,92例(86.8％)行根汉手术或局部切除,14例(13.2％)困病变广泛转移未能切除,仅做造屡或动脉插管姑息治疗。本文讨论了纤维结肠镜对结直肠癌确诊的价值。癌与腺瘤、癌与血吸虫病的关系,提示早发现大肠癌的临床重要性。     

A case of signet-ring cell type cancer of the colon

A rare case of a primary signet-ring cell carcinoma of the sigmoid colon in a 66-year-old man is reported. Endoscopically, a sessile polyp, 2 cm in diameter, was found in sigmoid colon, consisting mainly of a well differentiated adenocarcinoma and, partially of a signet-ring cell carcinoma. A residual polyp was found at the same site in the sigmoid colon, sixth months after surgery. The resected polyp was histologically confirmed as being a signet-ring cell carcinoma, which had infiltrated into submucosal space by scirrhous invasion. After a polypectomy, a partial colectomy was performed and no carcinoma cells have been identified in the resected colon. We have speculated that this signet-ring cell polyp could develop into Borrmann type 4 advanced colon cancer.     

纤维结肠镜检查诊断结直肠癌的评价──附106例分析报道

本文报告1430例纤维结肠镜检查结合镜下活检及手术病理确诊为大肠癌者106例，均为进展期癌（肿块伴狭窄型58．5％，溃疡伴狭窄型41．5％）。。肿瘤位于直肠62例（58．5％），乙状结肠19例（17．97％），降结肠、脾曲结肠11例（10．4％），升结肠、肝曲结肠13例（12．3％），多部位（升结肠、乙状结肠、直肠同时存在）1例（0．9％）。全部病例以手术切除后病理结果为标准，106例均经手术检查，92例（86．8％）行根汉手术或局部切除，14例（13．2％）困病变广泛转移未能切除，仅做造屡或动脉插管姑息治疗。本文讨论了纤维结肠镜对结直肠癌确诊的价值。癌与腺瘤、癌与血吸虫病的关系，提示早发现大肠癌的临床重要性。     

Strong subsite‐specific variation in detecting advanced adenomas by fecal immunochemical testing for hemoglobin

Fecal immunochemical tests (FITs) for hemoglobin are increasingly recommended and used in colorectal cancer (CRC) screening. We aimed to provide a detailed assessment of the sensitivity of FIT according to type and subsite of neoplasms in a true screening setting. A quantitative FIT (FOB Gold, Sentinel Diagnostics, Milano, Italy) was applied prior to colonoscopy by 3,466 participants of the German screening colonoscopy program. Subsite specific sensitivity for various types of colorectal neoplasms was derived by comparing FIT results with findings at screening colonoscopy. The most advanced finding at colonoscopy was CRC, advanced adenoma, and nonadvanced adenoma in 29, 354 and 686 cases, respectively. Per‐adenoma sensitivity for large advanced adenomas (>1 cm) strongly varied by location (p < 0.001): cecum: 0/14 (0%), ascending colon and right flexure: 11/43 (26%), transverse colon and left flexure: 2/14 (14%), descending colon: 7/12 (58%), sigmoid colon: 47/92 (51%), rectum: 14/39 (36%). By contrast, the FIT detected all of 5 proximal CRC and 23 out of 24 (96%) distal CRCs, whereas per‐adenoma sensitivity of both proximal (17/259, 7%) and distal nonadvanced adenomas (20/237, 8%) essentially equaled the false positivity rate among those without neoplasms (152/2,397, 6%). In conclusion, we found a very large gradient of subsite specific FIT sensitivity for detecting large advanced adenomas ranging from 0% for advanced adenomas located in the cecum to >50% for those located in the descending or sigmoid colon. By contrast, FIT sensitivity was uniformly excellent for CRC and uniformly poor for nonadvanced adenomas, regardless of their location.     

An Inflammatory Polyp of the Sigmoid Colon Observed in a Case with a Ruptured Ovarian Dermoid Cyst

We present here a rare case, an ovarian dermoid cyst with fistulaformation into the sigmoid colon, which forms an inflammatorypolyp of the sigmoid colon. A 58-year-old woman was admitted because of occasional analbleeding. Several examination disclosed the elevation of erythrocytesedimentation rate, a positive test of stool specimen for occultblood, a polyp of the sigmoid colon in barium enema. Laparotomyshowed that a dermoid cyst of the left ovary had ruptured intothe sigmoid. The etiology of the rupture was "idiopathic." Thefistulous communication between the cyst and the sigmoid colonwas thought to have developed the inflammatory polyp over aperiod of about two years.     

Glucose intolerance and adenomas of the sigmoid colon in Japanese men (Japan)

Objectives: The purpose was to investigate the relation between glucose tolerance and risk of sigmoid colon adenomas, a well-established precancerous lesion, in Japanese men.Methods: In the consecutive series of 7,637 men aged 48 to 59 years who received a preretirement health examination at four hospitals of the Self Defense Forces (SDF) in Japan from 1986 to 1994, we identified 821 cases of sigmoid colon adenomas and 4,372 controls with normal sigmoidoscopy or colonoscopy at 60 cm or more from the anus. Glucose tolerance status was classified as normal, impaired glucose tolerance (IGT), newly diagnosed non-insulin dependent diabetes mellitus (NIDDM), or diabetes mellitus under treatment, based ona75g oral glucose tolerance test and medical history. Statistical adjustment was made for body mass index (wt/ht2), cigarette smoking, alcohol use, rank of the SDF, and hospital.Results: Modest increases in adenoma risk were observed for newly diagnosed NIDDM and diabetes mellitus under treatment while there was no association between IGT and adenoma risk. When small (< 5 mm in diameter) and large (5+ mm) adenomas were analyzed separately, increased risk associated with newly diagnosed NIDDM was more pronounced for small adenomas, and diabetes mellitus under treatment showed a slightly stronger association with large adenomas.Conclusions: The findings suggest that NIDDM is associated with modestly increased risk of sigmoid colon adenomas, and add to evidence that hyperinsulinemia increases colon cancer risk.     

A malignant mass in the breast is not always breast cancer

A 37-year-old woman presented to the Internal Medicine Clinic with complaints of abdominal pain and constipation which had begun 3 months earlier. A colonoscopy was performed, and wall thickening of the sigmoid colon was detected. A biopsy of the sigmoid colon revealed a poorly differentiated, mucin-producing adenocarcinoma with a signet-ring pattern. No distant metastasis was detected. The patient was treated with chemotherapy consisting of 5-fluorouracil, leucovorin, and oxaliplatin. One and a half years later, a painless mass, which was not fixed to the skin, measuring 1 cm in diameter, was found in the lower outer quadrant of the left breast. A core biopsy of the mass was performed, and a histopathological report confirmed metastasis to the breast from mucinous adenocarcinoma of an intestinal primary.     

Ureterosigmoidostomy Associated Signet Ring Colon Cancer Presenting as Hip Pain

Purpose

We present a case of a young male with a history of ureterosigmoidostomy who presented with hip pain, the subsequent workup of which revealed metastatic bone lesions from a primary sigmoid signet ring cell adenocarcinoma.

Methods

Review of literature was conducted using databases PubMed Medline (1966–current), PubMed Central (1970–current), and EMBASE (1988–2009) to explore previous studies on the topic; used the Surveillance, Epidemiology and End Results Program for epidemiological data; and used the National Comprehensive Cancer Network guidelines for management recommendations.

Results

Ureterosigmoidostomy is well-documented risk factor for colonic neoplasms, the reported incidence being 2–41% with a latent period of 10 to 30 years and a risk of occurrence 80–7,000 times higher than in the general population. The most common histological type of colon cancer seen after ureterosigmoidostomy is adenocarcinoma, but cases of signet-ring cell carcinoma have also been described. Signet-ring cell adenocarcinoma occurs predominantly in stomach but may infrequently arise from other organs such as breast, urinary bladder, and small and large bowel.

Conclusions

This case underscores the importance of prolonged screening in patients with ureterosigmoidostomies and also calls for heightened awareness among primary care physicians regarding long-term risks associated with this unique entity.     

Colon ornithine decarboxylase activity following standard endoscopy preparation regimens

Ornithine decarboxylase (ODC) catalyzes the formation of putrescine from ornithine, which is the first step in the pathway of mammalian polyamine biosynthesis. Tissue activity levels of ODC have been suggested to be a marker of risk for colorectal cancer in hereditary polyposis and in adenoma formers. We analyzed ODC activity in rectal and sigmoid colon mucosal biopsies obtained at 10 cm and at 30 cm in 40 healthy, colon cancer risk factor-free adults following three endoscopic preparation regimens: 1) no special preparation; 2) two phosphate enemas; and 3) "Colyte" lavage preparation 12 hr previously. Levels of ODC, measured in fresh tissue, were approximately twofold higher for enema preparation vs. no preparation (for log-transformed data: sigmoid, P less than 0.0001; rectum, P = 0.0001) and for enema preparation vs. lavage (sigmoid, P = 0.0002; rectum, P = 0.008). Lavage and no preparation ODC levels were not significantly different. ODC activity levels ranged from 0.00 to 352.96 pmol/mg/hr.     

Synchronous Primary Adenocarcinoma and Ancient Schwannoma in the Colon: An Unusual Case Report

Gastrointestinal schwannomas are uncommon stromal tumors of the intestinal tract and colon schwannomas are extremely rare. We report a rare case of ascending colon schwannoma with associated synchronous adenocarcinoma of the sigmoid colon. A 68-year-old man presented with a 20-day history of bleeding per rectum. Colonoscopy revealed a mass of 4.2 cm in diameter with endoluminal protrusion in the sigmoid colon and a second submucosal tumor in the ascending colon. Surgical intervention was suggested and ileo-hemicolectomy was done. Microscopically, the submucosal tumor of 4 cm in diameter showed features of schwannoma with degenerative change (ancient schwannoma). Lesional cells were positive for S100p and negative for actin, desmin, CD34, CD117, and pankeratin. The mass showed features of an invasive moderately differentiated adenocarcinoma. Colon schwannoma is a rare submucosal tumor, and the incidental occurrence with adenocarcinoma has not been well described in the literature.Key words: Schwannoma, Ancient schwannoma, Gastrointestinal tract, Adenocarcinoma     

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.     

CYP1A1 Val462 and NQO1 Ser187 polymorphisms, cigarette use, and risk for colorectal adenoma

Cigarette use is a risk factor for colorectal adenoma, a known precursor of colorectal cancer. Polymorphic variants in NQO1 and CYP1A1 influence the activation of carcinogenic substances in tobacco smoke, possibly impacting on tobacco-associated risks for colorectal tumors. We investigated the association of cigarette smoking with risk for advanced colorectal adenoma in relation to the CYP1A1 Val(462) and NQO1 Ser(187) polymorphic variants. Subjects were 725 non-Hispanic Caucasian cases with advanced colorectal adenoma of the distal colon (descending colon, sigmoid and rectum) and 729 gender- and ethnicity-matched controls, randomly selected from participants in the prostate, lung, colorectal and ovarian cancer screening trial. Subjects carrying either CYP1A1 Val(462) or NQO1 Ser(187) alleles were weakly associated with risk of colorectal adenoma; however, subjects carrying both CYP1A1 Val(462) and NQO1 Ser(187) alleles showed increased risks (OR = 2.2, 95% CI = 1.1-4.5), particularly among recent (including current) (OR = 17.4, 95% CI = 3.8-79.8, P for interaction = 0.02) and heavy cigarette smokers (>20 cigarettes/day) (OR = 21.1, 95% CI = 3.9-114.4, P for interaction = 0.03) compared with non-smokers who did not carry either of these variants. These genotypes were unassociated with risk in non-smokers. In analysis of adenoma subtypes, the combined gene variants were most strongly associated with the presence of multiple adenoma (P = 0.002). In summary, joint carriage of CYP1A1 Val(462) and NQO1 Ser(187) alleles, particularly in smokers, was related to colorectal adenoma risk, with a propensity for formation of multiple lesions.     

Mucinous adenocarcinoma arising in a neovagina using the sigmoid colon thirty years after operation: a case report

BACKGROUND: Because of a relative rarity of the cases with an artificial vagina, the incidence of a case with malignant disease arising in the neovagina is extremely rare. A case of adenocarcinoma arising from a neovagina is presented with a review of the literature. CASE: A neovagina was constructed using the sigmoid colon at the age of 23 for congenital agenesis of the vagina, Rokitansky-Küster-Hauser syndrome. Subsequently, the patient had regular sexual intercourse for about 20 years. At the age of 53, she came to our outpatient clinic with a complaint of vaginal bleeding, and adenocarcinoma was found at the anterior wall of the neovagina adjoining the introitus. Total resection of the neovagina and adjuvant radiotherapy was performed. The pathological diagnosis was mucinous adenocarcinoma. CONCLUSIONS: In view of relatively low incidence of mucinous carcinoma arising in the sigmoid colon along with the ectopic localization, this case may have implications for the understanding of pathogenesis of sigmoid colon cancer.