c-Ki-ras mutations in dysplastic fields and cancers in ulcerative colitis.

A sensitive restriction fragment length polymorphism assay and DNA sequencing were used to detect c-Ki-ras mutations in 56 specimens of colonic epithelium from 18 patients with chronic ulcerative colitis. Mutations were not detected in biopsy specimens that were negative or indefinite for dysplasia. In 4 of 8 patients with high-grade dysplasia, a c-Ki-ras codon 12 or 13 mutation was detected. In three colectomy specimens, a wide area of dysplastic cells (greater than 10 cm2) contained a specific ras mutation. In two of these specimens, an invasive cancer contained a c-Ki-ras mutation identical to that found in adjacent dysplastic epithelium. These studies indicate that mutations of c-Ki-ras may be an excellent molecular genetic marker to map dysplastic fields and invasive cancer in ulcerative colitis.     

Calcified carcinoma of the colon superimposed on chronic ulcerative colitis

Summary A case of calcified colonic carcinoma superimposed on ulcerative colitis is reported. Only 10 cases of colonic carcinoma with radiographically visible calcification have been reported previously in the English-language literature. None of these has been associated with ulcerative colitis. Histologically, all of the previously reported cases have been mucoid adenocarcinoma.     

Carcinoma of the colon following chronic ulcerative colitis

Summary Two cases of chronic ulcerative colitis occurring in brothers who ultimately developed cancer of the large bowel are presented. These are the first cases of this kind that the authors have been able to discover in medical literature. The possibility of hereditary predisposition to both ulcerative colitis and cancer is discussed.     

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.     

Bile duct carcinoma associated with chronic ulcerative colitis

Patients with chronic ulcerative colitis are prone to a variety of liver disorders. This case report illustrates development of bile duct carcinoma in a patient with long-standing inactive colitis. The report emphasizes the association of chronic ulcerative colitis with bile duct carcinoma and discusses the radiologic preoperative evaluation of the ulcerative colitis patient who develops jaundice.     

In-situ and invasive carcinoma of the colon in patients with ulcerative colitis

Four cases are described in which ulcerative colitis was complicated by carcinoma and in which the extent of the accompanying in-situ carcinoma (precancer) was determined.The extent of the in-situ carcinoma was very variable and in all cases the rectum was spared in whole or part. Search for in-situ carcinoma in rectal biopsies will fail to indicate the development of malignancy in some patients with ulcerative colitis. Alternative methods of cancer detection in this group are discussed.     

A case of lymphoepithelioma-like carcinoma of the colon with ulcerative colitis

Follow-up colonoscopy of a 25-year-old Japanese man with ulcerative colitis (UC) who had undergone endoscopic mucosal resection twice for early colon cancers revealed the presence of a new 1.5-cm-diameter tumor in the sigmoid colon. It was diagnosed by preoperative biopsy as a poorly differentiated adenocarcinoma. Sigmoidectomy was performed, and the pathological findings revealed lymphoepithelioma-like carcinoma (LEC). In situ hybridization to detect Epstein-Barr virus (EBV)-encoded small RNAs showed positive signals in stromal lymphocytes, but weak signals in the tumor cells. The association between EBV and LEC was obscure in this case. Unlike typical UC-mediated colon cancers, the lesion was poorly differentiated, and negative for p53 signals immunohistochemically. These findings may hint at a novel mechanism of carcinogenesis in UC-mediated colorectal cancer.     

Cancer in chronic ulcerative colitis

Saline colonic lavage in 74 patients with chronic ulcerative colitis was performed utilizing a commercially available dental irrigating unit through a polyethylene catheter in the biopsy channel of a colonoscope or through a sigmoidoscope via a lavage-aspirating double-lumen probe. Six patients were found with colonic carcinoma. Two diagnoses of malignancy were established by cytologic smears and cell block alone. Two patients had positive mucosal biopsies and cell block. One patient with a hepatic flexure carcinoma and a second patient with a malignancy proximal to a left colon stricture were missed by these techniques. Considering the established proclivity for carcinoma in these patients, it is felt that segmental lavage in areas of stricture, grossly distorted mucosa, or endoscopically inaccessible areas represents a valuable adjunct in the diagnosis of carcinoma in chronic ulcerative colitis.     

Carcinoma of the colon and ulcerative colitis

Summary The records of 1258 patients with ulcerative colitis who were seen at the Cleveland Clinic in the years 1950 through 1963 were reviewed. Twenty-four cases of carcinoma of the colon were found, an approximate overall incidence of 1.9%. Of these 24 patients, 15 died of the carcinoma; 1 patient died of an unrelated condition, and 8 patients are living and well.Carcinoma was found to occur in patients with ulcerative colitis at an age earlier than that at which colonic malignant lesions develop in persons without colitis. The mean age of diagnosis of colonic carcinoma was 40.7 years. The mean interval between the onset of colitis and the time of diagnosis of colonic carcinoma was 18.3 years. Ten of the 24 patients had multiple carcinomas, including 3 with multifocal lesions of carcinoma in situ. Of 29 separate carcinomas found, 14 were in the rectosigmoid. The most frequent symptoms of neoplasm simulated those of an exacerbation of the colitis, and included diarrhea, abdominal pain, rectal bleeding, and weight loss. The unreliability of roentgenographic diagnosis of colonic carcinoma in association with colitis was re-emphasized by our study, as 6 of 13 potentially diagnosable lesions were missed. Carcinoma of the colon arising in patients with long-standing ulcerative colitis is a serious hazard, but is not so frequent as has been suspected. However, the physician who treats the patient with ulcerative colitis should be wary of new symptoms and should manage them vigorously with appropriate diagnostic and therapeutic procedures. In this manner, carcinoma may be detected early, and survival rates may be improved.A portion of this paper was presented at the fall meeting of the American College of Physicians, Los Angeles, Calif., Oct. 9, 1964.     

Adenosquamous-cell carcinoma in ulcerative colitis

Three adenosquamous carcinomas and 2813 adenocarcinomas of the colon proximal to a line 7 cm craniad to the dentate line were treated between 1946 and 1986. Of these, one adenosquamous carcinoma and 42 adenocarcinomas were associated with ulcerative colitis. Therefore it was calculated that adenosquamous carcinoma occurs 0.07 percent as frequently as adenocarcinoma of the colon in the general hospital population and 2.4 percent as frequently in patients with ulcerative colitis, a 33-fold increase. It is concluded that, although adenosquamous-cell carcinoma of the colon is a rare tumor, its frequency in relation to adenocarcinoma increases in the presence of ulcerative colitis.     

Carcinoma of colon complicating ulcerative colitis

Summary and Conclusions There were ten additional patients in whom ulcerative colitis was complicated by cancer of the colon. A total of 33 patients with carcinoma of the colon among approximately 1,200 patients with ulcerative colitis have been identified. Seven of the ten are dead. The average age when cancer appeared was 44 years and malignancy was diagnosed after an average duration of ulcerative colitis of 17 years. The distribution of carcinoma was more diffuse throughout the colon in ulcerative colitis than that in the case ofordinary cancer of the large bowel. The neoplasia frequently was multifocal, presented variable histopathologic characteristics, and involved new sites in the colon after removal of the initial tumor. Involvement of lymph nodes was present in most cases, but it did not exclude the possibility of prolonged periods of survival. This study was supported in part by grants from the National Cancer Institute of the National Institutes of Health.