Villous adenoma in augmentation colocystoplasty asociated to infiltrating urotelial cancer in bladder remanent

OBJECTIVE

To report a new case of villous adenoma developed in augmentation colocystoplasty.

METHODS

Characterization of a new case and review of the literature published to date.

RESULTS

We report the case of a 66 year-old man with a villous adenoma and synchronic infiltrating transitional cell carcinoma of the bladder after augmentation colocystoplasty. The latency period until the development of villous adenoma after surgery is long. Treatment consisted of transurethral resection.

CONCLUSIONS

Villous adenoma is a benign neoplasm that occurs in the colonic mucosa and shows a high ability to become a malignant colonic cancer. Only two cases of villous adenoma in augmentation colocystoplasty have been reported. We recommend follow up with periodic cystoscopy because of its high malignancy potency.

Villous adenoma of the urinary bladder: a case report

Villous adenomas of the urinary tract are rare, in contrast to urothelial neoplasms. Most reports were scattered individual cases. Only two case series of this entity have been published. The histopathology is identical to that of the much more common villous adenoma of the gastrointestinal tract. The authors reported a case of urinary bladder villous adenoma in a 41-year-old Thai patient who complained of hematuria for one day without any other symptom. Cystoscopic examination revealed a papillary growth at the bladder neck associated with marked degree of bullous edema and bilateral mild hydroureters. The clinical diagnosis was urothelial carcinoma. Transurethral resection was performed Histologic examination revealed typical features of villous adenoma. The tumor showed identical immunohistochemical profile to colonic villous adenoma. The patient has been well for more than a year after tumor removal.

Treatment of a nephrotic syndrome by endoscopic removal of a villous adenoma of the duodenum

We report the case of a patient diagnosed with a villous adenoma of the duodenum showing high degree dysplasia who developed a nephrotic syndrome (NS) due to a membranous nephropathy (MN), demonstrated by renal biopsy. Only the endoscopic resection of the duodenal adenoma could control the NS. The first manifestation of a MN is often the development of a NS. Up to 20% of patients older than 65 years who develop a MN have cancer. Tumours most often identified are those of lung, prostate and digestive tract. A renal biopsy is required to identify this type of nephropathy. If a diagnosis of MN is made, an associated tumour should be looked for.

[Experience with treatment of patients with villous adenoma of the large intestine]

The authors analyzed an experience with treatment of 176 patients. It was shown that increasing colonoscopy allowed clear differentiation of neoplasm in the colon, decision on the strategy of treatment. The effective method is endoscopic resection of intestine mucosa.

Endoscopic ampullectomy in a patient with a duodenal diverticulum. A challenging procedure

A 65 year-old male was admitted to the University hospital with obstructive jaundice. Endoscopic examination revealed a grossly abnormal major ampulla, situated at the edge of a large duodenal diverticulum. Biopsy of the ampulla was positive for villous adenoma. We describe the technique utilized to successfully perform an end-bloc endoscopic resection of a major ampulla on a diverticulum.

[Clinical application of intersphincteric resection in the anal-preserving operation for ultra-low rectal carcinoma]

OBJECTIVE

To investigate the clinical application of intersphincter resection (ISR) combined with total mesorectal excision (TME) and colon-anal anastomosis in the treatment for ultra-low rectal carcinoma.

METHODS

To review and analyze retrospectively the data of 34 patients with ultra-low rectal carcinoma (without external anal sphincter involvement) who received treatment of ISR, TME and colon-anal anastomosis.

RESULTS

Partial resection of internal sphincter was performed in the patients with a distal edge of the tumor greater than or equal to 2 cm from the dentate line. Subtotal removal of the rectum was performed between 1 cm and 2 cm. Total resection was performed in less than 1 cm or involvement of dentate line. Reconstruction of digestive tract was done by manual colon-anal anastomosis. The average distance from distal excised margin to the tumor was 2.3 (1.8 - 3.2) cm among 34 patients. The pathological types were as follows: 28 cases of adenocarcinoma (11 were well differentiated, 17 moderately differentiated), 1 case of papillary carcinoma and 5 cases of villous adenoma with malignant change. The postoperative pathological stages were: Dukes stage A in 28 cases, stage B in 1 and stage C in 5 cases. The pTNM staging was 28 cases in phase I, 1 in phase IIa, 4 in phase IIIa and 1 in phase IIIb. The T stages of the patients were as following: 16 Tl, 17 T2 and 1 T3. Postoperative anastomotic stenosis occurred in 3 cases, anastomotic dehiscence in 2 cases and rectovaginal fistula in 2 cases. The ability of controlling feces of patients decreased significantly in the early postoperative period, and restored gradually at 6 to 12 months after operation. Anastomotic recurrence occurred in 1 case at 5 months after operation and liver metastasis in 1 case at 40 months.

CONCLUSION

With strictly grasping indications, radical resection can be attained and anal sphincter preserved by ISR combined with TME and colon-anal anastomosis. It is an effective sphincter-preserving operation.

Tubulovillous adenoma in the common bile duct causing obstructive jaundice

Villous adenomas are benign epithelial lesions with a malignant potential which can occur at any site in the gastrointestinal tract, usually in the rectum and colon, less frequently in the small bowel and very rarely in the biliary tract. Villous adenomas of the extrahepatic bile ducts are exceptional and only a few cases have been reported. Common bile duct (CBD) adenomas often present in a fashion similar to their malignant counterparts, and adenocarcinoma arising from a villous adenoma of the ampullary biliary epithelium is also extremely rare. We present here a tubulovillous adenoma, arising in the common bile duct, as a cause of obstructive jaundice, and discuss the characteristics of these lesions.

Small intestinal tubulovillous adenoma--case report and literature review

Benign small intestinal tumour, though rare, have been reported. We report a case of sessile and extensive tubulovillous adenoma in a 13-year-old girl. She presented in a private hospital with three months history of abdominal pain, abdominal distension, vomiting, constipation, weight loss and anorexia. Significant findings on examination were weight loss, dehydration, and a huge smooth, not tender, mobile and indentable mass which extended from the left lumbar region to right iliac fossa. Visible peristalsis coursing from left to right was seen on the mass. Erect and supine plain abdominal x-rays revealed features of partial intestinal obstruction and abdominal ultrasound scan revealed dilated and hypertrophied bowel segment but could not say the bowel segment affected. The affected segment was found to be a 55cm portion of terminal ileum at operation which was resected due to hypertrophied proximal and collapsed distal segments, features in keeping with chronic intestinal obstruction, and ileo-ileal anastomosis done. Histology report was that of benign tubulovillous adenoma and the girl has enjoyed stable health for more than a year on close follow up in surgical outpatient clinic. This case highlights the unusual presentation and unusual gross nature of this small intestinal adenoma, which was found to be a benign adenoma on histological examination.

[Case of villous tumor of the rectum presenting with severe diarrhea and electrolyte depletion syndrome]

A 83-year-old man with a 2-year history of diarrhea was admitted hospital because of increased diarrhea and general fatigue. He had severe dehydration, hyponatremia, hypokalemia and hypochloremia. Abdominal CT showed tumor and fluid in the rectum. Colonoscopy revealed large tumor with a villous structure in the rectum. Low anterior resection was performed. The histopathological diagnosis was adenocarcinoma with villous adenoma. The immunostaining of the tumor revealed positive COX-2 expression. The diarrhea and electrolyte disturbance disappeared after the resection of tumor.

[Subtotal or total colectomy as surgical treatment of left-sided occlusive colon cancer]

INTRODUCTION

The treatment of acutely obstructed carcinoma of the left colon and sigmoid still represents a matter of controversy. The aim of this study was to assess retrospectively the results of its management by emergency subtotal or total colectomy with primary anastomosis.

MATERIALS AND RESULTS

Sixty-seven patients were reviewed. There were 42 males and 25 females. The mean age was 70.5 years (range: 26-87 years). Mean operative time was 210 minutes. There were five synchronous colon carcinomas (7.5%) and 23 (343%) synchronous tubulous and tubulo-villous adenomas. No death was noted in the series. Ten postoperative complications (15%) occurred in nine patients including one postoperative peritonitis without evidence of anastomotic leak, one alithiasic cholecystitis, one evisceration and two intra-abdominal abscesses. The mean hospital stay was 11.4 days. Fifty-eight patients were assessed at three and twelve months for functional results. No fecal incontinence was encountered. The mean number of bowel movements per 24 hours was 3.2 at three months and 2 at twelve months. All patients were satisfied with their quality of life. Twelve patients (20.7%) occasionally needed anti-diarrheic medications.

CONCLUSION

Urgent subtotal or total colectomy with primary anastomosis is a safe and efficient procedure in the management of acutely obstructed neoplasm of the left colon. It allows to treat in one stage the cancer and the obstruction, bearing no mortality, acceptable morbidity and satisfactory postoperative functional results.

[McKittrick- Wheelock syndrome: report of one case]

Villous colorectal adenomas are common tumors that normally provoke scarce symptomatology. We report a 59 year-old female that was admitted with severe dehydration due to severe diarrhea lasting 10 days and vomiting in the last 48 hours. On rectal palpation a large tumor located 5 cm above the anus was palpated. Colonoscopy confirmed the presence of a villous adenoma that was excised surgically. In this patient, the fluid and electrolyte hypersecretion of the rectal villous adenoma provoked a depletion syndrome with serious hydroelectrolytic alterations, acute renal failure and hypovolemic shock. This syndrome was first described by McKittrick and Wheelock in 1954.

Laparoscopy-assisted endoscopic mucosal resection in the colon: a preliminary report

Endocopic mucosal resection of flat villous tumours or giant polyps (> 3 cm) may give rise to local complications such as haemorrhage or perforation because of the very thin wall of the colon, above all in the right half. Our aim was to evaluate whether laparoscopy-assisted endoscopic excision of flat villous tumours or giant polyps (> 3 cm) can be safely performed, avoiding critical septic complications and can also help in the selection of patients to be submitted to colonic resection without increasing morbidity or mortality. The procedure is a new minimally invasive therapeutic approach in selected cases with large, sessile or awkwardly located polyps. Unlike other techniques such as polypectomy, endoscopic mucosal resection completely removes the affected mucosa by resecting through the middle or deeper part of the submucosa. Another purpose of the procedure is to obtain specimens for accurate pathological staging. Our experience consisted in the treatment of two patients, one of whom with a laterally spreading tumour of the transverse colon with the suck and cut cap-assisted technique, and one with a large sessile polyp of the caecum with the lift and cut technique. The patients presented no complications and no recurrence was observed during the subsequent follow-up.

Colon invasive micropapillary carcinoma arising in tubulovillous adenoma

Invasive micropapillary carcinoma (IMPC) is defined as a carcinoma composed of small clusters of tumor cells lying within clear spaces which simulate lymphovascular channels. This histologic pattern has been described in various organs, including the breast, lung, urinary bladder, ovary, stomach, pancreas, and major salivary glands. Although rarely observed as a pure histologic component, IMPC is usually mixed with conventional carcinoma, and is therefore often referred to as carcinoma with a micropapillary component. IMPCs are invariably associated with a high degree of aggressiveness, extensive lymphovascular invasion, extensive lymph node metastases, and poor prognosis. I herein describe a case of primary IMPC originating in colon polyp as a minor histologic component.

Villous adenoma of extrahepatic bile duct: contrast-enhanced sonography findings

We report a case of villous adenoma in the extrahepatic bile duct that was successfully diagnosed with contrast-enhanced sonography (CEUS) before surgical resection. On baseline sonography, the mass appeared as a homogeneously isoechoic mass filling the bile duct from the confluence of the right and left hepatic ducts to the distal common bile duct. No intralesional flow signal was found on color Doppler imaging and power Doppler imaging. On CEUS, the mass showed homogeneous enhancement during arterial phase, thus confirming the neoplastic nature of the lesion. The enhancement decreased gradually so that the mass became hypoenhanced during portal and late phases. Surgical resection was performed, and pathologic examination confirmed a villous adenoma of the bile duct epithelium with mild dysplasia.