Histology of polypoid lesions found in specimens resected for adenocarcinoma of the colon.

In a revision of 298 colectomy specimens resected for adenocarcinoma of the large bowell, 35 cases (13%) were found to have associated polypoid lesions. Twenty-nine of the polypoid lesions were adenomatous polyps, one a villous adenoma and other a retention polyp. Eight of the adenomatous polyps had a variable degree of benign atypical changes and malignant transformation occurred in four adenomatous polyps with the development of an adenocarcinoma. Four other lesions were small polypoid adenocarcinomas arising in normal colonic mucosa. Four double primary carcinomas were found among the 35 colectomy specimens with polyps. In this paper a significative incidence of malignant polypoid lesions associated with adenocarcinomas of the large bowell were found. The importance of well defined histological criteria in the diagnosis of malignancy and atypical changesin adenomatous polyps in stressed out.     

Verrucous carcinoma of the esophagus completely resected by endoscopy

Verrucous carcinoma of the esophagus is a very rare esophageal cancer. We present a case of verrucous carcinoma of the esophagus, the 14th such case reported. In contrast to the previous cases, our patient had no symptoms and did not have a history of severe or repeated injury of the esophagus. The patient was completely resected by endoscopy and was well after 3 yr of follow-up, without recurrence of the disease.     

The relationship between the histopathological atypia and expression of beta-catenin in colonic neoplasms resected by endoscopy; comparison with that of p53 protein]

Previous studies have reported predominantly nuclear localization of beta-catenin as a role for colorectal carcinogenesis. In this study, we examined the immunohistochemical expression of beta-catenin and p53 protein in 90 colonic neoplasms {33 carcinomas in adenoma (CIA), 28 high grade adenomas and 29 low grade adenomas}, resected by colonic endoscopy. Out of 33 CIAs. 28 (84.8%) cases showed predominantly nuclear localization of beta-catenin, and that was significantly higher than those of both high grade (46.4%) and low grade (13.8%) adenomas. The positiveness of p53 expression in CIAs was 51.5% (17/33), while 17.9% in high grade and 3.4% in low grade adenomas. However, there was no correlation between both protein expressions (p = 0.3472, chi 2 test). The results suggests that nuclear localization and accumulation of beta-catenin is earlier event than that of p53 mutation in adenoma-carcinoma sequence, and is useful as a marker in histopathological diagnosis for malignant conversion as well as p53.     

A case of polypoid cavernous hemangioma of the sigmoid colon excised by colonoscopic polypectomy

A 28-year-old Japanese man was admitted to our institute because of sharp anal pain and a mass that prolapsed from the anus after defecation. After spinal anesthesia for emergency operation, the mass spontaneously withdrew into the anus and the pain disappeared. Surgery was postponed. Barium enema and colonoscopy revealed a pedunculated polyp in the sigmoid colon, which was removed by snare polypectomy with electrocautery. The resected polyp was granular and reddish, and measured 33 × 22 × 14 mm. Histological examination of the polyp revealed a cavernous hemangioma. Hemangioma of the colon is rare; only 52 cases have been reported in Japan. Of these patients, eight underwent endoscopie polypectomy. The present lesion is the largest thus treated that has been documented. Endoscopie polypectomy seems to be a safe and preferable procedure for the diagnosis and treatment of small, solitary polypoid hemangiomas of the colon.     

A case of polypoid type ganglioneuroma of the decsending colon]

A 32-year-old woman came to our hospital with purpose of careful examination for anemia. Colonoscopy was revealed a solitary protrusion with irregular shape covered with red and discolored mucosa of the descending colon. Surface of this lesion was smooth, which had flexibility in dynamic study with infusion of the air and water. Additionally, multiple ulcer scars was recognized on this lesion. After dye-spraying using by crystal-violet, no neoplastic pits was detected on the lesion except for asteroidal pits and pattern of pinecone on reddish protrusions. Endoscopic ultrasonography demonstrated a thickened low echoic layer (from 2nd to upper half of the 3rd layer) and anechoic structure in higher reddish part of the lesion. Diagnostic EMR was performed with no complication. Histological examination was revealed a spindle cells and ganglion cells in much fiber which was positive for immunostaining of S-100 ptotein. Hyperplastic glands were seen with no neoplastic change in reddish protrusion. Therefore, Diagnosis of polypoid ganglioneuroma of the descending colon was made. To a rare thing, our case was the 16th reported case of ganglioneuroma in large intestine without neurofibroma-1 or multiple endocrine neoplasm.     

直肠异常隐窝病灶对结肠肿瘤的预警作用

目的 评判内镜下直肠异常隐窝病灶(ACF)与结肠病变及高癌变潜能肿瘤(AN)的关系.方法 接受全结肠镜检查的正常、息肉、腺瘤及癌的患者212例,在退镜时用0.4%靛胭脂对直肠进行染色,根据直肠ACF的数目对患者分级,无ACF者为0级,ACF数目为1～4,5～9,≥10者分别为Ⅰ、Ⅱ、Ⅲ级,统计分析ACF级别与结肠病变(息肉、腺瘤和癌),高癌变潜能肿瘤(≥1 cm,绒毛状、管状绒毛状,高度异型增生或浸润癌)的关系.结果 212例患者中,72例直肠ACF为0级,48例为Ⅰ级,41例为Ⅱ级,51例为Ⅲ级.直肠有ACF(包括Ⅰ、Ⅱ、Ⅲ级)的患者发生结肠病变及结肠高癌变潜能肿瘤的概率较无ACF者明显升高,其OR值(95%CI)分别为22.352(6.716～74.395),7.982(1.838～34.672).结论 直肠ACF对结肠病变及高癌变潜能肿瘤有预示作用.     

Experimental carcinogenesis in the resected colon of the rat.

Until now, carcinoma of the large intestine resected previously for benign disease has not been published. However an increasing number of patients resected for Crohn's disease, diverticulitis or trauma may reach nowadays a high lifespan. On the other hand, it is known that the gastroenteral anastomosis is predisposed to cancer development. In this study, the question of whether the large intestine following colotomy or ileotransversostomy is sensitive to carcinogenesis is examined. Male Wistar rats, subjected to colotomy or resection and ileotransversostomy, were treated weekly by subcutaneous injection of 1,2-dimethylhydrazine (12 mg/kg body weight) for seven weeks. The animals were killed 54 weeks after the first injection. At autopsy, 21 out of 29 operated rats had developed adenocarcinomas of the remaining colon. Intact control animals had the same incidence of malignant degeneration of the large bowel. When the anastomosis is chronically irritated by inflammation or by formation of a diverticulum, development, of carcinoma near the stoma was observed. This was the case in three rats of 28 animals. The results demonstrate that the resected colon of the rat is not more sensitive to experimental carcinogenesis than the intact one.