胃肠道多原发恶性肿瘤35例分析

目的 探讨胃肠道多原发恶性肿瘤的临床病理特点。方法 通过计算机病案管理系统检索我院近５年手术治疗的胃肠道恶性肿瘤８２０例,其中３５例经病理确诊为胃肠道多原发癌,发生率为４．３％。男女之比为２．５：１。结果 多原发大肠癌２５例,胃及胃肠多原发癌１０例;同时癌２３例,异时癌１２例;胃多原发癌的眼病年龄、病程、组织分化不良程度均高于大肠多原发癌及胃肠多原发癌。胃肠道多原发癌发病年龄轻,癌灶分布以右半结肠     

遗传性非患肉性大肠癌的临床表型分析

目的建立HNPCC家系登记档案,以便收集、归类遗传性大肠癌临床表型和人口统计学资料,为寻找大肠癌的易感基因奠定基础.方法选择符合阿姆斯特丹Ⅱ标准的13个HNPCC家系为研究对象.观察发病的一般规律①确诊时的年龄,性别;②肿瘤发生的部位(包括肠外癌);③同时多原发结肠癌;④异时多原发结肠癌;⑤临床表现.结果①13个家系中,18岁以上的家族成员共248人,确诊HNPCC的患者64例.②13个家系均为常染色体显性遗传.64例患者中,女性23例,男性41例.③确诊的中位年龄为41岁,50岁以前发病者为68.75%,60岁以前的发病率达90.63%.④72个原发癌灶中,肠外癌灶15个(20.83%);大肠癌灶57个(79.16%).大肠癌中右半结肠癌占66.67%(38/57),左半结肠癌为33 33%(19/57).⑤同时多原发癌4例,其中2例为3次多原发癌,2例为2次多原发癌;异时多原发癌1例.结论HNPCC的临床特点为发病年龄比西方患者年轻;右半结肠癌的比例高;大肠癌的垂直传递特征突出;肠外癌以胃癌比例较大;同时原发癌和异时原发癌较多.对患者及其家系成员进行长期监护和随诊将可早期发现大肠癌,并可经过干预治疗,降低家系成员的大肠癌发病率.     

遗传性非息肉病性结直肠癌家系临床病理特征分析

目的 探讨中国人遗传性非息肉病性结直肠癌(HNPCC)家系发病特点及预后.方法 收集24个符合Amsterdam标准的HNPCC家系,绘制其家系图谱、收集临床病理及随访资料,分析中国人HNPCC的发病特点及预后.结果 24个HNPCC家系中,共有肿瘤患者116例(其中先证者多原发癌16例,家系成员多原发癌9例),发病年龄19～74岁,其中结直肠癌灶120个,肠外相关肿瘤32个.在24个HNPCC家系的先证者中,患第一结直肠癌的平均年龄为42.5岁,男性多于女性,右半结肠肿瘤多于左半结肠;肿瘤分化均较好,以中分化多见,病理类型以管状腺癌多见,占45.8%(11/24);截至随访结束时,术后生存≥5年者共14例,占58.3%(14/24),其中9例超过10年,最长1例存活时间已达27年.结论 中国人HNPCC以中分化管状腺癌多见,发病年龄较轻,右半结肠癌多见.     

新疆地区遗传性非息肉病性大肠癌临床病理特点分析

目的探讨新疆地区遗传性非息肉病性大肠癌（HNPCC）的临床病理特点,并对中国人HNPCC诊断标准进行评价。方法新疆地区符合中国人HNPCC诊断标准的HNPCC 12家系63例（HNPCC组）,其中4家系同时符合AmsterdamⅡ标准为A组,其余为B组;随机选取同期收治的无家族遗传倾向的散发性大肠癌152例（散发组）。采用SPSS16.0软件,对HNPCC组、散发组间及HNPCC中A、B组患者的临床病理资料进行比较。结果 HNPCC组发病年龄〈50岁者23例,肿瘤位于右半结肠39例,低分化癌32例,多发癌12例,肠外恶性肿瘤22例,Dukes A期24例,黏液腺癌31例;散发组分别为26、50、38、6、5、34、43例。两组比较,P均〈0.05。HNPCC中A、B组患者临床病理特征比较,P均〉0.05。结论新疆地区HNPCC的特点是发病年龄早、右半结肠多见、病理分化差、多发癌常见,肠外恶性肿瘤发生率高;与AmsterdamⅡ标准比较,中国人HNPCC诊断标准更适用于新疆地区HNPCC的诊断。     

纤维结肠镜诊断大肠恶性肿瘤651例分析

纤维结肠镜诊断大肠恶性肿瘤６５１例分析徐向英，吴华星，王成良我院自１９８０年６月至１９９０年６月共行纤结镜检查３２１４例次。诊断为大肠恶性肿瘤６５１例，占同期受检人数的２０．３％。其中多原发癌１５例，占同期大肠癌检出率的２．３％。本文着重就纤结镜对大...     

结肠镜对诊断大肠多原发癌的作用

大肠多原发癌和腺瘤是引起大肠癌术后复发的重要原因。大肠癌术前全结肠的肠镜检查、术后的肠镜随访、肠镜下积极治疗癌前病变——大肠腺癌,是提高大肠多原发癌的诊断和降低发生率的重要手段。 临床资料 1973～1991年共行结肠镜检查2600例,发现大肠癌163例(6.3％),其中大肠多原发癌22例(13.5％)。男13例,女9例。年龄18～20岁3例,29     

遗传性非息肉病性大肠癌的研究进展

遗传性非息肉病性大肠癌(HNPCC)是一种由错配修复基因(MMR)突变造成的常染色体显性遗传病,又称Lynch综合征,是遗传性大肠癌的代表.HNPCC约占全部大肠癌的5%-15%.错配修复基因(MMR)的种系突变和微卫星不稳定(MSI)是其分子遗传学基础.HNPCC的临床病理特点突出,具有右半结肠多见、发病早、病理分化差、多原发癌多见的特点.目前其治疗方法以手术为主,COX-2阻滞剂可能成为HNPCC治疗的一个新的途径.近年来分子生物学的进展也为人们对HNPCC生物学行为和治疗的认识提供了有益的参考.     

多原发大肠癌临床病理特点及诊治分析

目的探讨多原发大肠癌(MPCC)的临床病理特点及诊治。方法回顾性分析2008年1月至2017年3月首都医科大学附属北京世纪坛医院收治的42例MPCC患者的病历资料,对其临床病理特点及诊治进行总结。结果MPCC占同期大肠癌患者的71%(42/592),其中同时性多原发癌(SC)32例(762%)64处癌灶,异时性多原发癌(MC)10例(238%)20处癌灶,首发癌灶与再发癌灶间隔时间18～105个月。SC患者中高、中分化腺癌比例高于MC患者(P<005),而含黏液分泌腺癌比例低于MC患者(P<005)。2组患者肿瘤大小、发病部位、是否合并腺瘤、TNM分期、淋巴结转移及DNA错配修复状态,差异均无统计学意义(P>005)。42例患者均行根治性手术治疗,10例肠梗阻患者中,6例接受结肠支架桥接一期根治手术。结论MPCC以双发癌为主,主要分布在直肠、乙状结肠。对于MPCC患者中的低分化、结直肠黏液腺癌、合并结肠腺瘤者,应予结肠镜密切随访。结肠支架置入桥接一期切除术可提高SC的检出。     

大肠癌中多药耐药相关蛋白表达的研究

目的：研究多药耐药相关虽白在在肠癌的表达及其意义。方法：应用单克隆抗体QCR-1行LSAB免疫组化法研究42例大肠癌组织中多药耐药相关蛋白的表达水平。结果：大肠癌组织中多药耐药相关蛋白表达的总阳性率为69.1％．其中乳头状腺癌66.7％，管状腺癌70.0％．粘液腺癌69.2％．大肠癌不同病理类型与MRP表达闻无显性差异(p>0.05)；癌旁正常肠组织呈阴性表达：在大肠癌不同病理分期中．MRP表达率癌阳性率分别为Dukcs’A期87.5％．Dukes’B期91.7％．Dkes’C期60.0％Dukes’D期28.6％．大肠癌Dukes’A期与Dukes’B期MRP表达率和Dukes’D期比较有显性差异(p<0.01)；大肠癌不同部位的MRP表达阳性率比较中．左半结肠62.5‰右半结肠63.7％直肠73.9％，两无显性差异。结论：表明多药耐药相关蛋白是参与大肠癌多药耐药的重要因素．其表达与大肠痛病理分期相关．     

遗传性非息肉病性结直肠癌的临床特征与诊断原则

目的：探讨遗传性非息肉病性结直肠癌（HNPCC）的临床特点和诊断。方法：收集22个符合Amsterdam标准的HNPCC家族，分析其临床特点。结果：本组符合Amsterdam标准的HNPCC发病率为2．6％＜22个家族有恶性肿瘤患者101例，结直肠癌患者84例，发生第一个结直肠癌的平均年龄为45．7岁，位于脾曲近侧结肠和直肠的分别占58．3％和23．8％。23．8％患者发生同时或异时多原发结直肠癌。20例患者发生肠外肿瘤，以胃癌居多。结论：HNPCC具有发病年龄早，近侧结肠多见，同时和异时多原发结直肠癌发生率高的特点，诊断治疗及随访应有别于散发性结直肠癌。本组肠外肿瘤以胃癌发生率高，与国外报道不同。建立中国人的HNPCC诊断标准是必要的。     

Gastrin and colorectal cancer

Plasma gastrin has been reported to be elevated among patients with colorectal cancer. The objectives of the present study were to confirm this observation and, if confirmed, to shed light on the reason for the elevation. Presurgical and postsurgical fasting plasma gastrin levels were compared between 24 patients hospitalized for colorectal adenocarcinoma resection and 25 control patients hospitalized for other surgery. Elevated presurgical gastrin levels in the case group that fell after surgery woulds be consistent with preduction of gastrin by the tumor. High presurgical gastrin levels in the case group that did not change following surgery would be consistent with excess gastrin production by G cells. The mean presurgical gastrin levels were 21.9±3.7 pM (cases) and 45.1±18.0pM (controls). The mean postsurgical gastrin levels were 20.5±3.9 pM (cases) and 43.4±14.6 pM (control). These results do not provide support for the hypothese that gastrin is elevated in colorectal cancer patients or that gastrin is secreted by colorectal tumors in sufficient quantities to be measurable in the plasma.This work was supported by the National Cancer Institute (P01-CA42101, Cancer Prevention Research Unit for Connecticut at Yale University). Dr. Yapp was supported by a Training Grant (DK 07017) awarded by the National Institute of Diabetes, Digestive and Kidney Diseases. Dr. Dubrow received support from a National Cancer Institut Preventive Oncology Academic Award (K07-CA01463).     

SUCCESSFUL PLACEMENT OF SELF‐EXPANDABLE METALLIC STENTS FOR DOUBLE COLORECTAL CANCERS

Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller‐Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly.     

Distribution trends of colorectal adenoma and cancer: a colonoscopy database analysis of 11,025 Chinese patients

Background and Aim: A left‐to‐right shift of colorectal cancer (CRC) has been reported in Western studies. However, few Asian studies have investigated the anatomic distribution of colorectal adenoma and CRC. We aimed to describe the time trends in the distribution of colorectal adenoma and CRC in a Chinese population. Methods: A colonoscopy database was reviewed, and all consecutive patients with lower gastrointestinal symptoms who underwent colonoscopy from 1998 to 2009 were identified. Data, including patients' sex, age, symptoms, and the number and anatomic locations of colorectal adenoma and CRC, were documented. Results: A total of 11 025 patients were included in the final analysis; 1012 and 363 patients were diagnosed with colorectal adenoma and CRC, respectively. Overall, there were more distal than proximal adenomas (54.4% vs 37.9%), and the proportion of proximal adenomas remained stable from 1998–2006 to 2007–2009 (38.2% vs 37.6%). Similarly, there were more distal than proximal CRC (56.5% vs 42.4%), and the proportion of proximal CRC declined from 45.8% in 1998–2006 to 38.4% in 2007–2009. Colorectal adenoma and CRC were equally distributed among both sexes. For elderly patients (> 50 years), there was a non‐significant trend towards more proximal adenoma and CRC. Conclusions: The present study suggests no distal‐to‐proximal shift of colorectal adenoma and CRC among the Chinese population in Shanghai over the past 12 years. The distribution pattern of colorectal adenoma and CRC of Chinese patients is different from that of Western patients, who had more colorectal lesions located in the distal part.     

Original research: Characteristics and attitudes of first round invitees in the Irish National Colorectal Cancer Screening Programme

Background/objectiveColorectal cancer (CRC) screening is proven to reduce CRC-related mortality. Faecal immunochemical testing (FIT)-positive clients in the Irish National CRC Screening Programme underwent colonoscopy. Round 1 uptake was 40.2%. We sought to identify barriers to participation by assessing knowledge of CRC screening and examining attitudes towards FIT test and colonoscopy.MethodsQuestionnaires based on a modified Champion’s Health Belief Model were mailed to 3500 invitees: 1000 FIT-positive, 1000 FIT-negative and 1500 non-participants. 44% responded: 550 (46%) FIT-positive, 577 (48%) FIT-negative and 69 (6%) non-responders (NR).Results25% of respondents (n=286) did not perceive a personal risk of cancer, did not perceive CRC to be a serious disease and did not perceive benefits to screening. These opinions were more likely to be expressed by men (p=0.035). One-fifth (n=251) found screening stressful. Fear of cancer diagnosis and test results were associated with stress. FIT-positive clients, women and those with social medical insurance were more likely to experience stress.ConclusionsThe CRC screening process causes stress to one-fifth of participants. Greater use of media and involvement of healthcare professionals in disseminating information on the benefits of screening may lead to higher uptake in round 2.     

结肠癌组织中MMP-7、MMP-9的表达及意义

目的观察结肠癌组织中基质金属蛋白酶（MMP）-7、MMP-9的表达，探讨其在结肠癌浸润、转移中的作用。方法采用免疫组化SP法检测50例结肠癌及其切缘组织中MMP-7、MMP-9的表达。结果肿瘤组织中MMP-7、MMP-9阳性表达率分别为68．00％和82．00％，标本切缘组织中分别为0和24．00％，两者相比，P均〈0．05，MMP-7、MMP-9在有淋巴结转移者中的阳性表达率为86．96％和91．30％，显著高于无淋巴结转移者的51．85％和74．07％，P均〈0．05；MMP-7、MMP-9在结肠癌组织中的表达呈正相关，r=0．84，P〈0．05。结论MMP-7、MMP-9高表达可能与结肠癌的浸润、转移有关。     

Identification and functional characterization of paxillin as a target of protein tyrosine phosphatase receptor T

Protein tyrosine phosphatase receptor-type T (PTPRT) is the most frequently mutated tyrosine phosphatase in human cancers. However, the cell signaling pathways regulated by PTPRT largely remain to be elucidated. Here, we show that paxillin is a direct substrate of PTPRT and that PTPRT specifically regulates paxillin phosphorylation at tyrosine residue 88 (Y88) in colorectal cancer (CRC) cells. We engineered CRC cells homozygous for a paxillin Y88F knock-in mutant and found that these cells exhibit significantly reduced cell migration and impaired anchorage-independent growth, fail to form xenograft tumors in nude mice, and have decreased phosphorylation of p130CAS, SHP2, and AKT. PTPRT knockout mice that we generated exhibit increased levels of colonic paxillin phosphorylation at residue Y88 and are highly susceptible to carcinogen azoxymethane-induced colon tumor, providing critical in vivo evidence that PTPRT normally functions as a tumor suppressor. Moreover, similarly increased paxillin pY88 is also found as a common feature of human colon cancers. These studies reveal an important signaling pathway that plays a critical role in colorectal tumorigenesis.     

Colorectal laceration after manual-anal intercourse

Injuries and illnesses related to changing sexual behaviors are being reported with increasing frequency. A practice found predominantly in the homosexual community, "handballing," may result in occult but serious colorectal trauma. Described is the case of a 31-year-old man who presented with an acute abdomen due to colorectal laceration secondary to handballing. After emergency surgical repair, he had an uneventful recovery, and returned once for elective colostomy closure.