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Han P, Lei Y, Hou W, Chen N, Liu J, Tian D, Guo Q, Yan W. Severe lower gastrointestinal bleeding caused by rectal Dieulafoy's lesion: Case reports and literature review. Medicine (Baltimore) 2022; 101:e32031. [PMID: 36482623 PMCID: PMC9726342 DOI: 10.1097/md.0000000000032031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Dieulafoy's lesion are relatively rare and can cause severe gastrointestinal bleeding. A Dieulafoy's lesion is defined as an artery that erodes the overlying epithelium without the presence of an ulcer. Bleeding in Dieulafoy's lesion predominantly involves the proximal stomach and upper gastrointestinal tract and is rarely observed in the lower gastrointestinal tract. PATIENT CONCERNS Case 1 was a 58-year-old woman complaining of sudden headache and vomiting who was diagnosed with subarachnoid hemorrhage. She underwent transcatheter embolization for intracranial aneurysm treatment but had an acute profuse hematochezia on the 11th day of admission. Case 2 was a 63-year-old man admitted to the respiratory intensive care unit because of fever with altered consciousness level for a week. He was diagnosed with advanced lung cancer that had metastasized to multiple organs one month prior. On the third day of admission, he had an attack of profuse hematochezia, and quickly developed shock and apathy. DIAGNOSIS Both patients were diagnosed with actively bleeding rectal Dieulafoy's lesion by bedside emergency colonoscopy. INTERVENTIONS Endoscopic hemostatic clipping was performed in 2 patients. OUTCOMES Hemostasis was successfully achieved in these 2 patients, and there was no recurrence of symptoms during follow-up. CONCLUSIONS We propose that hemostatic clipping is one of the options in the treatment of rectal Dieulafoy's lesions.
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Affiliation(s)
- Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu Lei
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Hou
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Nianjun Chen
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jingmei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qiaozhen Guo
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- * Correspondence: Wei Yan, Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095# Jiefang Avenue, Wuhan 430030, People’s Republic of China (e-mail: )
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Le HD, Pflaum T, Labrenz J, Sari S, Bretschneider F, Tran F, Lassen A, Nikolaus S, Szymczak S, Kormilez D, Rosenstiel P, Schreiber S, Aden K, Röcken C. Interobserver reliability of the Nancy index for ulcerative colitis: An assessment of the practicability and ease of use in a single-centre real-world setting. J Crohns Colitis 2022; 17:389-395. [PMID: 36282973 DOI: 10.1093/ecco-jcc/jjac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Histological disease severity assessment in ulcerative colitis (UC) has become a mainstay in clinical endpoints definition ("histologic remission") in clinical trials of UC. Several scores are established in the microscopical assessment of disease activity, but the Nancy index (NI) stands out being a histological index with the least amount of scoring items among these scores. To which extent histologic assessment using NI is affected by interobserver reliability in a real word setting, is poorly understood. We therefore performed a single-center retrospective analysis of NI assessment in patients with UC. METHODS We retrospectively evaluated the NI in two independent cohorts (total: 1085 biopsies, 547 UC patients) of clinically diagnosed UC patients, who underwent colonoscopy between 2007 and 2020. Cohort #1 consisted of 637 biopsies from 312 patients, Cohort #2 consisted of 448 biopsies from 235 patients. Two blinded pathologists with different levels of expertise scored all biopsies of each cohort. A consensus conference was held for cases with discrepant scoring results. Finally, an overall consensus scoring was obtained from both cohorts. RESULTS The interobserver-agreement of the NI was substantial after the assessment of 1085 biopsy samples (κ = 0.796 [95%-CI: 0.771-0.820]). An improvement of the interobserver-agreement was found with growing numbers of samples evaluated by both observers (Cohort #1: κ = 0.772 [95%-CI: 0.739-0.805]; Cohort #2: κ = 0.829 [95%-CI: 0.793-0.864]). The interobserver discordance was the highest in NI grade 1 (observer 1: n=128; observer 2: n=236). Interobserver discordance was the lowest in NI grades 0 (observer 1: n=504; observer 2: n=479) and 3 (observer 1: n=71; observer 2: n=66). CONCLUSION The NI is an easy-to-use index with high interobserver reliability to assess the histological disease activity of UC patients in a real-world setting. While NI grades 0 and 3 had a high level of agreement between the observers, NI grade 1 had a poorer agreement-level. This highlights the clinical need to specify histological characteristics leading to NI grade 1.
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Affiliation(s)
- Huy Duc Le
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Theresa Pflaum
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johannes Labrenz
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Soner Sari
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Fabienne Bretschneider
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arne Lassen
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susanna Nikolaus
- Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Silke Szymczak
- Institute for Medical Biometry and Statistics, University of Luebeck University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Diana Kormilez
- Institute for Medical Biometry and Statistics, University of Luebeck University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Konrad Aden
- Institute of Clinical Molecular Biology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Internal Medicine I, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University and University Hospital Schleswig-Holstein, Kiel, Germany
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53
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Buyana B, Naki T, Alven S, Aderibigbe BA. Nanoparticles Loaded with Platinum Drugs for Colorectal Cancer Therapy. Int J Mol Sci 2022; 23:11261. [PMID: 36232561 PMCID: PMC9569963 DOI: 10.3390/ijms231911261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer is a common cancer in both men and women. Numerous studies on the therapeutic effectiveness of nanoparticles against colorectal cancer have been reported. Platinum treatments as well as other medications comprising of nanoparticles have been utilized. Drug resistance restricts the use of platinum medicines, despite their considerable efficacy against a variety of cancers. This review reports clinically licensed platinum medicines (cisplatin, carboplatin, and oxaliplatin) combined with various nanoparticles that have been evaluated for their therapeutic efficacy in the treatment of colorectal cancer, including their mechanism of action, resistance, and limitations.
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Affiliation(s)
| | | | | | - Blessing Atim Aderibigbe
- Department of Chemistry, University of Fort Hare, Alice 5700, Eastern Cape Province, South Africa
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54
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Verkuijl SJ, Trzpis M, Broens PMA. The anorectal defaecation reflex: a prospective intervention study. Colorectal Dis 2022; 24:845-853. [PMID: 35194918 PMCID: PMC9541108 DOI: 10.1111/codi.16101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
AIM Our hypothesis is that there may be a neural pathway with sensory afferent neurons in the anal canal that leads to rectal contraction to assist defaecation. We aimed to compare rectal motility between healthy participants with or without anal anaesthesia. METHOD This prospective intervention study consisted of two test sessions: a baseline session followed by an identical second session. During each session we performed the anal electrosensitivity test, the rectoanal inhibitory reflex test and rapid phasic barostat distensions. Prior to the second session, participants were randomly assigned to receive either a local anal anaesthetic or a placebo. RESULTS We included 23 healthy participants aged 21.1 ± 0.5 years, 13 of whom received an anal anaesthetic and 10 a placebo. All participants showed a transient rectal contraction during the first test session, which decreased significantly after anal anaesthesia (18.6 ml vs. 4.9 ml, p = 0.019). The maximum rectal contraction was comparable to the baseline results in the placebo group. Furthermore, the electrosensitivity at the highest centimetre of the anal canal correlated with the maximum rectal contraction (r = -0.452, p = 0.045). CONCLUSION All healthy study participants display an involuntary, reproducible rectal reflex contraction that appears to be innervated by afferent nerves in the proximal anal canal. The rectal reflex contraction appears to play a role in defaecation and we therefore refer to this phenomenon as the anorectal defaecation reflex. Knowledge of the anorectal defaecation reflex may have consequences for the diagnostics and treatment of constipation.
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Affiliation(s)
- Sanne J. Verkuijl
- Department of SurgeryAnorectal Physiology LaboratoryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands,Department of SurgeryDivision of Paediatric SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Monika Trzpis
- Department of SurgeryAnorectal Physiology LaboratoryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Paul M. A. Broens
- Department of SurgeryAnorectal Physiology LaboratoryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands,Department of SurgeryDivision of Paediatric SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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55
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Li W, Liu Q, Mu Y, Zhang K, Liu T. Dedifferentiated liposarcoma (DDLPS) in the rectum: A case report. J Int Med Res 2022; 50:3000605221102081. [PMID: 35751419 PMCID: PMC9237925 DOI: 10.1177/03000605221102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dedifferentiated liposarcoma (DDLPS) is a rare subtype of liposarcoma with a poor prognosis. This current case report describes a rectal DDLPS in a 68-year-old Chinese male that presented with lower abdominal pain and weight loss. Computed tomography and magnetic resonance imaging were undertaken to evaluate the tumour. The patient underwent radical resection of the rectal tumour, sigmoid colostomy and partial ureterectomy. The tumour was positive for mouse double minute 2 by immunohistochemistry. The patient healed well but refused chemotherapy postoperatively for economic reasons. The tumour recurred and metastasized 4 weeks after the operation. After relevant treatment, the patient's condition deteriorated and he died of shock, metabolic acidosis, hyperlactataemia and acute renal failure. The case report also reviews the literature in terms of the clinical diagnosis, treatment and pathological characteristics of rectal DDLPS with the aim of improving the level of diagnosis and treatment.
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Affiliation(s)
- Wei Li
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qi Liu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yu Mu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Kai Zhang
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tongjun Liu
- Department of Colorectal and Anal Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, China
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56
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Cheah WH. Pictorial essay on MRI local staging of rectal carcinoma: An easy approach. Asia Pac J Clin Oncol 2022; 19:e80-e88. [PMID: 35437926 DOI: 10.1111/ajco.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Rectal cancer is common and accounts for more than one-third of colorectal tumors. It is associated with significant morbidity and mortality. Previously computed tomography scan is the key imaging modality in preoperative assessment to detect local invasion and distant metastasis. However, the advent of magnetic resonance imaging (MRI) has aided in local staging and prognosticates the outcome of rectal tumor. Here, the author briefly explains why rectal MRI has a comprehensive role and provides a simple and easy way in reporting an MRI rectal carcinoma, even for a non-radiologist.
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Affiliation(s)
- Wai-Hun Cheah
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
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57
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Miller KA, Kagramanov D, Cohen-Cutler S, Nadim B, Weng Z, Gallagher P, Kaslander JN, Freyer DR, Barzi A, Lenz HJ. Impacts of the SARS-CoV-2 Pandemic on Young Adult Colorectal Cancer Survivors. J Adolesc Young Adult Oncol 2022; 11:229-233. [PMID: 34143664 PMCID: PMC9057897 DOI: 10.1089/jayao.2021.0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has disrupted health care globally with dramatic impacts on cancer care delivery in addition to adverse economic and psychological effects. This study examined impacts of the SARS-CoV-2 pandemic on young adult colorectal cancer (CRC) survivors diagnosed age 18-39 years. Nearly 40% reported delays in cancer-related care, loss of income, and poorer mental health during the pandemic. Impacts were greater for survivors aged 20-29 years, with nearly 60% reporting cancer care delays and 53% experiencing income loss. Such impacts may result in detrimental downstream outcomes for young CRC survivors, requiring specific support, resources, and continued monitoring.
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Affiliation(s)
- Kimberly A. Miller
- Department of Preventive Medicine and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Dalia Kagramanov
- Department of Preventive Medicine and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Bahram Nadim
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Zhen Weng
- Department of Preventive Medicine and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Jonathan N. Kaslander
- Department of Preventive Medicine and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - David R. Freyer
- Department of Preventive Medicine and Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
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Matsui T, Naitoh E, Furutani K, Katoh T, Kobayashi K, Sekigawa K, Mitsui H. Spontaneous regression of a rectal tonsil presenting as a large submucosal tumor. DEN open 2022; 2:e34. [PMID: 35310746 PMCID: PMC8828185 DOI: 10.1002/deo2.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Rectal tonsils are localized hyperplastic lymphoid tissues in the rectum, and the initial endoscopic findings are consistent with those for neoplastic lesions. However, rectal tonsils are benign entities, and the diagnosis should be made cautiously. A 70‐year‐old man presented with pain on defecation with rectal bleeding. Colonoscopy revealed a 3‐cm protruding mass in the rectum with mucosal erosion, but no malignant features were observed on forceps biopsy. Endoscopic ultrasonography (EUS) showed that the lesion was a hypoechoic mass without blood flow. Fine needle aspiration under EUS revealed no malignant components, although the size of the lesion had shrunk, and symptoms, such as blood‐stained stool, tenesmus, and discomfort during defecation, had resolved. A second forceps biopsy showed intermediate‐sized lymphocytes without lymphoepithelial lesions. Based on immunostaining, the lesion was diagnosed as a rectal tonsil. Rectal tonsils occur due to localized proliferation of reactive lymphoid follicles in the submucosa or muscularis mucosa. However, endoscopic diagnosis is difficult since less invasive treatment is performed for neoplastic lesions of the rectum to preserve the function of the anal sphincter. Diagnosis and treatment of small lesions might be possible by endoscopic resection; however, for relatively large lesions, formulating a diagnosis based only on biopsy specimens becomes even more difficult. Therefore, repeated biopsies might be helpful for the diagnosis of rectal tonsils and for excluding other neoplasms.
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Affiliation(s)
- Toru Matsui
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
| | - Eri Naitoh
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
| | - Kengo Furutani
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
| | - Tomoji Katoh
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
| | - Katsuya Kobayashi
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
| | | | - Hiroshi Mitsui
- Department of Gastroenterohepatology Tokyo Teishin Hospital Tokyo Japan
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Ward J, Gill S, Armstrong K, Fogarty T, Tan D, Scott A, Yahya A, Dhaliwal SS, Jacques A, Tang C. Randomised controlled trial on the effect of simethicone bowel preparation on rectal variability during image-guided radiation therapy for prostate cancer (SPoRT study). J Med Imaging Radiat Oncol 2022; 66:866-873. [PMID: 35322563 DOI: 10.1111/1754-9485.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to assess whether simethicone reduces the rectal volume (RV) and gas volume (GV), to increase treatment accuracy and to decrease toxicity of prostate radiation therapy. METHODS 30 patients were randomised to simethicone or no intervention. Cone-beam computed tomography (CBCT) scans were performed on Days 1-3 and weekly until completion of radiation. RV and GV were measured using volume delineation. Toxicity data were collected. RESULTS 264 CBCTs were analysed. RV and GV were not significantly different in the simethicone group compared with the control group at each time point (P >0.05) after adjusting for Week 0 values as a covariate. The simethicone group showed an average reduction in RV and GV of 10% and 21%, respectively, compared with the control group (P >0.05). Standard deviations were calculated over 10 time points, which were grouped to represent the first 2-3 weeks of radiation therapy versus subsequent weeks. These were not significantly different between the simethicone and control group. However, there was a statistically significant decrease in the variability of RV at time points 6-10 compared with time points 1-5 within the simethicone group (P = 0.012), but no significant difference was found between these grouped time points in the control group (P = 0.581). The toxicity questionnaires showed no significant difference between the groups. CONCLUSIONS Simethicone did not decrease the RV or GV overall. However, simethicone appeared to significantly decrease the RV variability from Week three onwards. This suggests that taking simethicone two to three weeks before starting radiation therapy may reduce RV variability, although a larger study is needed to confirm this.
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Affiliation(s)
- Jennifer Ward
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Division of Internal Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Armstrong
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tamara Fogarty
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Daren Tan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Alison Scott
- Radiation Oncology Medical Physics, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Aylin Yahya
- Department of Radiation Oncology, Clinical Trials and Research Unit, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia
| | - Satvinder Singh Dhaliwal
- Department of Radiation Oncology, Clinical Trials and Research Unit, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, George Town, Pulau Pinang, Malaysia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Colin Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital Cancer Centre, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Zhai B, Liu L, Li X, Lv X, Wu J, Li J, Lin S, Yin Y, Lan J, Du J, Wu C, Wen Y, Wang Y, Wang Y, Hou Z, Li Y, Chai H, Zeng X. The Variation of Duck RIG-I-Mediated Innate Immune Response Induced by Different Virulence Avian Influenza Viruses. Front Microbiol 2022; 13:842721. [PMID: 35300481 PMCID: PMC8921926 DOI: 10.3389/fmicb.2022.842721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/11/2022] [Indexed: 01/22/2023] Open
Abstract
In recent years, the emerging highly pathogenic avian influenza (HPAI) A(H5N8) virus has been reported with features of widely spread, an expanding host range, and cross-species transmission, attracting wide attention. The domestic duck plays a major role in the epidemiological cycle of the HPAI H5N8 virus, but little is known concerning innate immune responses during influenza infection in duck species. In this study, we used two wild-bird-origin viruses, H5N8 and H4N6, to conduct duck infection experiments, and detect the load of the two viruses, and retinoic acid-inducible gene I (RIG-I) and interferon β (IFN-β) in the host's natural immune response. Through comparison, it is found that the expression levels of RIG-I and IFN-β are both fluctuating. The innate immunity starts rapidly within 6 h after infection and is inhibited by the virus to varying degrees. The expression of RIG-I and IFN-β decreased on 1-2 days post-infection (dpi). The HPAI H5N8 virus has a stronger inhibitory effect on RIG-I than the low pathogenic avian influenza (LPAI) H4N6 virus and is the strongest in the lungs. After infection with HPAI H5N8 virus, 2 dpi, viral RNA replicates in large amounts in the lungs. It has been proven that RIG-I and IFN-β play an important role in the innate immune response of ducks to HPAI H5N8 virus infection, especially in the lungs. The main battlefield of RIG-I and IFN-β after infection with the LPAI H4N6 virus is in the rectum. Both viruses have been effectively controlled after 7 dpi. These results will help to understand the transmission mechanisms of avian influenza virus in wild ducks and help effectively prevent and control avian influenza.
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Affiliation(s)
- Boyu Zhai
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Lanlan Liu
- College of Basic Medical Science, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiang Li
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Xinru Lv
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Jinyan Wu
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Jing Li
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Shengze Lin
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Yuxiang Yin
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Jiaqi Lan
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Jianan Du
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Chenwei Wu
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Yi Wen
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Yajun Wang
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Yulong Wang
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Zhijun Hou
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Yanbing Li
- Chinese Academy of Agricultural Sciences Harbin Veterinary Research Institute, Harbin, China
| | - Hongliang Chai
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
| | - Xiangwei Zeng
- State Forestry Administration Key Laboratory of Wildlife Conservation, College of Wildlife and Protected Area, Northeast Forestry University, Harbin, China
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Leite CHB, Lopes CDH, Leite CAVG, Terceiro DA, Lima GS, Freitas JA, Cunha FQ, Almeida PRC, Wong DVT, Lima-Júnior RCP. A Novel Murine Model of a High Dose Brachytherapy-Induced Actinic Proctitis. Front Oncol 2022; 12:802621. [PMID: 35280725 PMCID: PMC8909144 DOI: 10.3389/fonc.2022.802621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/28/2022] [Indexed: 12/19/2022] Open
Abstract
Background Radiation proctitis affects 1-20% of cancer patients undergoing radiation exposure due to pelvic malignancies, including prostate, gynecological and rectum cancers. The patients manifest rectal discomfort, pain, discharge, and bleeding. Notably, the efficacy of prophylactic measures remains controversial due to the lack of adequate animal models that mimic this condition. Objective The present study then aimed to develop a murine model of high-dose-rate (HDR) brachytherapy-induced proctitis. Material/Methods C57BL/6 male mice were subjected to HDR (radiation source: iridium-192 [Ir-192]) through a cylindrical propylene tube inserted 2 cm far from the anal verge into the rectum. The animals received radiation doses once a day for three consecutive days (fractions of 9.5 Grays [Gy]), 3.0 mm far from the applicator surface. The sham group received only the applicator with no radiation source. The survival rate was recorded, and a colonoscopy was performed to confirm the tissue lesion development. Following euthanasia, samples of the rectum were collected for histopathology, cytokines dosage (IL-6 and KC), and immunohistochemical analysis (TNF-α and COX-2). Results HDR significantly reduced animals’ survival ten days post first radiation exposure (14% survival vs. 100% in the non-irradiated group). Day seven was then used for further investigation. Mice exposed to radiation presented with rectum injury confirmed by colonoscopy and histopathology (P < 0.05 vs. the control group). The tissue damage was accompanied by an inflammatory response, marked by increased KC and IL-6 tissue levels, and immunostaining for TNF-α and COX-2 (P < 0.05 vs. control group). Conclusions We established a novel animal model of actinic proctitis induced by HDR brachytherapy, marked by inflammatory damage and low animal mortality.
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Affiliation(s)
- Carlos Heli Bezerra Leite
- Radiation Oncology Service, Haroldo Juaçaba Hospital, Cancer Institute of Ceara (ICC), Fortaleza, Brazil
| | - Carlos Diego Holanda Lopes
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Caio Abner Vitorino Gonçalves Leite
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Dulce Andrade Terceiro
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Gabriel Silva Lima
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Jéssica Andrade Freitas
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Fernando Queiroz Cunha
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Deysi Viviana Tenazoa Wong
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
| | - Roberto César Pereira Lima-Júnior
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil
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Atarod Z, Zamaniyan M, Moosazadeh M, Valadan R, Soleimanirad SM, Gordani N. Investigation of vaginal and rectal swabs of women infected with COVID-19 in two hospitals covered by Mazandaran University of Medical Sciences, 2020. J OBSTET GYNAECOL 2022; 42:2225-2229. [PMID: 35260029 DOI: 10.1080/01443615.2022.2036966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Due to the emergence of COVID-19 virus worldwide and need to identify ways of transmitting the virus, we conducted a cross-sectional study from July to November 2020 on 80 women with COVID-19 infection was confirmed by nasopharyngeal proper time polymerase chain reaction (RT-PCR). We investigated SARS-CoV-2 in their vaginal and rectal swabs. The results showed that (n = 6, 7.5%) patients had positive rectal PCR and (n = 10, 12.5%) had positive vaginal PCR. There was a statistically significant relationship between positive rectal test and positive vaginal test (p=.001). Positive rectal PCR was significantly higher in women over 60 years old than in other age groups (p=.004).Impact StatementWhat is already known on this subject? In the past studies, the presence of the virus in the vagina and rectum was less or not confirmed.What do the results of this study add? The results of our study showed that the COVID-19 virus can infect the vagina and rectum of women.What are the implications of these findings for clinical practice and/or further research? This finding should be considered in sexual transmission and mother to child transmission and also vaginal colonisation, especially at the time of delivery.
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Affiliation(s)
- Zoleikha Atarod
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marzieh Zamaniyan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.,Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Department of Epidemiology, Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Valadan
- Department of Immunology, Molecular and Cell Biology Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Mohsen Soleimanirad
- Department of Family Health, Population and School Management, Mazandaran University of Medical Sciences, Sari, Iran
| | - Noushin Gordani
- Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
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63
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Nowak JK, Szymańska CJ, Walkowiak J. Differential correlation network analysis of rectal transcriptomes reveals cystic fibrosis-related disturbance. Pharmacogenomics 2022; 23:339-344. [PMID: 35189732 DOI: 10.2217/pgs-2021-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Intestinal pathology in cystic fibrosis (CF) remains mechanistically underexplored. Aim: We hypothesized that differential correlation network analysis of expression data would reveal hub genes of CF-related disturbance in the large bowel. Materials & methods: Transcriptomes of 29 rectal tissue samples were accessed at ArrayExpress (E-GEOD-15568 by Stanke et al.). Results: We identified 279 transcript pairs differentially correlating in CF and controls, including: ESRRA and RPL18 (rCF = 0.55; rcontrols = -0.68; padj = 1.60 × 10-100), SRP14 and FAU (rCF = -0.69; rcontrols = 0.48; padj = 2.99 × 10-90), SRP14 and GDI2 (rCF = -0.34; rcontrols = 0.60; padj = 1.05 × 10-78). The genes related to membrane protein targeting (q = 8.34 × 10-14) and one cluster was clearly linked to male infertility. Conclusion: FAU, SRP14 and GDI2 may be involved in a compensatory protein trafficking mechanism in CF rectum, highlighting their potential therapeutic value.
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Affiliation(s)
- Jan K Nowak
- Department of Pediatric Gastroenterology & Metabolic Diseases, Poznan University of Medical Sciences, Poznan, 60-572, Poland
| | - Cyntia J Szymańska
- Department of Pediatric Gastroenterology & Metabolic Diseases, Poznan University of Medical Sciences, Poznan, 60-572, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology & Metabolic Diseases, Poznan University of Medical Sciences, Poznan, 60-572, Poland
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Karthikeyan M, Kolandasamy C, Naganath Babu OL. Malignant Gastrointestinal Stromal Tumor of Rectum: A Case Report and Review of Literature. Surg J (N Y) 2022; 8:e60-e64. [PMID: 35187230 PMCID: PMC8850004 DOI: 10.1055/s-0042-1742778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/22/2021] [Indexed: 11/07/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract accounting for less than 1% of all gut tumors. GISTs occurring in the rectum are extremely rare and these usually present at an advanced stage compared with other sites. We report a case of a middle-aged female who presented with features of anemia and subacute obstruction due to a large rectal tumor and underwent abdominoperineal resection. The histopathological examination confirmed the diagnosis of high-grade malignant GIST with multiple lymph nodal metastasis. She was started on adjuvant imatinib therapy and is on follow-up without any evidence of recurrence. The authors conclude that GIST must be included in the differential diagnosis of a rectal tumor. Diagnosis is established by biopsy and immunohistochemistry studies. Surgical resection with histological negative margins is the standard curative treatment. Adjuvant targeted therapy can reduce long-term recurrence in high-risk cases.
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Affiliation(s)
- Mohan Karthikeyan
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Chinnusamy Kolandasamy
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Obla L Naganath Babu
- Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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S. Al Ghamdi S, Leeds I, Fang S, Ngamruengphong S. Minimally Invasive Endoscopic and Surgical Management of Rectal Neoplasia. Cancers (Basel) 2022; 14:cancers14040948. [PMID: 35205695 PMCID: PMC8869910 DOI: 10.3390/cancers14040948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
Rectal cancer demonstrates a characteristic natural history in which benign rectal neoplasia precedes malignancy. The worldwide burden of rectal cancer is significant, with rectal cancer accounting for one-third of colorectal cancer cases annually. The importance of early detection and successful management is essential in decreasing its clinical burden. Minimally invasive treatment of rectal neoplasia has evolved over the past several decades, which has led to reduced local recurrence rates and improved survival outcomes. The approach to diagnosis, staging, and selection of appropriate treatment modalities is a multidisciplinary effort combining interventional endoscopy, surgery, and radiology tools. This review examines the currently available minimally invasive endoscopic and surgical management options of rectal neoplasia.
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Affiliation(s)
- Sarah S. Al Ghamdi
- Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Ira Leeds
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Sandy Fang
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21224, USA;
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD 21224, USA
- Correspondence:
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Ottaiano A, Santorsola M, Perri F, Pace U, Marra B, Correra M, Sabbatino F, Cascella M, Petrillo N, Ianniello M, Casillo M, Misso G, Delrio P, Caraglia M, Nasti G. Clinical and Molecular Characteristics of Rare Malignant Tumors of Colon and Rectum. Biology (Basel) 2022; 11:biology11020267. [PMID: 35205133 PMCID: PMC8869306 DOI: 10.3390/biology11020267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/21/2022] [Accepted: 02/05/2022] [Indexed: 02/04/2023]
Abstract
Simple Summary Tumors of colon and rectum other than adenocarcinomas represent a neglected issue from clinical and laboratory points of view because of their rarity. In this review, we summarize and describe the rare histologic entities occurring in colon and rectum. Clinical and pathologic characteristics, prognostic behavior, treatments, and altered genes are reported to provide readers with a paramount and comparative perspective. In relation to this, we propose that improvements in registries and multidisciplinary research are warranted to ameliorate their management. Abstract The most frequent form of colorectal cancer is represented by adenocarcinoma being about 98% of tumor histological types. However, other rare histotypes can be found in colon and rectum (adenosquamous, goblet cell adenocarcinoma, lymphoma, medullary carcinoma, melanoma, mesenchymal, neuroendocrine, plasmacytoma, signet ring, squamous tumors). Altogether, these forms account for less than 2% of colorectal tumors. There are no specific diagnostic or therapeutic recommended approaches and most of the information available from literature derives from small and retrospective clinical series. In the present study, we provide a paramount and updated view on clinical and biologic characteristics of rare colorectal tumors.
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Affiliation(s)
- Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
- Correspondence:
| | - Mariachiara Santorsola
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Francesco Perri
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Ugo Pace
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Bruno Marra
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Marco Correra
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Francesco Sabbatino
- Oncology Unit, San Giovanni di Dio e Ruggi D’Aragona University Hospital, Universisty of Salerno, 84131 Salerno, Italy;
| | - Marco Cascella
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Nadia Petrillo
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (N.P.); (M.I.); (M.C.)
| | - Monica Ianniello
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (N.P.); (M.I.); (M.C.)
| | - Marika Casillo
- AMES, Centro Polidiagnostico Strumentale srl, 80013 Naples, Italy; (N.P.); (M.I.); (M.C.)
| | - Gabriella Misso
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Via de Crecchio 7, 80138 Naples, Italy; (G.M.); (M.C.)
| | - Paolo Delrio
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Via de Crecchio 7, 80138 Naples, Italy; (G.M.); (M.C.)
| | - Guglielmo Nasti
- Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy; (M.S.); (F.P.); (U.P.); (B.M.); (M.C.); (M.C.); (P.D.); (G.N.)
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Mokhtari M, Iranpour P, Golbahar Haghighi A, Ghahramani L. Schwannoma of the Rectosigmoid Colon. Adv Biomed Res 2022; 11:5. [PMID: 35284347 PMCID: PMC8906087 DOI: 10.4103/abr.abr_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/12/2021] [Accepted: 10/30/2021] [Indexed: 11/08/2022] Open
Abstract
Schwannoma is a rare tumor in the colon which originates from the peripheral nerve plexus. Most of the cases have been asymptomatic but occasionally present as an obstructive mass. Abdominal investigations are effective in some cases, but usually, they are not informative. A significant number of cases have been detected after their operation by histopathology examination. Immune and histochemical staining shows the spindle cells that have been positive for S-100 and vimentin, but negative for CD34 and smooth muscle actin. If the diagnosis of Schowannoma is confirmed preoperatively, segmental resection is recommended. In this case report, we presented a 58-year-old woman with pelvic mass and normal colonoscopy that mimic extramural large uterine myoma with extraluminal pressure effect on the rectosigmoid.
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Affiliation(s)
- Maral Mokhtari
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Iranpour
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ardalan Golbahar Haghighi
- Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghahramani
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Address for correspondence: Dr. Leila Ghahramani, Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail:
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Abstract
Rectovaginal fistula (RVF) occurring during the course of Crohn's disease (CD) constitutes a therapeutic challenge and is characterized by a high rate of recurrence. To optimize the outcome of CD-related RVF repair, the best conditions for correct healing should be obtained. Remission of CD should be achieved with no active proctitis, the perianal CD activity should be minimized, and local septic complications should be controlled. The objective of surgical repair is to close the fistula tract with minimal recurrence and functional disturbance. Several therapeutic strategies exist and the approach should be tailored to the anatomy of the RVF and the quality of the local supporting tissues. Herein, we review the medical and surgical management of CD-related RVF.
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Affiliation(s)
- Jeremy Meyer
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland,Medical School, University of Geneva, Genève, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland,Medical School, University of Geneva, Genève, Switzerland
| | - Miles Parkes
- Division of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom,Address for correspondence Richard Justin Davies, MChir Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation TrustCambridge CB2 0QQUnited Kingdom
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Mandarino FV, Barchi A, Biamonte P, Esposito D, Azzolini F, Fanti L, Danese S. The prophylactic use of endoscopic vacuum therapy for anastomotic dehiscence after rectal anterior resection: is it feasible for redo surgery? Tech Coloproctol 2022; 26:319-320. [PMID: 34981274 DOI: 10.1007/s10151-021-02566-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/22/2021] [Indexed: 12/14/2022]
Affiliation(s)
- F V Mandarino
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - A Barchi
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - P Biamonte
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - D Esposito
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - F Azzolini
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Fanti
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Danese
- Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.,Division of Gastroenterology and Gastrointestinal Endoscopy, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kit OI, Gevorkyan YA, Kolesnikov EN, Soldatkina NV, Dashkov AV, Kolesnikov VE. [Gastrointestinal stromal tumors: potential of minimally invasive surgical interventions]. Khirurgiia (Mosk) 2022:25-33. [PMID: 35593625 DOI: 10.17116/hirurgia202205125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the issue of gastrointestinal stromal tumors (GISTs) and potential of minimally invasive surgical interventions. MATERIAL AND METHODS We analyzed postoperative outcomes in 97 patients with gastric and intestinal GISTs who underwent surgical treatment at the National Medical Research Centre for Oncology between 2015 and 2020. RESULTS Twenty (24.7) patients with gastric GISTs underwent laparoscopic partial and distal gastric resections. Five (35.7%) patients with GISTs of the small intestine underwent minimally invasive segmental bowel resections. Only minimally invasive interventions were performed in patients with rectal GISTs. Analysis of laparoscopic and open surgeries for GISTs found no significant differences. Analysis of laparoscopic and open surgeries for gastric and small bowel GISTs revealed the obvious advantages of minimally invasive access regarding postoperative outcomes. Indeed, we found no need for nasogastric drainage in 50% of patients (p<0.001), earlier recovery of intestinal motility and oral feeding (p<0.001), lower postoperative morbidity (p=0.036), fast recovery of motor activity (p<0.001) and shorter postoperative hospital-stay (p<0.001). CONCLUSION Despite small incidence, GISTs are a complex problem in modern oncology. Diagnosis and treatment require a multidisciplinary medical team (morphologists, geneticists, radiologists, surgeons, chemotherapists, gastroenterologists and other specialists) that is possible in a reference center. Minimally invasive interventions for GISTs of the stomach, small intestine and rectum improve postoperative course.
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Affiliation(s)
- O I Kit
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - Yu A Gevorkyan
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - E N Kolesnikov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - N V Soldatkina
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - A V Dashkov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
| | - V E Kolesnikov
- National Medical Research Centre for Oncology, Rostov-on-Don, Russia
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Bednarek A, Sołek J, Szymczyk K, Gwardys M, Wierzchniewska-Ławska A, Jesionek-Kupnicka D, Braun M, Romańska HM. Liver metastasis or a pseudocyst? A rare presentation of leiomyosarcoma's metastasis in the liver. Contemp Oncol (Pozn) 2022; 26:306-9. [PMID: 36816396 DOI: 10.5114/wo.2022.124595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/14/2022] [Indexed: 02/12/2023] Open
Abstract
Gastrointestinal neoplasms most commonly metastasize to the liver, where they are typically found as solid and hypervascular lesions. Here, we describe a case of a 44-year-old man with a leiomyosarcoma of the rectum, who at the time of diagnosis presented with a small (5 mm in diameter) cyst-like lesion in the liver. Positron emission tomography demonstrated no increased metabolism in the area of the cyst, suggesting a benign character of the lesion. However, after 3 years, CT scans revealed enlargement of the cyst, and local surgical excision was performed. The results of histopathological examination of the resected material were consistent with metastatic leiomyosarcoma. Subsequently, the patient developed lung metastases and died within 2 years. Our case describes a very rare presentation of leiomyosarcoma's metastasis that led to an ill-fated misdiagnosis and dismal disease outcome.
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72
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Ran L, Chuanwang Y, Wei S, Wenguang Y, Liang H, Jiancheng Z, Wen L, Hui Y, Lijian X. Risk factors and treatment of rectal stenosis after transanal endoscopic microsurgery. Colorectal Dis 2022; 24:85-92. [PMID: 34491609 DOI: 10.1111/codi.15904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
AIM Rectal stenosis is a relatively rare complication after transanal endoscopic microsurgery (TEM). This study aims to identify the predictive parameters for stenosis and the application of TEM in the treatment. METHOD The clinical data of patients who underwent TEM for rectal adenoma and early cancer from 2008 to 2019 were retrospectively reviewed. We compared the clinicopathological characteristics of patients with stenosis and those without stenosis and analysed the risk factors for stenosis. Treatment outcomes of stenosis with TEM were evaluated. RESULTS A total of 230 patients were enrolled in this study. Overall, the postoperative complication rate was 11.7% (27/230), including eight (3.5%) patients with stenosis. Patients with stenosis exhibited a higher rate of tumour showing a laterally spreading morphology (P = 0.048), a wider circumferential extent of mucosal defect (P < 0.001), a shorter distance of the tumour from the anal verge (P = 0.001) and a wider longitudinal extent of mucosal defect (P = 0.027). A circumferential extent of mucosal defect >3/4 (OR 94.945, 95% CI 3.611-2496.41, P = 0.006) was identified as the only independent risk factor for stenosis. The four patients with both stenosis and clinical symptoms were treated by incising the stenosis ring using the TEM platform; the stenosis was cured, and symptoms disappeared after one to four courses of treatment. CONCLUSIONS Circumferential extent of mucosal defect ≥3/4 was an independent risk factor for stenosis in treating rectal adenoma and early cancer with TEM. Incision of the stenosis ring using the TEM platform is an effective strategy for treating stenosis.
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Affiliation(s)
- Liu Ran
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China
| | - Yan Chuanwang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Weifang Medical College, Weifang, Shandong, China
| | - Shang Wei
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China
| | - Yuan Wenguang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China
| | - Hao Liang
- Department of Gastrointestinal Surgery, Zibo First People's Hospital, Zibo, Shandong, China
| | - Zhai Jiancheng
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Wen
- First Department of General Surgery, Linyi Central Hospital, Linyi, Shandong Province, China
| | - Yang Hui
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China
| | - Xia Lijian
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, the First Affiliated Hospital of Shandong First Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, Shandong, China
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73
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Mahajan N, Agarwal H, Gupta CR, Sengar M, Khatri A, Khan N. Pediatric Colorectal Carcinoma: A Series of Seven Cases. J Indian Assoc Pediatr Surg 2022; 27:304-308. [PMID: 35733586 PMCID: PMC9208681 DOI: 10.4103/jiaps.jiaps_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Colorectal carcinoma (CRC) accounts for <1% of all the neoplasms of children. Unfavorable histology and delayed diagnosis often result in poor outcome. This study aimed to investigate the clinical characteristic and prognosis of pediatric patients with CRC. Materials and Methods A retrospective review of medical records of all patients diagnosed of CRC between 2015 and 2020 was performed. Data regarding gender, age, location, and histopathology were collected. Results Seven children (5 males and 2 females) were included in the study. Age ranged between 8.6 and 11.8 years. Abdominal pain was the most common symptom. The duration between onset of symptoms to the diagnosis ranged from 5 days to 8 months. Right-sided tumors were more common than the left side. Histopathological examination showed mucinous adenocarcinoma in four/seven patients and signet cell variant was seen in 2/7. Immunohistochemistry was positive for cytokeratin and beta-catenin, however, all microsatellite instability markers were found negative. Despite surgical treatment and chemotherapy, four of our cases faced mortality and one patient was lost to follow-up. Conclusion CRC can present in first decade of life and often misdiagnosed. Pediatric CRC has distinct tumor biology and shares a poor prognosis. Paucity of literature from the Indian subcontinent should urge further clinicopathological trials for establishing etiology and for refining treatment recommendations in these children.
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Affiliation(s)
- Nidhi Mahajan
- Department of Pathology, Chacha Nehru Bal Chiktsalaya, Delhi, India
| | - Harshita Agarwal
- Department of Pathology, Chacha Nehru Bal Chiktsalaya, Delhi, India
| | - Chhabi Ranu Gupta
- Department of Pediatric Surgery, Chacha Nehru Bal Chiktsalaya, Delhi, India
| | - Mamta Sengar
- Department of Pediatric Surgery, Chacha Nehru Bal Chiktsalaya, Delhi, India
| | - Arti Khatri
- Department of Pathology, Chacha Nehru Bal Chiktsalaya, Delhi, India
| | - Niyaz Khan
- Department of Pediatric Surgery, Chacha Nehru Bal Chiktsalaya, Delhi, India,Address for correspondence: Dr. Niyaz Khan, Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalaya, Delhi - 110 031, India. E-mail:
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74
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Munk NE, Bondeven P, Pedersen BG. Diagnostic performance of MRI and endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy: a systematic review of the literature. Acta Radiol 2021; 64:20-31. [PMID: 34928715 DOI: 10.1177/02841851211065925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The diagnostic performance of magnetic resonance imaging (MRI) modalities and/or endoscopy for assessing complete response in rectal cancer after neoadjuvant chemoradiotherapy (nCRT) is unclear. PURPOSE To summarize existing evidence on the diagnostic performance of diffusion-weighted MRI, perfusion-weighted MRI, T2-weighted MR tumor regression grade, and/or endoscopy for assessing complete tumor response after nCRT. MATERIAL AND METHODS MEDLINE and Embase databases were searched. The PRISMA guidelines were followed. Sensitivity, specificity, negative predictive, and positive predictive values were retrieved from included studies. RESULTS In total, 81 studies were eligible for inclusion. Evidence suggests that combined use of MRI and endoscopy tends to improve the diagnostic performance compared to single imaging modality. The positive predictive value of a complete response varies substantially between studies. There is considerable heterogeneity between studies. CONCLUSION Combined re-staging tends to improve diagnostic performance compared to single imaging modality, but the vast majority of studies fail to offer true clinical value due to the study heterogeneity.
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Affiliation(s)
| | - Peter Bondeven
- Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Bodil Ginnerup Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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75
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Alvfeldt G, Aspelin P, Blomqvist L, Sellberg N. Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting. Acta Radiol 2021; 63:1603-1612. [PMID: 34866405 DOI: 10.1177/02841851211057276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. PURPOSE To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. MATERIAL AND METHODS A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. RESULTS Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. CONCLUSION The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.
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Affiliation(s)
- Gustav Alvfeldt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Sellberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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76
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Khor V, Khairul-Asri MG, Fahmy O, Hamid SA, Lee CKS. Linitis plastica of the rectum secondary to metastatic prostate cancer: A case report of a rare presentation and literature review. Urol Ann 2021; 13:442-445. [PMID: 34759661 PMCID: PMC8525488 DOI: 10.4103/ua.ua_188_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/16/2021] [Indexed: 01/18/2023] Open
Abstract
Linitis plastica is a rare tumor with poor prognosis. It is a circumferentially infiltrating intramural tumor which can result in rigid, nondistensible thickening of the affected organ. It most commonly affects the stomach, followed by the rectum, and can be due to primary or secondary cancer. Secondary rectal linitis plastica (RLP) caused by metastatic cancers has been reported from the stomach, breast, gallbladder, urinary bladder, and very rarely, the prostate, with only <5 reported cases in the literature. We report the case of a 66-year-old man who presented with altered bowel habit and loss of weight, with elevated prostate-specific antigen of 180.6 ng/mL. Sigmoidoscopy showed thickened rectal mucosa, and biopsy was negative for malignancy. Magnetic resonance imaging showed circumferential wall thickening, "target sign" appearance suggestive of RLP, PIRADS 5 lesion with extraprostatic extension, infiltrating bilateral seminal vesicles, and right neurovascular bundle. Repeat colonoscopy was performed under anesthesia, and deeper biopsy revealed poorly differentiated metastatic prostate adenocarcinoma. This case report highlights the atypical presentation of metastatic prostate cancer secondary to RLP, the rarity of this condition, and emphasizes the importance of deeper biopsy in RLP due to disease involvement predominantly in the submucosa and muscularis propria layers.
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Affiliation(s)
- Vincent Khor
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia
| | - Mohd Ghani Khairul-Asri
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Omar Fahmy
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Suzana Ab Hamid
- Department of Radiology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Christopher Kheng Siang Lee
- Department of Urology, Hospital Pengajar Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia.,Department of Urology, Hospital Serdang, Selangor Darul Ehsan, Malaysia.,Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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77
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Manoria P, Singhai A, Gulwani HV. Isolated Rectal Tuberculosis in Immunocompetent Host. J Glob Infect Dis 2021; 13:148-150. [PMID: 34703157 PMCID: PMC8491808 DOI: 10.4103/jgid.jgid_318_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
Abdominal tuberculosis (TB) is the sixth most common site for extrapulmonary TB. Ileocecal region is the most common site for it, and its incidence reduces as we move proximally and distally from it. Isolated rectal TB in an immunocompetent person is very rare, and it usually mimics as rectal carcinoma. The yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions, and mostly, they are diagnosed after surgical intervention. We report a case of isolated rectal TB in a middle-aged female who present with chronic diarrhea and was diagnosed by the presence of epithelioid cells forming granulomas and acid-fast bacilli in rectal biopsy.
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Affiliation(s)
- Piyush Manoria
- Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
| | - Abhishek Singhai
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Hanni V Gulwani
- Department of Pathology, Bhopal Memorial Hospital and Research Centre, Bhopal, Madhya Pradesh, India
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78
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Wekha G, Ssewante N, Iradukunda A, Jurua M, Nalwoga S, Lanyero S, Olum R, Bongomin F. Colorectal Cancer in Uganda: A 10-Year, Facility-Based, Retrospective Study. Cancer Manag Res 2021; 13:7697-7707. [PMID: 34675666 PMCID: PMC8504868 DOI: 10.2147/cmar.s334226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/21/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Colorectal cancer (CRC) is the most common type of gastrointestinal malignancies and the third leading cause of cancer-related deaths for both sexes worldwide. Although the burden of CRC is highest in developed countries, reports are indicating a rise in the incidence of early-onset CRC in developing countries. In this study, we aimed to determine the prevalence of CRC among patients hospitalized with lower gastrointestinal complaints at a tertiary health facility in Uganda. Methods We conducted a 10-year retrospective chart review of patients admitted to Mulago National Referral Hospital in Kampala, Uganda, between 1st January 2010 and 31st December 2020. We reviewed all charts of patients admitted to the lower gastrointestinal tract (GIT) ward. Charts with grossly missing data, pediatric patients, and those from other non-lower GIT specialties were excluded. Results Data of 1476 unique eligible patients were analyzed. Of these,138 had a diagnosis of CRC (prevalence: 9.3%, 95% confidence interval (95% CI): 6.5-11.7%). Among patients with CRC, the female:male ratio was 1:1. The most common site for CRC was the rectum (59.8%, n= 79). For the 138 participants with CRC, 44 had staging data with 72.8% (n=32) having advanced disease, that is, stage 3 or 4. Factors independently associated with CRC were age ≥50 years (adjusted odds ratio (aOR): 4.3, 95% CI: 2.6-7.1, p < 0.001), female sex (aOR: 1.8, 95% CI: 1.2 -2.8, p = 0.005), being widowed (aOR: 2.5, 95% CI: 1.3-5.0, p = 0.006), and presence of any risk factor for CRC (aOR: 5.3, 95% CI: 2.9-9.9, p < 0.001). Conclusion CRC is relatively common among patients hospitalized with lower GIT complaints, particularly among women and those with known risk factors for CRC. Awareness creation and screening programs should be instituted to allow early diagnosis of CRC in our setting.
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Affiliation(s)
- Godfrey Wekha
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Ssewante
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Angelique Iradukunda
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Micheal Jurua
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shadia Nalwoga
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sharon Lanyero
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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79
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Gurung N, Mukherjee U, Khurana A. Extranodal Follicular dendritic cell sarcoma presenting as a rectal polyp: An entity overlooked by its differentials. INDIAN J PATHOL MICR 2021; 64:814-816. [PMID: 34673612 DOI: 10.4103/ijpm.ijpm_316_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extranodal follicular dendritic cell sarcoma (ENFDCS) is a rare hematolymphoid tumor, masquerading as soft tissue sarcoma on initial histological examination. So, for its confirmation, the application of immunohistochemistry (IHC) is of paramount importance. Over the years there has been a major shift in the demography of follicular dendritic cell sarcoma (FDCS), with a rise in the number of extranodal cases. Herein we report a case of ENFDCS presenting as a rectal polyp, who had a history of intermittent bleeding per rectum and passage of fleshy mass while defecation. As these tumors share an overlapping morphology with other spindle cell tumors and can occur at unpredictable locations, they pose a diagnostic challenge, especially for young pathologists.
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Affiliation(s)
- Niteeka Gurung
- Department of Lab Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Urmi Mukherjee
- Department of Lab Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Anuj Khurana
- Department of Lab Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
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80
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Abstract
RATIONALE Colorectal mixed neuroendocrine-nonneuroendocrine neoplasms constitute a rare group of gastrointestinal tumors composed by both neuroendocrine and nonneuroendocrine components. Nondiagnostic macroscopic features, specific histological features, and poor awareness of the disease are responsible for the underestimated incidence and conflicting data available. Due to lack of randomized clinical trials and validated clinical guidelines, diagnostic and therapeutic approach are based on the standard of care for pure colorectal neuroendocrine carcinomas or adenocarcinomas. PATIENT CONCERNS A 76-year-old caucasian male, without relevant medical or familial history, presented a positive faecal occult blood test during colorectal cancer screening. DIAGNOSIS Total colonoscopy identified a rectal lesion with biopsy showing a moderate rectal adenocarcinoma staged as cT2N0M0. INTERVENTIONS Anterior resection of the rectum with right ileostomy followed by local radiotherapy with radio-sensitising chemotherapy and adjuvant chemotherapy with capecitabine 1000 mg bid plus oxaliplatin 130 mg/m2. Due to chronic nodular pulmonary aspergillosis and chemotherapy induced immunosuppression patient was on 400 mg/daily of oral voriconazole. OUTCOMES Overall survival of 15 months after progression under first line treatment and under palliative chemotherapy with platinum plus etoposide regimen. LESSONS The reported case illustrates the challenge associated to the management of mixed neuroendocrine-nonneuroendocrine carcinomas due to lack of validated guidelines and scientific evidence. From diagnosis and staging to treatment, all steps must be tailored to individual clinical and histological features.
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Affiliation(s)
- Diogo J. Silva
- Medical Oncology Department, Local Health Unity Matosinhos – Hospital Pedro Hispano, Porto, Portugal
| | - Joana dos Santos
- Pathology Department, Local Health Unity Matosinhos – Hospital Pedro Hispano, Porto, Portugal
| | - Ana Paula Vaz
- Pneumology Department, Local Health Unity Matosinhos – Hospital Pedro Hispano, Porto, Portugal
| | - Alexandra Mesquita
- Medical Oncology Department, Local Health Unity Matosinhos – Hospital Pedro Hispano, Porto, Portugal
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81
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Rørtveit ØL, Hysing LB, Stordal AS, Pilskog S. Reducing systematic errors due to deformation of organs at risk in radiotherapy. Med Phys 2021; 48:6578-6587. [PMID: 34606630 DOI: 10.1002/mp.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE In radiotherapy (RT), the planning CT (pCT) is commonly used to plan the full RT-course. Due to organ deformation and motion, the organ shapes seen at the pCT will not be identical to their shapes during RT. Any difference between the pCT organ shape and the organ's mean shape during RT will cause systematic errors. We propose to use statistical shrinkage estimation to reduce this error using only the pCT and the population mean shape computed from training data. METHODS The method was evaluated for the rectum in a cohort of 37 prostate cancer patients that had a pCT and 7-10 treatment CTs with rectum delineations. Deformable registration was performed both within-patient and between patients, resulting in point-to-point correspondence between all rectum shapes, which enabled us to compute a population mean rectum. Shrinkage estimates were found by combining the pCTs linearly with the population mean. The method was trained and evaluated using leave-one-out cross validation. The shrinkage estimates and the patient mean shapes were compared geometrically using the Dice similarity index (DSI), Hausdorff distance (HD), and bidirectional local distance. Clinical dose/volume histograms, equivalent uniform dose (EUD) and minimum dose to the hottest 5% volume (D5%) were compared for the shrinkage estimate and the pCT. RESULTS The method resulted in moderate but statistically significant increase in similarity to the patient mean shape over the pCT. On average, the HD was reduced from 15.6 to 13.4 mm, while the DSI was increased from 0.74 to 0.78. Significant reduction in the bias of volume estimates was found in the DVH-range of 52.5-65 Gy, where the bias was reduced from -1.3 to -0.2 percentage points, but no significant improvement was found in EUD or D5%, CONCLUSIONS: The results suggest that shrinkage estimation can reduce systematic errors due to organ deformations in RT. The method has potential to increase the accuracy in RT of deformable organs and can improve motion modeling.
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Affiliation(s)
- Øyvind Lunde Rørtveit
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of physics and technology, University of Bergen, Bergen, Norway
| | - Liv Bolstad Hysing
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of physics and technology, University of Bergen, Bergen, Norway
| | | | - Sara Pilskog
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.,Department of physics and technology, University of Bergen, Bergen, Norway
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82
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Sato K, Miura T, Sakamoto Y, Morohashi H, Hakamada K. Fascial Organisation and Lymphatic Systems Around the Pelvic Floor: A Literature Review. Anticancer Res 2021; 41:4705-4714. [PMID: 34593418 DOI: 10.21873/anticanres.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022]
Abstract
This review summarises the anatomy and lymphatic systems around the pelvic floor. We investigated the lymphovascular network in the anorectal region, focusing on the hiatal ligament, which comprises smooth muscle fibres derived from the longitudinal muscle and connecting the anal canal and coccyx, and the endopelvic fascia, which seems to comprise collagen and elastic fibres. During rectal surgery, endopelvic fascia is recognized as a sheet of fascia covering the levator ani muscle. Endopelvic fascia is extensively attached to the smooth muscle fibres diverging from the longitudinal muscle of the rectum. Analysis of the lymphovascular network using submucosal India ink injection and indocyanine green fluorescence imaging suggests a functional lymphatic flow between rectal muscle fibres and hiatal ligament and endopelvic fascia. Precise analysis of the lymphatic systems of fascial organization around the pelvic floor may be useful in formulating therapeutic strategies for low rectal cancer.
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Affiliation(s)
- Kentaro Sato
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan.,Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hokkaido, Japan
| | - Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University, Graduate School of Medicine, Aomori, Japan;
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83
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Donatelli G, Cereatti F, Fazi M, Ceci V, Dhumane P. Endoscopic ultrasound-guided drainage of intra-abdominal diverticular abscess. A case series. J Minim Access Surg 2021; 17:513-518. [PMID: 34558427 PMCID: PMC8486052 DOI: 10.4103/jmas.jmas_184_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
AIM Diverticular disease is widespread worldwide. Mainstay approach is non-operative treatment with bowel rest and broad-spectrum intravenous antibiotics. However, extra-colic abscess larger than 4 cm may require percutaneous trans-abdominal drainage. We report a single centre case series of patients underwent to trans-luminal endoscopic ultrasound (EUS)-guided drainage of pelvic abscess in diverticular disease with temporary placement of lumen apposing metal stent (LAMS). METHODS All patients referred to our tertiary centre from January 2019 to July 2020 were enrolled in a prospective data base that was retrospectively analysed. Procedural steps were as follows: pre-operative computed tomography scan, broad-spectrum antibiotic therapy, EUS-guided deployment of LAMS for 15 days, LAMS removal and deployment of pigtail stent in case of pseudo-cavity persistence. RESULTS Ten patients (6F) with an average of 59.6 years were enrolled with deployment of 10 LAMS. One patient was excluded after EUS evaluation and 1 patient had 2 LAMS for 2 separate abscesses. Technical and clinical success was achieved in 88.8% (8/9). CONCLUSIONS Management of diverticulitis has shifted from primary surgical intervention towards a non-operative approach of bowel rest and broad-spectrum intravenous antibiotics in conjunction with interventional procedures to drain abscesses whenever necessary. EUS-guided drainage with LAMS for the management of diverticular abscesses seems an efficient treatment modality for encapsulated abscesses more than 4 cm in size and close to colonic wall. In expert centres, it may avoid radiologic intervention and/or surgery in a relevant percentage of cases.
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Affiliation(s)
- Gianfranco Donatelli
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Fabrizio Cereatti
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
- Department of Medical, Gastroenterology and Endoscopy Unit, ASST Cremona, Cremona, Italy
| | - Maurizio Fazi
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Vincenzo Ceci
- Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
| | - Parag Dhumane
- Department of Surgical, General and Laparoscopic Surgery Unit, Lilavati Hospital and Research Center, Mumbai, India
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Han J, Zhu Z, Zhang C, Xie HP. Successful Endoscopic Resection of Primary Rectal Mucosa-Associated Lymphoid Tissue Lymphoma by Endoscopic Submucosal Dissection: A Case Report. Front Med (Lausanne) 2021; 8:715256. [PMID: 34568373 PMCID: PMC8460763 DOI: 10.3389/fmed.2021.715256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma arises in extra-nodal sites from the malignant transformation of B lymphocytes that are mainly triggered by infection or autoimmune process. MALT lymphoma is frequently detected in the gastrointestinal tract. As the causal relationship between Helicobacter pylori (H. pylori) infection and gastric MALT lymphoma, it was well-established that early-stage gastric MALT lymphoma could be cured by H. pylori eradication, and about 50–95% of cases achieved complete response with anti-H. pylori treatment. Compared to the stomach which is the most involved site due to the high prevalence of H. pylori infection, the colorectum is rarely affected. Primary rectal MALT lymphoma is a rare malignancy, and there are no specific therapeutic strategies so far. Here we report a case of rectal MALT lymphoma successfully resected by endoscopic submucosal dissection (ESD). ESD serves as a novel strategy to cure small localized rectal MALT lymphomas to avoid unnecessary surgery or chemo-radiotherapy.
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Affiliation(s)
- Jian Han
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Zhu
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States
| | - Chao Zhang
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Ping Xie
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kim JH, Kim H, Kim JW, Kim HM. Trends in the Incidence and Survival Rates of Colorectal Signet-Ring Cell Carcinoma in the South Korean Population: Analysis of the Korea Central Cancer Registry Database. J Clin Med 2021; 10:4258. [PMID: 34575368 DOI: 10.3390/jcm10184258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Signet-ring cell carcinoma (SRCC) is a rare histopathological subtype of colorectal cancer (CRC) constituting approximately 1% of CRC cases. This study analyzed the incidence and survival rates of colorectal SRCC. Methods: We analyzed the incidence and survival rates of colorectal SRCCs based on patients’ data of the Korea Central Cancer Registry. Results: The age-standardized incidence rates of colon and rectum SRCC in 2017 were 0.17 and 0.07 individuals per 100,000, respectively. Between 1993 and 2017, the 1-, 2-, 3-, 4-, and 5-year relative survival rates of patients with colon SRCC were 65.6%, 49.0%, 38.9%, 34.9%, and 33.0%, respectively, while those of patients with rectum SRCC were 69.6%, 47.8%, 38.5%, 32.8%, and 29.4%, respectively. According to the Surveillance, Epidemiology, and End Results summary stages, the 5-year relative survival rates of colon SRCC between 1993 and 2017 were 70.4% for the localized stage, 41.0% for the regional stage, and 7.0% for the distant stage, while those for rectum SRCC were 60.7%, 34.4, and 3.3%, respectively. Conclusions: Although the incidence of colorectal SRCC is extremely low in South Korea, it has been increasing in recent decades. As the prognosis of colorectal SRCC is extremely poor; clinicians should be aware of the differential diagnosis of SRCC in colorectal cancer cases.
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Abstract
RATIONALE Rectal inflammatory myofibroblastic tumor (IMT) is an extremely rare mesenchymal tumor characterized by a mixture of spindle-shaped myofibroblasts or fibroblasts and inflammatory infiltration of lymphocytes and plasma cells. To date, only 8 cases of rectal IMT have been reported. Herein, we report an additional case of rectal IMT in a 28-year-old woman. PATIENT CONCERNS A 28-year-old woman presented with abdominal pain and hematochezia. DIAGNOSES Colonoscopy showed a 3.0-cm subepithelial tumor with central ulceration, covered by white exudate in the rectum. Rectal magnetic resonance imaging revealed a 4.0 × 3.0-cm-sized well-defined subepithelial tumor in the right wall of the rectum, with suspicious right perirectal fat infiltration. INTERVENTIONS Laparoscopic anterior resection was performed. Microscopic examination of the surgical specimen revealed bland-looking spindle cells intermingled with lymphoplasma cells. Immunohistochemistry and fluorescence in situ hybridization showed anaplastic lymphoma kinase positivity and anaplastic lymphoma kinase positivity rearrangement. Rectal IMT was confirmed based on histological, immunohistochemical, and fluorescence in situ hybridization findings. The patient was doing well without evidence of tumor recurrence 1 year after the surgery. LESSONS Rectal IMT, despite its rarity, should be considered in the differential diagnosis of rectal cancer. Second, an accurate histopathologic diagnosis and complete surgical resection can be the most important approaches to offer a chance for the cure of rectal IMT.
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87
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Pop D, Tătar S, Fufezan O, Farcău D. Rectum sizes: Assessment by ultrasonography in children with functional constipation. J Paediatr Child Health 2021; 57:1244-1249. [PMID: 33665902 DOI: 10.1111/jpc.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
AIM This study aimed to compare the transverse diameter and thickness of the anterior wall of the rectum in children with normal bowel movement and children with functional constipation in different age groups. Another objective was to find correlations of rectum sizes with faecal incontinence and constipation duration. METHODS In the study, we included children with normal bowel movement and functional constipation diagnosed based on the Rome III and Rome IV criteria. We collected clinical data from the parents. We measured the rectum transverse diameter and the thickness of the anterior wall by abdominal ultrasound. RESULTS The study included 65 children, 31 with normal bowel movement and 34 with functional constipation. The rectum transverse diameter and the thickness of the anterior wall had statistically significant higher values in patients with constipation (P < 0.05). There was a moderate and significant correlation between the duration of the disease (mean ± standard deviation = 31.7 ± 33.1 months) and rectum transverse diameter (r = 0.54; P = 0.0009). The rectum transverse diameter correlated moderately with the presence of faecal incontinence (r = 0.62; P = 0.003), but the thickness of the anterior wall did not correlate with this symptom (r = 0.02; P = 0.39). CONCLUSIONS We found statistically significant differences between the transverse rectal diameter and thickness of the rectum anterior wall, measured by abdominal ultrasound, in children with functional constipation compared with normal defaecation patterns. Faecal incontinence and long-term constipation were correlated with the increased rectum diameter.
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Affiliation(s)
- Daniela Pop
- 3rd Pediatric Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Tătar
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Radiology Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Dorin Farcău
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Nursing Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yang W, Liu Q, Lin G, Zhang B, Cao H, Zhao Y, Xia L, Feng F, Xiong Z, Hu J, Ye Y, Tao K, Zhang P. The effect of neoadjuvant imatinib therapy on outcome and survival in rectal gastrointestinal stromal tumors: A multiinstitutional study. J Surg Oncol 2021; 124:1128-1135. [PMID: 34324197 DOI: 10.1002/jso.26628] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/28/2021] [Accepted: 07/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to characterize the efficacy of neoadjuvant imatinib in rectal gastrointestinal stromal tumors (GISTs) and the prognostic characteristics of patients after surgery. METHODS Patients with rectal GISTs who received neoadjuvant imatinib between 2000 and 2019 were selected from 11 large-scale tertiary hospitals in China. The best response to neoadjuvant imatinib was assessed. Propensity score matching (PSM) was conducted to reduce confounders. Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier method. RESULTS Of the 100 patients, 75, 18, and 7 had a partial response (PR), stable disease (SD), and progressive disease (PD), respectively. The median tumor size decreased from 5 cm before treatment to 4 cm after treatment (p < 0.001). A total of 31 patients underwent genetic testing after surgery; 23 of patients with exon 11 mutation had PR and 2 had SD. One of the patients with exon 9 mutation had PR, 2 had SD, and 1 had PD. Two patients with the wild type GIST had PD. A total of 86 patients underwent surgery of which 85 underwent complete resection; 72 underwent anal preservation and 40 underwent local excision (LE). After PSM, patients who received neoadjuvant therapy had higher rates of LE (p = 0.001) and anal preservation (p = 0.033) than those of patients without neoadjuvant therapy. The median follow-up time was 37 months. Nine patients experienced recurrence and one patient died. The 3-year RFS and OS rates were 95.0% and 100%, respectively. After PSM, we found that there was no significant difference in RFS between patients who received or did not receive neoadjuvant therapy (p = 0.623). Univariate analysis showed postneoadjuvant tumor size (p = 0.469) and mitotic count (p = 0.294) were not associated with the RFS in patients who received neoadjuvant imatinib. CONCLUSIONS Neoadjuvant imatinib can shrink rectal GIST size, increasing the possibility of complete resection and anal preservation. Further studies are warranted to understand the long-term outcomes of rectal GISTs in patients receiving neoadjuvant imatinib.
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Affiliation(s)
- Wenchang Yang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guole Lin
- Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zhao
- Department of Gastric Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Lijian Xia
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, China
| | - Zhiguo Xiong
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Junbo Hu
- Department of Gastrointestinal Surgery, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, People's Hospital, Peking University, Beijing, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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89
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Pang WS, Tan JH, Tan HCL, Tan JKG. Case series of retained rectal foreign body. A Malaysian experience. Malays Fam Physician 2021; 16:78-82. [PMID: 34386169 PMCID: PMC8346757 DOI: 10.51866/cr1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Retained rectal foreign body, with its associated social stigma, is a medical condition that is infrequently reported in Malaysia. We report the surgical management of five cases of retained foreign objects in the rectum seen over a one-year period. There were three young and two elderly male patients. One of the elderly patients presented with altered bowel habits and an abdominal mass that mimicked a symptomatic colonic tumor. All patients had an abdominal radiograph which clinched the diagnosis of a retained foreign rectal body. Successfully retrieved objects included two bottles, one bidet device, and two sex toys. Open surgery for retrieval of the impacted rectal foreign body was required in one patient. All underwent successful retrievals without any adverse postoperative complications. In our case series, retained rectal foreign bodies were observed only in the male gender. The age presentation was bimodal, with age groups in the twenties and sixties. The treatment options used for the retrieval of these impacted foreign bodies included transanal extraction or explorative laparotomy. Proximal migration and delayed presentation are possible indications for the latter approach.
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Affiliation(s)
- Wei Soon Pang
- MD, MRCS (Ed.), General Surgical Trainee, Pusat, Perubatan Universiti Kebangsaan, Malaysia
| | - Jih Huei Tan
- MMed Surg. (UKM), General Surgeon, Hospital Sultanah Aminah, Johor Bahru, Malaysia,
| | - Henry Chor Lip Tan
- MMed Surg. (UKM), General Surgeon, Hospital Sultanah Aminah, Johor Bahru, Malaysia
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Heiliger C, Piecuch J, Frank A, Andrade D, von Ehrlich-Treuenstätt V, Evtimova D, Kühn F, Werner J, Karcz K. Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery. Sci Rep 2021; 11:14753. [PMID: 34285284 PMCID: PMC8292501 DOI: 10.1038/s41598-021-94244-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.
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Affiliation(s)
- Christian Heiliger
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
| | - Jerzy Piecuch
- Klinika Chirurgii Ogolnej, Metabolicznej i Medycyny Ratunkowej w Zabrzu, Slaski Universytet Medyczny w Katowicach, Katowicach, Poland
| | - Alexander Frank
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Viktor von Ehrlich-Treuenstätt
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Dobromira Evtimova
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Florian Kühn
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Konrad Karcz
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
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Saito K, Yamaoka Y, Shiomi A, Kagawa H, Hino H, Manabe S, Kato S, Hanaoka M. Short- and Long-Term Outcomes of Robotic Surgery for Rectal Neuroendocrine Tumor. Surg Innov 2021; 29:315-320. [PMID: 34228945 DOI: 10.1177/15533506211030436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The optimal radical surgical approach for rectal neuroendocrine tumor (NET) is unknown. Methods. This study evaluated the short- and long-term outcomes of 27 patients who underwent robotic radical surgery for rectal NET between 2011 and 2019. Results. The median distance from the lower border of the tumor to the anal verge was 5.0 cm. The median tumor size was 9.5 mm. Six patients (22%) had lymph node metastasis. The incidences of postoperative complications of grade II and grade III or more according to the Clavien-Dindo classification were 11% and 0%, respectively. All patients underwent sphincter-preserving surgery, and no patients required conversion to open surgery. The median follow-up time was 48.9 months, and both the 3-year overall survival and relapse-free survival rates were 100%. Conclusions. Short- and long-term outcomes of robotic surgery for rectal NET tumor were favorable. Robotic surgery may be a useful surgical approach for rectal NET.
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Affiliation(s)
- Kentaro Saito
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Shunichiro Kato
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
| | - Marie Hanaoka
- Division of Colon and Rectal Surgery, 38471Shizuoka Cancer Center, Nagaizumi, Japan
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Vieujean S, Latour P, Coimbra C, Delvenne P, Louis E, Van Kemseke C. Unusual intra-rectal "laterally spreading tumour" in immunosuppressed patient with ulcerative colitis. Acta Gastroenterol Belg 2021; 84:509-12. [PMID: 34599578 DOI: 10.51821/84.3.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Condyloma acuminatum (CA) is a manifestation of Human Papillomavirus (HPV) infection which usually occurs in genital and perianal regions. We report a 46-year-old man with an ulcerative proctitis diagnosed four years earlier, asymptomatic for a long time under azathioprine but without any follow-up for three years. A colonoscopy was performed prior to potential immunosuppressive treatment discontinuation and showed a circumferential "laterally spreading tumour" in the rectum. Surprisingly biopsies revealed a CA with a very focally high-grade intra-epithelial lesion. Azathioprine was stopped and a transanal surgical resection was performed. At guided anamnesis, patient confirmed to be a former active "men who have sex with men". No recurrence of proctitis occurred despite azathioprine discontinuation. A retrospective review of the histological sections suggests that it was, in fact, an intestinal spirochetosis misdiagnosed as inflammatory bowel disease. Involvement of the rectal mucosa by HPV is a rare condition and this may have been promoted by inappropriate immunosuppressive treatment.
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93
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Sargos P, Faye MD, Bacci M, Supiot S, Latorzeff I, Azria D, Niazi TM, Vuong T, Vendrely V, de Crevoisier R. Late Gastrointestinal Tolerance After Prostate Radiotherapy: Is the Anal Canal the Culprit? A Narrative Critical Review. Front Oncol 2021; 11:666962. [PMID: 34221983 PMCID: PMC8242201 DOI: 10.3389/fonc.2021.666962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Late gastro-intestinal toxicities (LGIT) secondary to pelvic radiotherapy (RT) are well described in the literature. LGIT are mainly related to rectal or ano-rectal irradiation; however, involvement of the anal canal (AC) in the occurrence of LGIT remains poorly described and understood. Materials and Methods The aim of this work was to explore the potential role of the AC in the development of LGIT after prostate irradiation and identify predictive factors that could be optimized in order to limit these toxicities. This narrative literature review was realized using the Pubmed database. We identified original articles published between June 1997 and July 2019, relating to LGIT after RT for localized prostate cancer and for which AC was identified independently. Articles defining the AC as part of an anorectal or rectal volume only were excluded. Results A history of abdominal surgery or cardio-vascular risk, anticoagulant or tobacco use, and the occurrence of acute GIT during RT increases the risk of LGIT. A dose-effect relationship was identified between dose to the AC and development of LGIT. Identification and contouring of the AC and adjacent anatomical structures (muscles or nerves) are justified to apply specific dose constraints. As a limitation, our review mainly considered on 3DCRT which is no longer the standard of care nowadays; we did not identify any reports in the literature using moderately hypofractionated RT for the prostate and AC specific dosimetry. Conclusion These results suggest that the AC may have an important role in the development of LGIT after pelvic RT for prostate cancer. The individualization of the AC during planning should be recommended in prospective studies.
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Affiliation(s)
- Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux Cedex, France
| | - Mame Daro Faye
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Manon Bacci
- Department of Radiation Oncology, Institut Bergonié, Bordeaux Cedex, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Igor Latorzeff
- Department of Radiation Oncology, Clinique Pasteur, Toulouse, France
| | - David Azria
- Department of Radiation Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - Tamim M Niazi
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Te Vuong
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Véronique Vendrely
- Department of Radiation Oncology, Bordeaux University Hospital, Bordeaux, France
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Hanicinec V, Brynychova V, Rosendorf J, Palek R, Liska V, Oliverius M, Kala Z, Mohelnikova-Duchonova B, Krus I, Soucek P. Gene expression of cytokinesis regulators PRC1, KIF14 and CIT has no prognostic role in colorectal and pancreatic cancer. Oncol Lett 2021; 22:598. [PMID: 34188700 PMCID: PMC8228381 DOI: 10.3892/ol.2021.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/12/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most common cancers and pancreatic cancer is among the most fatal and difficult to treat. New prognostic biomarkers are urgently needed to improve the treatment of colorectal and pancreatic cancer. Protein regulating cytokinesis 1 (PRC1), kinesin family member 14 (KIF14) and citron Rho-interacting serine/threonine kinase (CIT) serve important roles in cytokinesis, are strongly associated with cancer progression and have prognostic potential. The present study aimed to investigate the prognostic relevance of the PRC1, KIF14 and CIT genes in colorectal and pancreatic cancer. PRC1, KIF14 and CIT transcript expression was assessed by reverse transcription-quantitative PCR in tumors and paired distant unaffected mucosa from 67 patients with colorectal cancer and tumors and paired non-neoplastic control tissues from 48 patients with pancreatic cancer. The extent of transcript dysregulation between tumor and control tissues and between groups of patients divided by main clinical characteristics, namely patients' age and sex, disease stage, localization and grade, was determined. Finally, the associations of transcript levels in tumors with disease-free interval and overall survival time were evaluated. PRC1, KIF14 and CIT transcripts were upregulated in tumors compared with control tissues. PRC1, KIF14 and CIT levels strongly correlated to each other in both colorectal and pancreatic tumor and control tissues after correction for multiple testing. However, no significant associations were found among the transcript levels of PRC1, KIF14 and CIT and disease-free interval or overall survival time. In summary, the present study demonstrated mutual correlation of PRC1, KIF14 and CIT cytokinesis regulators with no clear prognostic value in pancreatic and colorectal cancers. Hence, according to the results of the present study, transcript levels of these genes cannot be clinically exploited as prognostic biomarkers in colorectal or pancreatic cancer patients.
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Affiliation(s)
- Vojtech Hanicinec
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic
| | - Veronika Brynychova
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic
| | - Jachym Rosendorf
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic.,Deparment of Surgery, Teaching Hospital and Faculty of Medicine in Pilsen, Charles University, 30460 Pilsen, Czech Republic
| | - Richard Palek
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic.,Deparment of Surgery, Teaching Hospital and Faculty of Medicine in Pilsen, Charles University, 30460 Pilsen, Czech Republic
| | - Vaclav Liska
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic.,Deparment of Surgery, Teaching Hospital and Faculty of Medicine in Pilsen, Charles University, 30460 Pilsen, Czech Republic
| | - Martin Oliverius
- Department of Surgery, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Zdenek Kala
- Department of Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Beatrice Mohelnikova-Duchonova
- Department of Oncology and Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 77900 Olomouc, Czech Republic
| | - Ivona Krus
- Department of Toxicogenomics, National Institute of Public Health, Prague 10042, Czech Republic
| | - Pavel Soucek
- Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic.,Department of Toxicogenomics, National Institute of Public Health, Prague 10042, Czech Republic
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95
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Piredda ML, Ammendola S, Sciammarella C, Turri G, Bagante F, Fassan M, Mafficini A, Mombello A, Cataldi S, Paolino G, Mattiolo P, Florena AM, Genna M, Fior F, Cheng L, Lawlor RT, Scarpa A, Pedrazzani C, Luchini C. Colorectal cancer with microsatellite instability: Right-sided location and signet ring cell histology are associated with nodal metastases, and extranodal extension influences disease-free survival. Pathol Res Pract 2021; 224:153519. [PMID: 34119815 DOI: 10.1016/j.prp.2021.153519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 02/08/2023]
Abstract
Colorectal cancer (CRC) with microsatellite instability (MSI) accounts for 15-18 % of all CRCs and represents the category with the best prognosis. This study aimed at determining any possible clinical/pathological features associated with a higher risk of nodal metastasization in MSI-CRC, and at defining any possible prognostic moderators in this setting. All surgically resected CRCs of the last 20 years (mono-institutional series) with a PCR-based diagnosis of MSI, with and without nodal metastasis, have been retrieved for histological review, which was performed following WHO guidelines. Furthermore, the most important prognostic moderators have been investigated with a survival analysis. The study of 33 cases of MSI-CRCs with nodal metastasis highlighted a high fidelity of histology maintenance between primary tumors and matched nodal metastases. At survival analysis, the strongest prognostic variable in MSI-CRCs with nodal metastasis was the extranodal extension (multivariate analysis, HR: 14.4, 95 %CI: 1.46-140.9, p = 0.022). Furthermore, through a comparison between nodal positive (33 cases) and nodal negative (71 cases) MSI-CRCs, right-sided location (p < 0.0001), pT4 stage (p = 0.0004) and signet-ring histology (p = 0.0089) emerged as parameters more commonly associated with nodal metastasization. These findings shed new light on the biology of MSI-CRC and can be of help for the prognostic stratification of MSI-CRC patients.
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Affiliation(s)
- Maria L Piredda
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - Serena Ammendola
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | | | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Fabio Bagante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Andrea Mafficini
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy; Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Aldo Mombello
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Simone Cataldi
- Department of Sciences for Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Gaetano Paolino
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Ada M Florena
- Department of Sciences for Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Michele Genna
- Department of General Surgery, Unit of General and Obesity Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Francesca Fior
- Department of General Surgery, Unit of General and Obesity Surgery, University and Hospital Trust of Verona, Verona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rita T Lawlor
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy
| | - Aldo Scarpa
- ARC-Net Research Center, University and Hospital Trust of Verona, Verona, Italy; Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | - Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy.
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96
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Bhattarai S, Shaikh O, Gaur NK, Tajudeen M, Kumbhar U. A Rare Case of Primary Anorectal Malignant Melanoma. Cureus 2021; 13:e15474. [PMID: 34262812 PMCID: PMC8259073 DOI: 10.7759/cureus.15474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 11/29/2022] Open
Abstract
Malignant melanoma affecting the anorectum is very rare. We present a 63-year-old female who presented with features of bleeding per rectum and painful defecation. On examination, the patient had a palpable mass on the right side of the anorectum, with predominant exophytic growth and intraluminal extension. Biopsy and imaging studies were diagnostic of malignant melanoma. The patient was discussed on the tumor board and planned for abdominoperineal resection. Postoperatively, the patient was started on chemotherapy. The patient was followed up for two years, and there was no evidence of any recurrence.
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Affiliation(s)
- Sandeep Bhattarai
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Naveen Kumar Gaur
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Muhamed Tajudeen
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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97
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Maconi G, Hausken T, Dietrich CF, Pallotta N, Sporea I, Nurnberg D, Dirks K, Romanini L, Serra C, Braden B, Sparchez Z, Gilja OH. Gastrointestinal Ultrasound in Functional Disorders of the Gastrointestinal Tract - EFSUMB Consensus Statement. Ultrasound Int Open 2021; 7:E14-E24. [PMID: 34104853 PMCID: PMC8163523 DOI: 10.1055/a-1474-8013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Abdominal ultrasonography and intestinal ultrasonography are widely used as first diagnostic tools for investigating patients with abdominal symptoms, mainly for excluding organic diseases. However, gastrointestinal ultrasound (GIUS), as a real-time diagnostic imaging method, can also provide information on motility, flow, perfusion, peristalsis, and organ filling and emptying, with high temporal and spatial resolution. Thanks to its noninvasiveness and high repeatability, GIUS can investigate functional gastrointestinal processes and functional gastrointestinal diseases (FGID) by studying their behavior over time and their response to therapy and providing insight into their pathophysiologic mechanisms. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has established a Task Force Group consisting of GIUS experts, which developed clinical recommendations and guidelines on the role of GIUS in several acute and chronic gastrointestinal diseases. This review is dedicated to the role of GIUS in assisting the diagnosis of FGID and particularly in investigating patients with symptoms of functional disorders, such as dysphagia, reflux disorders, dyspepsia, abdominal pain, bloating, and altered bowel habits. The available scientific evidence of GIUS in detecting, assessing, and investigating FGID are reported here, while highlighting sonographic findings and its usefulness in a clinical setting, defining the actual and potential role of GIUS in the management of patients, and providing information regarding future applications and research.
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Affiliation(s)
- Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milano, Italy
| | - Trygve Hausken
- Department of Medicine, University of Bergen, Bergen, Norway
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
| | - Nadia Pallotta
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Roma, Italy
| | - Ioan Sporea
- Department of Gastroenterology, University of Medicine and Pharmacy, Victor Babes Timisoara, Timisoara, Romania.,Department of Gastroenterology, Universitatea de Vest din Timisoara, Timisoara, Romania
| | - Dieter Nurnberg
- Brandenburg Institute for Clinical Ultrasound (BICUS) - Medical University Brandenburg "Theodor Fontane", Faculty of Medicine and Philosophy and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Laura Romanini
- Department of Radiology, Radiologia 1, Hospital of Cremona, Cremona, Italy
| | - Carla Serra
- Internal Medicine and Gastroenterology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zeno Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Odd Helge Gilja
- Haukeland University Hospital, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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98
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Roman H, Merlot B, Forestier D, Noailles M, Magne E, Carteret T, Tuech JJ, Martin DC. Nonvisualized palpable bowel endometriotic satellites. Hum Reprod 2021; 36:656-665. [PMID: 33432338 PMCID: PMC7891810 DOI: 10.1093/humrep/deaa340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/03/2020] [Indexed: 11/16/2022] Open
Abstract
STUDY QUESTION What is the prevalence of laparoscopically nonvisualized palpable satellite bowel nodules at or near the planned stapler site in women undergoing segmental bowel resection for endometriosis? SUMMARY ANSWER Overall, 13 (25.5%) of 51 patients who underwent resection had nonvisualized palpable satellite lesions as small as 2 mm, including seven (14%) who had nonvisualized palpable lesions at or beyond the planned stapler site. WHAT IS KNOWN ALREADY Both laparoscopy and laparotomy for bowel resection are standard of care in Europe and the USA. Reoperation rates after laparoscopic bowel procedures are 1–16%. Endometriotic lesions at the stapler margin of bowel resections are associated with increased repeat surgery. Nodules of 0.1 mm to 1 cm in size were not recognized during laparoscopic bowel surgery but were recognized on histological examination. Up to 20 nodules not visualized at laparoscopy have been recognized and excised at laparotomy. Tenderness is found at up to 27 mm from a recognized lesion. The size of a lesion does not always predict its symptoms or behavior. STUDY DESIGN, SIZE, DURATION This single-arm, observational study focused on the presence of nonvisualized palpable satellite lesions of the bowel. Fifty-one patients scheduled for laparoscopic-assisted bowel resection for deep infiltrating endometriosis with suprapubic incision for placement of the stapler’s anvil and removal of the specimen in the course of routine clinical care were included. There were no additional inclusion or exclusion criteria. PARTICIPANTS/MATERIALS, SETTING, METHODS Laparoscopic-assisted segmental bowel resection for endometriosis was performed in a private referral center on women aged 24–49 years. MAIN RESULTS AND THE ROLE OF CHANCE Forty-nine (96.1%) of the 51 patients underwent segmental resection of the sigmoid or rectum, and 14 (27.5%) underwent segmental resection of the ileum for large nodule(s) recognized on MRI. Twelve patients underwent both procedures. Eleven (22.4%) of the 49 patients with recognized sigmoid or rectal lesions and 5 (35.7%) of the 14 patients with recognized ileal lesions had nonvisualized, palpable, satellite lesions. All the large lesions and none of the satellite lesions had been recognized preoperatively on MRI. Five (10%) of 49 patients with lesions of the large bowel and 4 (28.6%) of the 14 patients with lesions of the ileum had nonvisualized palpable satellite lesions at or beyond the planned stapler site. Lesions as small as 2 mm were palpable. LIMITATIONS, REASONS FOR CAUTION This is an observational study. It is not known if the small lesions of this study contributed to the symptoms or were progressive, stable or regressive. This study analyzed lesions in the bowel segment proximal to the primary large bowel lesion, but not in the distal segment as that would have required a change in standard of care surgical technique. This study protocol did not include shaving or disk resection or patients in whom no lesions were visualized. The use of additional techniques for recognition, such as hand-assisted laparoscopy or rectal probes, was not investigated. WIDER IMPLICATIONS OF THE FINDINGS This study confirms that some nonvisualized satellite lesions as small as 2 mm are palpable and that an increased length of resection can be used to remove lesions recognized by palpation and to avoid lesions at and beyond the stapler site. This may decrease recurrent surgery in 1–16% of the women undergoing surgery for bowel endometriosis. Knowledge of the occurrence of these small lesions may also be particularly useful in plans for repeat surgery or for women with clinically significant bowel symptoms and no visible lesions at laparoscopy. Moreover, small lesions are considered to be important as there is no current technique to determine whether a large primary lesion, smaller lesions, an associated adjacent tissue reaction or a combination of those cause symptoms. STUDY FUNDING/COMPETING INTEREST(S) This CIRENDO cohort was supported by the G4 Group (the University Hospitals of Rouen, Lille, Amiens and Caen) and the ROUENDOMETRIOSE association. No specific funding was received for the study. H.R. reports receiving personal fees from Plasma Surgical Inc., Ethicon Endosurgery, Olympus and Nordic Pharma for presentations related to his experience with endometriosis surgery. D.C.M. reports being given access to Lumenis Surgical CO2 Lasers’ lab at a meeting. None of the other authors have conflicts of interest to disclose. TRIAL REGISTRATION NUMBER N/A
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Affiliation(s)
- H Roman
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
- Department of Gynecology and Obstetrics, Aarhus Medical University, Aarhus, Denmark
| | - B Merlot
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - D Forestier
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - M Noailles
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - E Magne
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - T Carteret
- Endometriosis Center, Clinique Bordeaux Tivoli-Ducos, Bordeaux, France
| | - J-J Tuech
- Department of Surgery, Rouen University Hospital, Rouen, France
| | - D C Martin
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Office of Research Subjects Protection, Institutional Review Board, Virginia Commonwealth University, Richmond, VA, USA
- Correspondence address. Office of Research Subjects Protection, Institutional Review Board, Virginia Commonwealth University, 201 Wakefield Road, Richmond, VA 23221-3258, USA. Tel: +1 (901) 761-4787; E-mail:
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99
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Rey I, Putra A, Lindarto D, Yusuf F. Association between CD133 expression and clinicopathological profile in colorectal cancer. Med Glas (Zenica) 2020; 17:402-7. [PMID: 32253906 DOI: 10.17392/1106-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/10/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022]
Abstract
Aim To investigate CD133 expression and its relationship to clinicopathological profile in colorectal cancer (CRC) patients. Methods This cross-sectional study was performed at the Internal Medicine Department, School of Medicine, Adam Malik General Hospital. The colorectal cancer tissue was taken from surgical resection and colonoscopy biopsy from CRC patients. Clinical profile was obtained by a questionnaire. Histopathology examination was done using hematoxylin and eosin staining. Immunohistochemistry (distribution score and intensity score) combined with ROC analysis were conducted to determine CD133 expression. An association between CD133 expression and clinicopathological profile was then analyzed. Results Out of 118 patients, 690 (58.5%) were male. The high and low level of CD133 expression were found in 44 (37.3%) and 74 (62.7%) patients, respectively. No difference between gender, age, body mass index, hemoglobin, leucocytes, platelets, and histopathology with CD133 expression was found. There was a significant difference between CD133 and different CRC locations (p=0.002). CD133 expression was higher in the proximal colon than the rectum (p=0.002), and it was higher in the distal colon than the rectum (p=0.008), especially in terms of percentages of stained cancer cells (distribution score). Conclusion CD133 expression was associated with the tumour location, but not with other clinicopathological factors.
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100
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Martin JE, English W, Kendall JV, Sheshappanavar V, Peroos S, West M, Cleeve S, Knowles C. Mega rectum: systematic histopathological evaluation of 35 patients and new common pathways in chronic rectal dilatation. J Clin Pathol 2021; 75:jclinpath-2021-207413. [PMID: 34035078 PMCID: PMC9510396 DOI: 10.1136/jclinpath-2021-207413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/29/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022]
Abstract
AIMS Megarectum is well described in the surgical literature but few contemporary pathological studies have been undertaken. There is uncertainty whether 'idiopathic' megarectum is a primary neuromuscular disorder or whether chronic dilatation leads to previously reported and unreported pathological changes. We sought to answer this question. METHODS Systematic histopathological evaluation (in accord with international guidance) of 35 consecutive patients undergoing rectal excision surgery for megarectum (primary: n=24) or megarectum following surgical correction of anorectal malformation (secondary: n=11) in a UK university hospital with adult/paediatric surgical and gastrointestinal neuropathology expertise. RESULTS We confirmed some previously reported observations, notably hypertrophy of the muscularis propria (27 of 35, 77.1% of patients) and extensive fibrosis (30 of 35, 85.7% of patients). We also observed unique and previously unreported features including elastosis (19 of 33, 57.6%) and the presence of polyglucosan bodies (15 of 32, 46.9% of patients). In contrast to previous literature, few patients had any strong evidence of specific forms of visceral neuropathy (5 of 35, including 3 plexus duplications) or myopathy (6 of 35, including 3 muscle duplications). All major pathological findings were common to both primary and secondary forms of the disease, implying that these may be a response to chronic rectal distension rather than of primary aetiology. CONCLUSIONS In the largest case series reported to date, we challenge the current perception of idiopathic megarectum as a primary neuromuscular disease and propose a cellular pathway model for the features present. The severe morphological changes account for some of the irreversibility of the condition and reinforce the need to prevent ongoing rectal distension when first identified.
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Affiliation(s)
- Joanne E Martin
- Department of Cellular Pathology, Blizard Institute, Queen Mary University of London, London, UK
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - William English
- Department of Colorectal Surgery, Barts Health NHS Trust, London, UK
- Department of Colorectal Surgery, Blizard Institute, Queen Mary University of London, London, UK
| | - John V Kendall
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | | | - Sara Peroos
- Department of Cellular Pathology, Blizard Institute, Queen Mary University of London, London, UK
| | - Milly West
- Department of Cellular Pathology, Blizard Institute, Queen Mary University of London, London, UK
| | - Stewart Cleeve
- Department of Paediatric Surgery, Barts Health NHS Trust, London, UK
| | - Charles Knowles
- Department of Colorectal Surgery, Blizard Institute, Queen Mary University of London, London, UK
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