Diffuse esophageal leiomyomatosis with a pedunculated polyp

Although leiomyomas are the most common benign tumors of the esophagus, esophageal leiomyomatosis is a rare pathological entity, and pedunculated presentation is even rarer. A 61-year-old man was found, incidentally, to have an esophageal tumor on a survey of chest computed tomography (CT) examination for a pulmonary nodule. Endoscopy disclosed a pedunculated polyp covered by nearly normal esophageal mucosa, with surrounding annular extension of a submucosal elevation. Endoscopic ultrasonography (EUS) revealed a hypoechoic tumor, with a maximum diameter of 3cm originating from the thickened muscularis mucosa layer. The underlying muscularis propria layer was also prominently thickened. The polypoid lesion was then removed by endoscopic resection with wire-loop ligation, followed by snare electrocoagulation. The pathological diagnoses of the polyp and the surrounding submucosal lesions were both leiomyoma. Diffuse esophageal leiomyomatosis was suspected in this situation because of the characteristic pathological distribution. In this patient, the EUS findings corresponded well to the characteristic features of diffuse esophageal leiomyomatosis noted in previous reports, and this was of great help for the diagnosis, in addition to the endoscopic findings. This case report is presented with a particular focus on the problems associated with accurate diagnosis.     

A rare case of a signet ring cell carcinoma of the colon mimicking a juvenile polyp

Primary signet ring cell carcinoma (SRC) of colon at early stage is quite rare. Only 26 cases were reported until now. We report an early stage of primary SRC which was misdiagnosed as a juvenile polyp and treated with polypectomy followed by surgical resection. A 21-year-old male was administered for hematochezia. Abdominopelvic enhanced computed tomography revealed a polyp with active bleeding at the proximal rectum just below the rectosigmoid junction. Colonoscopy examination revealed a colon polyp with 0.5 cm sized head. Polypectomy was performed with snare and the polyp was completely removed. Biopsy revealed SRC. Surgical resection was also performed and there were no residual tumor or lymph node metastasis in the surgical specimen.     

Early colon cancer detected by 18F-FDG PET

Positron emission tomography (PET) is a noninvasive functional imaging modality that can disclose the presence of a malignant disease. It has recently been reported that PET may be useful to detect primary colorectal cancer (CRC). We present the case of a 47-yr-old man with early colon cancer detected by ¹⁸F-fluorodeoxyglucose (FDG) PET. The patient consulted us because of a positive fecal occult blood test and focal FDG uptake in the pelvic cavity detected at a physical check-up. After the usual work up, he was diagnosed as having a sigmoid polyp, 16 mm in diameter. Subsequently, colonoscopic polypectomy was carried out. The surgical specimen was histologically diagnosed as a well-differentiated adenocarcinoma, invading the submucosal layer with lymphatic invasion. Therefore, the involved portion of the sigmoid colon was laparoscopically resected. The FDG PET carried out 1 yr after the operation, showed no abnormal FDG uptake. PET can noninvasively detect an early colon cancer as small as in our patient, as well as other cancers in the whole body. Therefore, we consider it suitable as a screening examination.     

A case of perianal Paget’s disease associated with a sigmoid colon carcinoma

A case of perianal invasive Paget’s disease associated with a sigmoid colon carcinoma is presented. The chief complaint was perianal irritation for a year. Histologic examination yielded a correct diagnosis and abdominosacral resection with wide excision of the cutaneous component was performed. Histology of the resected specimen revealed the Paget’s disease to be invasive of the dermis, the sigmoid colon carcinoma to be in Dukes’ A stage and the two lesions to be different. The patient has been disease-free for more than 5 years after the operation.     

Superficial depressed early carcinoma that developed into protuberant advanced carcinoma in the transverse colon

A screening colonoscopic examination in a 70-year-old man revealed a nonpolypoid type superficial depressed early carcinoma, about 2 cm in diameter, in the transverse colon. The lesion was not resected and was observed because of coexisting nonresectable hepatocellular carcinoma (HCC). Fifteen months later, follow-up examinations revealed a polypoid type protuberant advanced carcinoma, about 6 cm in diameter, at the same site. Because complete response of the HCC had been induced by transarterial embolization, the colon carcinoma was operatively resected. There is an indefinite concept that colorectal carcinomas develop without substantial morphological changes, and no superficial depressed carcinoma that developed into a protuberant type advanced carcinoma has been reported. The case reported here provides evidence that some polypoid carcinomas arise from superficial depressed precursors. There is some intermingling between the two postulated colorectal carcinogenic pathways, the conventional polypoid pathway named the "adenoma-carcinoma sequence", and the nonpolypoid pathway, including so-called "de-novo" carcinogenesis. Received: December 17, 1999 / Accepted: April 28, 2000     

A large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma

An inflammatory polyp of the gallbladder is a rare variant of benign gallbladder polyp. Differentiation between an inflammatory polyp and polypoid gallbladder carcinoma is difficult when the polyp is more than 1 cm in diameter. We report a rare case of a large inflammatory polyp of the gallbladder masquerading as gallbladder carcinoma in a 37-year-old Japanese woman who was incidentally diagnosed with a large gallbladder polyp, measuring 1 cm in diameter, by ultrasonography. She was asymptomatic and physical examination was unremarkable. Abdominal ultrasonography and endoscopic ultrasonography revealed three polypoid lesions in the gallbladder. One lesion was an isoechoic polyp, measuring 15 × 8 mm, showing a nodular surface and located in the fundus of the gallbladder. The other two lesions were hyperechoic polyps, measuring 5 × 5 mm, in the body of the gallbladder. Computed tomography and magnetic resonance imaging revealed marked enhancement of the largest polypoid lesion by dynamic study, and no lymph node enlargement was noted. Endoscopic retrograde cholangiography revealed a 12 × 8 mm polyp with an irregular surface in the fundus of the gallbladder. Superselective angiography of the cystic artery revealed neovascularity and a tumor stain in the fundus of the gallbladder. Cholecystectomy with lymph node dissection was performed. Intraoperative frozen section diagnosis of the largest polyp was an inflammatory polyp of the gallbladder. The other two polyps were cholesterol polyps. Inflammatory polyp should be considered as a differential diagnosis of hypervascular gallbladder polyps that measure more than 1 cm in diameter. Received Dec. 26, 1997; accepted Apr. 24, 1998     

Early stage colon cancer

Evidence has now accumulated that colonoscopy and removal of polyps,especially during screening and surveillance programs,is effective in overall risk reduction for colon cancer.After resection of malignant pedunculated colon polyps or early stage colon cancers,long-term repeated surveillance programs can also lead to detection and removal of asymptomatic high risk advanced adenomas and new early stage metachronous cancers.Early stage colon cancer can be defined as disease that appears to have been completely resected with no subsequent evidence of involvement of adjacent organs,lymph nodes or distant sites.This differs from the clinical setting of an apparent"curative"resection later pathologically upstaged following detection of malignant cells extending into adjacent organs,peritoneum,lymph nodes or other distant sites,including liver.This highly selected early stage colon cancer group remains at high risk for subsequent colon polyps and metachronous colon cancer.Precise staging is important,not only for assessing the need for adjuvant chemotherapy,but also for patient selection for continued surveillance.With advanced stages of colon cancer and a more guarded outlook,repeated surveillance should be limited.In future,novel imaging technologies(e.g.,confocal endomicroscopy),coupled with increased pathological recognition of high risk markers for lymph node involvement(e.g.,"tumor budding")should lead to improved staging and clinical care.     

Diverticular disease as a risk factor for sigmoid colon adenomas

BACKGROUND: Diverticular disease and colorectal neoplasia share similar epidemiological features and risk factors. AIM: To evaluate a possible association between diverticular disease and both adenomas and colorectal cancer in patients undergoing total colonoscopy. METHODS: Overall, 630 consecutive patients were recruited from the 3 Units. Inclusion criteria were age over 45 years and the performance of total colonoscopy. Demographic and clinical data were recorded. Adenomas were defined as advanced when their size was >1 cm in diameter, and/or the percentage of the villous component was >30% and/or high grade dysplasia was present. RESULTS: At endoscopy, 291 (47%) out of 630 patients presented evidence of diverticular disease. Adenomas were found in 92 (31.9%) patients with diverticular disease and in 98 (28.9%) patients without [p=ns]. The prevalence of adenomas located in the sigmoid colon was significantly higher in patients with diverticula than in controls (64.1% vs 41.8%; p<0.05). Similarly, the detection of advanced adenomas located in the sigmoid colon was more likely in patients with diverticula than in controls (59.6% vs 37.5%; p<0.05). Colorectal cancer prevalence was similar in patients with and without diverticula (8.3% vs 7.1%; p=ns), and no difference was detected regarding site, between the two groups. CONCLUSIONS: Patients with diverticular disease have a higher risk of harbouring adenomas and advanced adenomas in the sigmoid colon. This observation should be taken into account in screening and surveillance programmes for colorectal neoplasia.     

Poor correlation between clinical impression, the small colonic polyp and their neoplastic risk

BACKGROUND AND OBJECTIVES: Significance of the small colonic polyp is unclear and its removal is frequently determined by the proceduralist's clinical impression. Our aims were to determine if clinical discernment is accurate, and the likelihood that lesions < 10 mm are histologically advanced. METHOD: We prospectively collected 1988 lesions from 854 subjects (2215 consecutive colonoscopies). Lesion size, location, patient age, sex and the colonoscopist's clinical impression was recorded. RESULTS: Clinical assessment for neoplasia had a sensitivity of 87.4%, specificity of 65.0%, positive predictive value of 76.0% and negative predictive value of 80.2%, resulting in an accuracy of 73.4%. Factors predictive of correct clinical impression were polyp size, location in the rectum and being pedunculated, but not the patient's age, sex or the endoscopist's experience. Of the 1434 lesions < or = 5 mm in size, 44.5% were neoplastic and 3.5% were histologically advanced. Of the 266 lesions 6-9 mm, 79.3% were neoplastic, 19.9% were histologically advanced, five demonstrated high-grade dysplasia and three were malignant. Only two patients with an adenocarcinoma or high-grade dysplasia in a polyp <10 mm had a lesion > or =10 mm elsewhere in the colon. Of the 288 lesions > or =10 mm in size, 92.7% were neoplastic, 29.5% had a villous component, 6.9% demonstrated high-grade dysplasia and 29.2% were malignant. Factors predictive of neoplasia were patient age, polyp size and sessile nature of the lesion. CONCLUSION: Polyps < 10 mm had a significant risk of neoplasia and advanced histology and, in general, clinical impression correlated poorly with neoplasia. Removal of all lesions proximal to the rectum, regardless of size, should therefore be considered.     

Humoral hypercalcemia complicating adenosquamous carcinoma of the proximal colon

Summary Hypercalcemia as a complication of carcinoma of the colon is uncommon (1). It usually occurs in the presence of anorectal or rectal carcinoma that metastasizes to the lumbosacral vertebrae (2–4). Hypercalcemia complicating colon carcinoma in the absence of bone metastases—so-called humoral hypercalcemia of malignancy or paraneoplastic hypercalcemia—is rare. Only two such cases associated with adenocarcinoma of the colon (5, 6) and two cases associated with adenosquamous carcinoma of the distal colon (rectum and sigmoid) (7) have been reported. We describe the first reported case of an adenosquamous carcinoma of the cecum and ascending colon that was accompanied by severe humoral hypercalcemia. The hypercalcemia was associated with a parathyroid hormone (PTH) -like substance.     

Long-term follow-up of patients with malignant pedunculated colon polyps after colonoscopic polypectomy

BACKGROUND:

Previously published studies have suggested that patients with resected colon cancer have an increased risk for early metachronous colon cancer. Current screening guidelines recommend intense surveillance by colonoscopy for the initial five years after the initial colon cancer has been resected. Information regarding endoscopically removed malignant polyps is limited.

METHODS:

In the present study, 25 consecutive patients (14 male, 11 female) with malignant pedunculated colon polyps treated with snare cautery polypectomy were followed for more than one decade up to 20 years. Five patients required an additional resection to ensure that removal of the original cancer was complete. Annual colonoscopies were planned for five years. If an adenoma was detected in the fifth year, colonoscopy was performed annually until no adenomas were detected. Otherwise, colonoscopy was planned every three years after five years.

RESULTS:

In the present study, there was no mortality from colon cancer and no patient developed either recurrent colon cancer or an early metachronous colon cancer during the initial five-year period of surveillance. Two patients (one male, one female) ultimately developed late cecal cancers almost one decade after the original colon cancers were resected. One had an early stage cancer that was resected, while the other had an infiltrating mucinous carcinoma complicating a small tubulovillous adenoma with extension to a single lymph node. After surgical removal and adjuvant chemotherapy, no further neoplastic disease has been detected.

CONCLUSIONS:

Overall, patients with malignant pedunculated polyps do extremely well if appropriately managed at the time of the initial polypectomy. Short-term outcomes after removal of a malignant polyp(s) appear to be similar to those with a nonmalignant polyp. However, late metachronous colon cancer may still occur. Long-term follow-up should be considered in each patient, assuming reasonable life expectancy, because risk of additional adenomas and metachronous colon cancer persists even after the initial five years of currently recommended surveillance. Patients with resected malignant polyps may represent a special patient subgroup that requires surveillance for more extended periods than current guidelines have recommended.     

Squamous-cell carcinoma of the colon

Primary squamous-cell and adenosquamous-cell carcinoma of the colon are uncommon and their characteristics not well known. This paper reports the clinical features and pathologic findings of two colonic adenosquamous carcinomas and reviews other reports of adenosquamous and squamous carcinoma of the colon from the English medical literature. Including these two cases, 63 cases have been reported since 1927. Of these, six occurred in patients with ulcerative colitis, three occurred at the colonic opening of chronic colocutaneous fistulas, and concomitant schistosomiasis was present in two patients. Synchronous squamous-cell carcinoma of the colon was present in 3.2 percent of cases and 10 percent had either antecedent, synchronous, or metachronous adenocarcinoma of the colon. These lesions appeared to be distributed uniformly throughout the colon. The five-year survival after resective therapy for primary squamous-cell and adenosquamous-cell carcinoma of the colon calculated with life table analysis is 50 percent for Dukes' B lesions, 33 percent for Dukes' C lesions, and 0 percent for Dukes' D lesions.     

Signet-ring cell carcinoma arising from a fundic gland polyp in the stomach

Fundic gland polyps (FGPs) are currently the most common type of gastric polyps and are usually benign. However, although rare, gastric adenocarcinoma of FGP has been recently proposed as a new variant of gastric adenocarcinoma. Here we report the first case of a 49-year-old woman with focal signet ring cell carcinoma that arose from an FGP of the stomach. The tumor was completely excised by endoscopic snare polypectomy. FGPs should therefore be evaluated for malignant changes although they occur rarely, if the FGP has an erosive or irregular surface.     

Effect of sigmoidectomy in treating sigmoid colon cancer: A protocol of systematic review

Background:This study will assess the effect of sigmoidectomy in treating sigmoid colon cancer (SCC).Methods:This study will search the following databases from inception to the present: MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, OpenGrey, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched with no restrictions of language. Two researchers will independently handle all study selection, data extraction, and risk of bias, respectively. Any disparities between 2 researchers will be figured out by a third researcher through discussion. RevMan 5.3 software will be used for statistical analysis in this study.Results:This study will provide a high-quality synthesis of targeted outcomes to evaluate the efficacy and complications of sigmoidectomy in treating SCC.Conclusion:The results of this study will provide evidence to judge whether sigmoidectomy can benefit patients with SCC.Study registration on OSF:osf.io/dpxkg.     

Interendoscopist variability in proximal colon polyp detection is twice higher for serrated polyps than adenomas

AIMTo assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.METHODSThis study was a retrospective analysis of prospectively collected data from a regional colorectal cancer (CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma (A), one proximal adenoma (PA), one distal adenoma (DA), and one proximal serrated polyp (PSP) was assessed by using multilevel logistic regression models.RESULTSThe observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6% (mean = 35.7%) for A, from 19.1% to 39.0% (mean = 29.4%) for DA, from 6.0% to 22.9% (mean = 12.4%) for PA, and from 1.3% to 19.3% (mean = 6.9%) for PSP. After adjusting for patient-level variables (sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA (P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA (6.6%) compared with A (2.1%), and twofold higher for PSP (12.3%) compared with PA.CONCLUSIONThese results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated polyps, but not for distal adenoma detection. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.     

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.     

Squamous-cell carcinoma of the colon responsive to combination chemotherapy

PURPOSE: The majority of colorectal neoplasms diagnosed are adenocarcinomas. Other histologies such as squamous, adenosquamous, carcinoid tumors, or lymphoid tumors are occasionally identified. Given the rarity of squamous-cell tumors, it is very difficult to study their natural course and response to therapy. An attempt is made to describe the frequency, anatomic location, and response to therapy with a review of the literature. METHODS: From the Cancer Registry at the University of Missouri-Columbia Ellis Fischel Cancer Center, tumors of the colon identified above the dentate line were selected for chart review. Data were extracted from cases between the years 1940 and 1996. The key terms used to identify cases were epidermoid, squamous cell, and cancer of the rectum or colon. Using this approach, forty patients were identified and each record was reviewed. RESULTS: The majority of these cases were anal cancers with proximal extension into the rectum and were excluded. Of 4,561 cases of epithelial colon and rectal cancers identified, only one additional case of squamouscell cancer could be verified. In this report we describe a patient with a primary squamous-cell carcinoma of the sigmoid colon with metastatic disease to the liver at diagnosis who responded to systemic chemotherapy. We believe this to be the first reported case of this rare tumor type in which the patient's tumor responded to systemic chemotherapy. Two cases with a thorough review of literature are presented. CONCLUSIONS: Primary squamous-cell carcinoma of the colon is a rare malignancy of unknown cause and pathogenesis. Metastatic tumors to the colon should be ruled out in all cases before therapy. Early detection and surgery remain the main therapeutic options, but as presented in our case, response to chemotherapy in advanced disease is encouraging.     

黏着斑激酶在结肠癌组织中的表达及意义

目的探讨黏着斑激酶（FAK）在结肠癌发生、发展中的作用。方法采用RT-PCR法检测30例新鲜结肠癌及与之相对应的癌旁组织的FAK mRNA表达；同时用Western印迹法检测20例新鲜结肠癌及相对应的癌旁组织FAK蛋白表达水平，调平每对组织FAK蛋白含量后再行FAK Tyr397磷酸化位点蛋白检测。结果30例结肠癌组织FAK mRNA阳性率为90．0％，其表达值为0．745±0．530，对应癌旁组织阳性率为43．3％，其表达值为0．241±0．131（P〈0．01）；20例结肠癌组织FAK蛋白阳性率为95．0％，表达值为0．482±0．150；对应癌旁组织阳性率为60．0％，表达值为0．269±0．015；P均〈0．01。20例结肠癌组织中FAK Tyr397磷酸化蛋白阳性率为90．0％（18／20），表达值为0．385±0．021；而对应癌旁组织阳性率为20％（4／20），表达值为0．110±0．005，P均〈0．01。结论FAK特别是FAK Tyr397磷酸化蛋白表达增加在结肠癌的发生、发展中可能起重要作用。