Colorectal cancer in children: case report and review of literature

Compared to adults, colorectal carcinoma is rare in children and has poorer prognosis, due to delay in diagnosis, advanced stage at presentation and aggressive natural history. We describe a case of mucinous adenocarcinoma of the rectum in a eleven year old boy and review the literature regarding colorectal cancer in children. A high index of suspicion and an early diagnosis may lead to an improvement in the dismal prognosis of this disease in children.

Synchronous cardiac myxoma and colorectal cancer: a case report

The occurrence of synchronous but unrelated cardiac and colorectal tumors is extremely rare. We present the case of a 56-year-old man who had a left atrial cardiac myxoma that nearly obstructed the mitral valve outflow tract and an unrelated, synchronous colorectal-vesicle carcinoma that nearly obstructed the lumen of the intestine. The patient underwent emergency resection of the cardiac mass under cardiopulmonary bypass and underwent successful resection of the colorectal mass 2 weeks later Two years after these operations, the patient is well with no recurrence of either tumor Synchronous tumors, particularly when one of them involves the heart, require aggressive surgical treatment at multiple sites in order for the patient to survive.

Anal duct carcinoma: case report and review of the literature

This report details the clinical course of two patients with true anal duct carcinoma. The incidence of this malignancy is low. The tissues of origination are the glands of the anal duct. The features that differentiate this tumor from the usual rectal carcinoma are prominent ductal structures, abundant mucin production with organized mucinous pools, and infiltration into the perirectal soft tissue. The clinical management of anal duct carcinoma remains a surgical challenge. The extent of surgical resection must be radical because of the infiltrative nature of the tumor. This report describes treatment of two patients with anal duct carcinoma. The first patient was a black woman with no previous history of rectal disease. Her operative procedure was an abdominoperineal resection with posterior vaginectomy. Nine months after initial surgery a local recurrence was resected. The second patient was a white man with a previous history of hemorrhoidectomy and anal fissure. He underwent an abdominoperineal resection but had positive dermal skin margins on permanent sections despite wide perirectal soft tissue resection. A secondary resection with confirmed clear margins of the skin was performed 2 weeks postoperatively. One management aspect of anal duct carcinoma that needs emphasis is the need for wide local excision of the perirectal soft tissues.

Colon cancer in aged captive rhesus monkeys (Macaca mulatta)

The age-related incidence of malignant neoplasia was surveyed from a total of 301 necropsy cases of rhesus monkeys ranging in age from 13-37 years performed in the Pathology Service Unit of the Wisconsin Regional Primate Research Center during the past 15 years. All our aged monkeys lived in indoor cages and were fed with monkey chow and supplemental fruits during the past decades. In this survey, we found a total of 51 malignant neoplasms, and among them 25 cases were colon cancer. The incidence of colon cancer increased with advancing age: 3.2% at 13-19 years, 9.2% at 20-25 years, 13.5% at 26-29 years, and 20.7% at 30-37 years. Most cancers were located in the cecum and transverse regions with a unicentric origin. Two multicentric cases were associated with chronic hypertrophic colitis. Precancerous polypous lesions were not found in all cases. Histologically, all cases were mucinous adenocarcinoma and had local invasion to the muscular wall. Metastasis to the mesenteric lymph nodes was found in only two cases. As in humans, colon cancer is a common outcome of aging in nonhuman primates.

Multiple births and risk of epithelial ovarian cancer

BACKGROUND AND METHODS

Prevailing hypotheses about the causes of ovarian carcinogenesis predict that women with a history of multiple births (twins, triplets, etc.) should be at increased risk of epithelial ovarian cancer. However, the scant available evidence suggests that they may actually be at lower risk. To resolve this issue, we pooled data from eight studies involving 2859 parous women with epithelial ovarian cancer (case patients) and 7434 parous women without ovarian cancer (control women). In addition to assessing their history of multiple births (and the sex of the children, where available), we obtained information on age, parity, oral contraceptive use, and other reproductive factors for each woman. Details of tumor histology were available for all case patients. We estimated the relative risks of various histologic types of ovarian cancers associated with multiple births by using multivariable logistic regression analysis, adjusting for matching and confounding variables.

RESULTS

Among these parous women, 73 case patients (2. 6%) and 257 control women (3.5%) had a history of multiple births. The adjusted summary odds ratio (OR) for developing all types of epithelial ovarian cancer that are associated with multiple births was 0.81 (95% confidence interval [CI] = 0.61-1.08). We found no evidence that risks associated with multiple births differed among women with borderline or invasive tumors and among women with same-sex and opposite-sex offspring from multiple births. The risk reductions appeared specific for nonmucinous tumors (n = 2453; summary adjusted OR = 0.71 [95% CI = 0.52-0.98]); in contrast, associations with mucinous tumors (n = 406) were heterogeneous across studies.

CONCLUSIONS

Parous women with nonmucinous ovarian cancer are no more likely to have a history of multiple births than other parous women, counter to the predictions of current hypotheses for causes of ovarian cancer.

[Molecular biological and clinical-morphological studies of gastric tumors associated with Epstein-Barr virus]

The paper presents the results of the studies of gastric cancer (GC) associated with Epstein-Barr virus (EBV) among the patients residing in 4 geographical regions. In situ hybridization (ISH) techniques revealed that 49(11.4%) of the 430 examinees were EBV positive (EBV+), the virus-specific marker mRNA-1 of EBV, EBER-1) was found to be present in 80-100) of tumor cells. The proportion of EBV(+)-associated GC cases in different geographic regions ranged from 7.3 to 15%. These tumors were predominant in males (15%) as opposite to females (5.5%). Histological types most common among EBV+ tumors and their location in the stomach are also described. Serological findings indicated that the increased anti-EDV antibody response in 70% of GC cases coincided with the presence of the viral genetic information detected by ISH. In contrast to a humoral response to EBV, a humoral response to Helicobacter pylori was equal both in patients with EBV(+)- and EBV(-)-associated gastric tumors. Further molecular biological analysis of EBV isolates from virus positive and virus negative GC may answer the question whether there are really the so-called tumor and non-tumor variants of EBV.

Epidemiologic differences between women with borderline ovarian tumors and women with epithelial ovarian cancer

OBJECTIVE

The aim of this study was to study the relationship between borderline ovarian tumors (BLOT) and epithelial ovarian cancer (EOC) by comparing the epidemiologic features of women with BLOT with those of women with EOC of similar histology.

MATERIAL AND METHODS

The epidemiologic features of 32 women with serous and mucinous BLOT were compared with those of 273 women with primary serous or mucinous EOC. We included all women with the documented respective histologic diagnoses admitted to Roswell Park Cancer Institute between 1982 and 1996 who returned a self-administered epidemiologic questionnaire which contained 44 items pertaining to reproductive, contraceptive, medical, social, dietary, occupational, and family histories of cancer. Individual variables between both groups were compared using the Student t test, chi2 analysis, the Mantel-Haenszel test, and the Wilcoxon nonparametric test. Two-tailed P < 0.05 was considered significant.

RESULTS

The response rate to the questionnaire was 63% in the BLOT group and 60% in the EOC group. There was no significant difference between the two groups in geographic location, race, education, income, smoking, marital status, age at first pregnancy, age at first birth, history of hysterectomy, history of infertility, history of tubal surgery, use of hormone replacement therapy, or history of diaphragm or intrauterine contraceptive device use. There were no significant differences in family history of malignancy between women with BLOT and those with EOC. Women with BLOT were significantly younger than those with EOC (mean age 47 +/- 14.0 versus 56 +/- 13.7, P < 0.01). There was an apparent difference in oral contraceptive pill use between both groups. However, when we adjusted for age by stratification this difference was not significant (P = 0.089).

CONCLUSIONS

The epidemiologic features of women with BLOT are similar to those of women with EOC with the exception of an earlier age of onset. These findings might be consistent with one etiology for both conditions.

Prevalence of HNPCC in a series of consecutive patients on the first endoscopic diagnosis of colorectal cancer: a multicenter study. The Italian Collaborative Group

BACKGROUND AND STUDY AIMS

It is difficult to measure the prevalence of hereditary non-polyposis colorectal cancer (HNPCC) in geographical areas that do not have tumor registers, as is the case in the present study, and it was therefore decided to assess the prevalence in Italy using different methods.

PATIENTS AND METHODS

The pedigree was established for 485 of 501 colorectal cancer patients diagnosed with colorectal carcinomas. Patients were included consecutively in 13 gastroenterology centers; they had not taken part in prevention examinations. Information was collected regarding the neoplastic pathology observed in the families, confirmed in 90% of cases among 3515 first-degree relatives and in 79.5% of cases among 7068 second-degree relatives.

RESULTS

In the 3515 first-degree relatives (1002 parents, 1560 siblings and 953 children), 61 colorectal carcinomas, 29 carcinomas in the digestive tract outside the colon, and 99 carcinomas in other locations were reported. Only five of the 485 patients (1%) satisfied the Amsterdam criteria (three cancers, two of which were in first-degree relatives in different generations and one in a relative younger than 50). When broadening the criteria that we are proposing (satisfying only two of the three Amsterdam criteria), the prevalence would increase to 3% (15 cases).

CONCLUSIONS

Modifying the criteria makes it easier to identify new mutations or confirm the existence of those already known, as well as allowing preventative treatment in relatives who are apparently healthy.

Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas

OBJECTIVE

Intraductal papillary mucinous tumor (IPMT) of the pancreas has a favorable prognosis. Non-pancreatic primary neoplasms have potential prognostic significance in patients with IPMT. This study focused on the incidence and characteristics of nonpancreatic neoplasms in IPMT patients.

METHODS

Forty-two patients (mean age, 64 yr) with IPMT underwent surgery; 16 had adenoma and 26 adenocarcinoma. Preoperative and postoperative, nonpancreatic neoplasms were investigated. The mean postoperative follow-up period was 4.2 yr (range, 0.2-13 yr). Furthermore, 46 patients with pancreatic ductal adenocarcinoma were analyzed for nonpancreatic neoplasms.

RESULTS

Five-year survival rates were 100% for benign and 82% for malignant IPMT. Twenty patients (48%) had nonpancreatic neoplasms, before (n = 11), at (n = 4), and after (n = 10) surgery for IPMT. Fifteen patients (32%) had nonpancreatic malignancies. Nonpancreatic neoplasms included colorectal adenomas (21%) and adenocarcinomas (12%), and gastric carcinomas (10%). One patient died of subsequent bile duct carcinoma. Development of nonpancreatic neoplasms was related to age but not to gender, family history, adjuvant chemotherapy, or IPMT pathology. The incidences of nonpancreatic neoplasms and malignancies were significantly higher in patients with IPMT than in those with pancreatic ductal adenocarcinoma (11% and 7%, respectively).

CONCLUSIONS

IPMT is associated with a high incidence of nonpancreatic neoplasms, particularly colorectal neoplasms. In IPMT patients, systemic surveillance may allow early detection of second tumors. In preoperative screening and postoperative follow-up of patients with nonpancreatic neoplasms, the possibility of IPMT should be considered.

Borderline ovarian tumours: retrospective analysis of twenty-one cases

Twenty-one borderline ovarian tumour cases, diagnosed and treated in our oncology section between 1986 and 1996, were retrospectively analysed. Thirty-three percent of the cases had serous tumours and the rest (66.6%) were mucinous, 57.1% of the mucinous tumours were the intestinal type and the remaining 42.9% were the endocervical type. When all the cases were analysed, the average age was 45.4+/-18.6 years, the average follow-up period was 5.5+/-2.6 years. The preoperative average CA125 level was 55.1+/-51.9 U/mL, and for CA19.9 it was 48.2+/-47.8 U/mL. Of the patients 85.7% were stage I and 14.3% state III. There were not any significant differences between the serous, intestinal-type mucinous and endometroid-type mucinous tumours regarding tumour volumes (p>0.05). When serous and mucinous tumours were compared according to the tumour markers, CA125 levels were significantly higher in the serous tumours (p=0.04) and CA19.9 levels were significantly higher in the mucinous tumours (p=0.02). All of the patients are under our follow-up and are in remission, except one, who died in the third year of the treatment because of chronic renal failure unrelated to the ovarian pathology.

Low-malignant potential epithelial tumors of the ovary: a clinicopathological study

Low-malignant potential (LMP) epithelial tumors of the ovary are a group which occupy an intermediate position between the benign and those of the frankly malignant ovarian neoplasms. The actual incidence, present age and treatment are still being discussed. During the period 1991-1996, from the 650 ovarian tumors which were diagnosed and treated in our institution, 401 were epithelial tumors. The LMP serous epithelial tumors consisted of 4.36% of all serous tumors while LMP mucinous tumors were 9.70% of all mucinous tumors. The LMP serous tumors had an 8 cm diameter on average, 83% were unilocular and 76.5% unilateral. The LMP mucinous tumors had a 17 cm diameter on average, 95% were multilocular and 95% unilateral. The mean age at diagnosis was 39 years for LMP serous tumors and 48 years for LMP mucinous tumors.

The incidence of borderline ovarian tumors in Israel: a population-based study

BACKGROUND

In hospital-based studies, one-eighth of ovarian cancers have been considered borderline ovarian tumors (BOTs). Population-based data regarding the incidence of BOTs are lacking in the international literature. The authors' objectives were to measure the incidence of BOT in Israel and compare rates among ethnic groups (based on ethnic group and country of birth) for the years 1985-1993.

METHODS

The authors analyzed data reported to a nationwide cancer registry. Population estimates by subpopulation were derived from census and intercensus estimates, which were based on an updated population registry.

RESULTS

The age-adjusted standard rate (ASR) for the entire population was 10.6 per million (95% confidence interval [CI], 9.2-12.0) for the period 1985-1993. Significant differences in ASR were observed among ethnic subgroups, with the lowest incidence among non-Jews (ASR, 5.0 per million; 95% CI, 0.7-9.3) and the highest among new immigrants from the former Soviet Union (FSU) who had been arriving since 1989 (ASR, 22.7 per million; 95% CI: 14.2-31.3). Between the periods 1985-1989 and 1990-1993, the ASR for Jews nearly doubled (rate ratio, 1.86; 95% CI, 1.1-2.5). This near-doubling was influenced, but not wholly accounted for, by the immigration from FSU and was observed in all ethnic subgroups.

CONCLUSIONS

The variations in the incidence rates of BOT among ethnic groups may be related to differences in fertility patterns, use of fertility drugs, and genetic predisposition. The pattern of near-doubling in rates may reflect biases caused by increased detection or shifts in the classification of ovarian tumors; if they are real, a biologic explanation is needed.

Mucinous tumors of the ovary: interobserver diagnostic variability and utility of sectioning protocols

OBJECTIVES

To determine the interobserver variability of the subclassification of ovarian mucinous tumors and the utility of different sectioning protocols.

METHODS

Six pathologists retrospectively reclassified 73 mucinous tumors (30 adenomas, 22 low malignant potential tumors, and 21 carcinomas). Using probabilities, the accuracy of limited sectioning protocols was compared with that of a one section per centimeter protocol.

RESULTS

The mean kappa statistic was 0.56, indicating only good agreement. Although a limited sectioning protocol would result in misdiagnosing cases of stage IA carcinoma as a low malignant potential tumor, the overall prognosis of patients with low malignant potential tumors would not markedly change. The prognosis of a patient with a low malignant potential tumor using limited sectioning was within the prognostic range owing to interobserver variability alone.

CONCLUSIONS

We conclude that extensive sectioning of ovarian mucinous tumors has limited benefit.

Colorectal carcinoma in different age groups: a population-based investigation

Although colorectal cancer is a disease of the older population, these tumors are not infrequent before the age of 55. Through the data of a population-based registry, we proposed giving a description of the clinical features of three groups of patients in whom the disease occurred at a relatively early age of onset (group I: < 40 yr; group II: 41-50 yr; group III: 51-55 yr). There were only 14 patients under the age of 40 yr (1.1% of total registered patients, n = 1298 in the period 1984-1992). Group II and III represented 5.9% and 6.0%, respectively (n = 76 and 78), with minor fluctuations throughout the 9-yr period of registration. Inherited colorectal tumors [hereditary nonpolyposis colorectal cancer (HNPCC), adenomatosis coli, and suspected HNPCC] accounted for 38.4% of group I patients (5 of 14), 17.1% of group II, 10.2% of group III, and only 3.5% of individuals older than 55 (p, for trend, < 0.001). Thus, hereditary colorectal tumors were detected significantly more often in younger individuals. The majority of colorectal malignancies were localized in the left colon or rectum in all three groups, with a tendency (not significant) to a preferential localization in the right colon for tumors developed in group I (37% vs 18% and 14% in groups II and III, respectively). Pathological stage and main histological types did not differ among the three groups. Finally, life-table analysis did not show significant differences in 5-yr survival among the three groups; however, when considered together, early onset cases showed a more favorable prognosis than older individuals (log-rank 11.6; p < 0.001). In conclusion, colorectal cancer is diagnosed very rarely before the age of 40 yr, whereas about 12% of all cases belong to the age group 41 to 55 yr of age. Hereditary tumors were found more frequently in younger patients, with a well-defined inverse relationship between age of onset and frequency of genetically determined tumors. Finally, the clinical outcome was more favorable in the whole series of early onset cases than in older registered patients.

[Mucous-secreting breast cancer]

3 groups are distinguished among 219 cases of the breast carcinoma with mucus formation: one-component colloid carcinoma, combined colloid carcinoma and signet ring cell carcinoma. Morphological features and prognosis for each group are listed. One-component colloid carcinoma has the most favourable prognosis: incidence of distant metastases 15% versus 27% and 33% in combined colloid and signet ring cell carcinoma, respectively. Signet ring cell carcinoma should obviously be regarded as a variant of invasive lobular carcinoma.

Cancer of the colon and rectum in the first three decades of life

BACKGROUND/AIMS

Recently an increasing number of young colorectal carcinoma patients attending the University Hospital, Kuala Lumpur were noted. This report represents our experience with patients suffering from colorectal cancer aged 30 years or younger.

MATERIALS AND METHODS

All cases of primary carcinoma of the colon and rectum admitted to the University Hospital during 1990 to 1994 were respectively reviewed. Inclusion criteria was that the patient had been 30 years or younger. Data collected included age, gender, race, site of tumour, presenting symptomatology, duration of symptoms, histology, extension of tumour and nodal involvement predisposing factors, treatment and follow-up.

RESULTS

21 patients were included, 5 patients (24%) were 30 years old at diagnosis, 12 (57%) patients were aged 20-29 years and 4 patients (19%) were less than 20 years old. Thirteen of the 21 patients were female, and 8 (38%) were male, 6 of the 21 patients (29%) were Malaysian, while 1 was Indian (4%). The remainder were Chinese, 14 patients (67%). Six patients (29%) had their primary tumour located in the rectosigmoid, 4 (19%) in the left colon, 1 (4%) in the splenic flexure, 2 in the transverse colon (9%), 1 in the hepatic flexure (4%) and 5 in the caecum 24(%). One patient had a tumour too diffuse to detect a primary site at the time of operation. One patient with a family history of polyps had his entire colon removed at age 14. He had 3 separate foci of tumour. The 5-year survival rate was 25%.

DISCUSSION

Most patients with extensive disease and mucinous histology. Lesions are commonly seen beyond the transverse colon (57%). Presentation included most commonly abdominal pain, haematochezia or haemoccult positive stools.

CONCLUSION

The symptoms above should alert surgeons to colorectal carcinoma as a differential diagnosis.

[Ovarian cancer in Israel, 1960-1989]

In Israel ovarian cancer ranks among the most common malignant diseases in women. It is also one of the main causes of death from cancer in females in this country. Our population is composed of immigrants from diverse social, cultural, and geographical backgrounds, and only a sector of the inhabitants, mainly the younger generation, is Israeli-born. This study evaluates the trends of epidemiological and clinical data on ovarian cancer during 3 decades, 1960-1989, and includes a total of 5,786 cases of ovarian cancer. Information was obtained from the Central Israel Cancer Registry of the Ministry of Health and from the Central Bureau of Statistics. The incidence was stable during the survey period and was about 15-17/100,000 in women over the age of 15. Most (90%) were diagnosed over the age of 40. In women of European/American origin the incidence of ovarian cancer is 3 times greater than in women of Asian/African origin. The rate in the Israeli-born is between those of the other 2 groups, but closer to that of the European/American group. Over 70% were diagnosed with advanced disease (stage III-IV). Prognosis improved during the period of the study: 5-year survival was 19% in the early 60's and 31% in the 80's. During the last decade of the survey improvement was mainly in 2-year survival (from 38.5% to 60%).

Mucinous adenocarcinoma of the renal pelvis in natives of India

A case of mucinous adenocarcinoma of the renal pelvis and ureter presenting as chronic flank pain, calculus, and hydronephrosis in an immigrant from India is presented. A literature review reveals a high frequency of reporting this otherwise rare tumor in India and suggests an inflammatory, environmental, or dietary etiology.

Primary signet ring cell carcinoma of colorectum: an age- and sex-matched controlled study

OBJECTIVE

To evaluate the differences of clinicopathological features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma.

METHODS

The clinicopathological data of 28 cases with primary colorectal signet ring cell carcinoma was reviewed and compared with the data from 56 age- and sex-matched patients with ordinary adenocarcinoma.

RESULTS

Fifteen cases (53.5%) with primary signet ring cell carcinoma were younger than 40 yr of age. Compared with 985 ordinary adenocarcinoma cases, signet ring cell carcinoma is present in excess in younger patients (p < 0.005). Further comparison with 56 age- and sex-matched ordinary adenocarcinomas showed that signet ring cell carcinomas could affect any sites of colon, presented as scirrhous appearance more frequently, had a higher percentage of stage III or IV tumors (78.6 vs 48.2%, 14.3 vs 7.2%, p < 0.005), had a higher rate of peritoneal seeding (35.7 vs 12.5%, p < 0.005) but a lower rate of liver metastasis (14.3 vs 32.1%, p < 0.005), and had a lower curative resection rate (64.2 vs 80.4%, p < 0.005) and a higher local or distant metastasis rate (61.1 vs 17.8%, p < 0.05). Survival with signet ring cell carcinoma is lower than that of ordinary adenocarcinoma. "Stage-on-diagnosis" and "presence of subsequent distant metastasis" were the major factors influencing survival of signet ring cell carcinoma patients.

CONCLUSION

The delay in diagnosis reduces the chance of curative resection, increases the possibility of local or distant metastasis postoperatively, and, thus, shortens the survival chances. To improve outcome, recognition of the factors responsible for this delay should be stressed so that this tumor may be found at a stage when cure is possible.

[Colorectal cancer: study on 365 cases]

We report a clinic-endoscopical study about 365 patients, both of sex, between 26-95 years old, with colonoscopic diagnosis of colorectal cancer. Results showed that 61,92% were men and 38,08% women; in 92,60% the disease ocurred over 40 years old. 13,42% had malignant personal history -colorectal cancer, uterus and breast cancer, and others-; 13,97% had bening personal history-colorectal adenoma, cholecystectomy, and others-; Abdomina pain, change in intestinal habits, and bleeding were the moist frequent symptoms, with differences depending of the tumors localization in the colon or rectum. 62,57% of patients had anemia under 10g% of hernoglobin; in 85,23% the fecal occult blood test was positive. On 199 patients, the simple barium enema diagnosed the tumor in 66,33% only; but in the same group, colonoscopy diagnosed the cancer in 96,49% at first examination. In all patients, colonoscopywas excellent for diagnosis of the principal lesion, and for the identification of synchronous neoplasia. On 365 patients, colonoscopy diagnosed the cancer in 98,08% at first examination. The localization of tumors was: 57,63% in left colon (49,47% in rectum and sigmoid colon); 34,21% in the right colon; and 8,16% in transverse. Pathology showed that adenocarcinoma was the most frequent tumor 95,23%; 1,06% mucoid carcinoma; 1,06% epidermoid carcinoma; and 2,65% lymphorna. In 32,05% of cases there were synchronous lesions; 3,01% had other cancer, and 54 patients had 112 polyps (62,50% adenomatous polyp, 6,25% adenoma with non invasive or invasive adenocarcinoma, and 31,25% hiperplastic polyp. Authors emphasize the value of the detection and early diagnosis to decrese the colorectal cancer mortality.

Carcinoma of the colon in children

The symptoms, histology, extent and course of disease in 16 adolescents with colorectal carcinoma who were admitted to Hacettepe University Children's Hospital between 1972 and 1990 are presented. Most patients presented with vague abdominal complaints. Twelve of the 16 patients had mucin-producing adenocarcinoma. Extensive disease at diagnosis and unresponsiveness to medical management were determined. Only one patient survived free of disease four years after diagnosis. Nine of the patients died between one day and one year following the initial surgery. The remaining six patients were very ill when they were discharged from the hospital, after which time no information was received concerning them.

Clinicopathological study of colorectal mucinous carcinoma in Taiwan: a multivariate analysis

The clinicopathological significance of colorectal mucinous carcinoma is controversial, although some authors feel mucinous carcinoma has a worse prognosis than that of non-mucinous carcinoma. To clarify the significance of this type of carcinoma in Taiwan, a retrospective review of patients with colorectal carcinoma treated at Chang Gung Memorial Hospital between 1984 and 1988 was undertaken. During this period, 53 mucinous carcinomas and 401 non-mucinous carcinomas fulfilling the inclusion criteria were analysed. Mucinous carcinomas were more common in patients 39 years of age or under (P < 0.005). Most mucinous carcinomas were located in the rectum/rectosigmoid, followed by the right colon; however, the right colon had a higher relative incidence (38 vs 8%, respectively; P < 0.005). Mucinous carcinomas presented at a significantly more advanced stage (23 vs 8%, respectively, stage D disease; P < 0.005) and had a markedly lower curative resection rate (68 vs 84%, respectively; P < 0.05). Following curative resection, mucinous carcinomas tended to have an increased incidence of subsequent distant metastasis (27.8 vs 18.8%, respectively; P < 0.005). The overall survival rate of patients with mucinous carcinoma was worse than that of non-mucinous carcinoma (P < 0.005). Multivariate analysis showed that clinically important predictive factors were stage of disease on diagnosis and subsequent distant metastasis. The mucinous histological type itself was not an independent prognostic factor in colorectal cancer.

Mucinous adenocarcinoma of the stomach-clinicopathological studies

The clinical and morphological features of 58 cases of the rare mucinous adenocarcinoma of the stomach (MUC) were investigated and compared to those of other pathological types. The incidence of MUC was only 2.9% of all cases of resected gastric cancer. Among the 58 cases of MUC, the incidence of early cases was only 19% (Group 1), while among other pathological types of cancer, it was 42% (Group 2) (p < 0.001). The incidence of early mucosal cancer was 0% in Group 1, and 54% in Group 2 of the resected early gastric cancer. The incidence of lymph node metastasis rate was 81% in Group 1, and was 46% in Group 2 (p < 0.001). The presence of peritoneal dissemination was 21% in Group 1, and was 8% in Group 2 (p < 0.001). The incidence of liver metastasis pre- and intraoperatively was 0% in Group 1, and was 3.5% in Group 2. The overall 5-year-survival rate was 45% in Group 1, and was 61% in Group 2 (p < 0.05). In stage III, the 5-year-survival rate was 30% in Group 1, and was 49% in Group 2 (p < 0.05). There was no statistical prognostic difference between the two groups in stage I, II and stage IV. Therefore, to improve the outcome for MUC, more effective radical gastrectomy and aggressive immunochemotherapy should be selected especially for stage III mucinous adenocarcinoma of the stomach.

Clinicopathological trends in colorectal carcinoma in a Black South African population

The clinico pathological characteristics of colorectal carcinoma in 127 Black South African patients were studied. The main presenting symptoms were altered bowel habits in 70% of the patients, weight loss in 64.3% and abdominal pain in 47.1%. Anaemia was present in 75.7%. There was a 31% incidence of mucinous carcinoma with a particular predilection for the younger age groups. Mucinous tumors were found more commonly in Duke stage C and D than in earlier stages. Tumors arising from a pre-existing adenoma constituted to 5.5% of the lot of patients with cancer colon.