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Baidoun F, Elshiwy K, Elkeraie Y, Merjaneh Z, Khoudari G, Sarmini MT, Gad M, Al-Husseini M, Saad A. Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr Drug Targets 2021; 22:998-1009. [PMID: 33208072 DOI: 10.2174/1389450121999201117115717] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/30/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer related deaths in the world with an estimated number of 1.8 million new cases and about 881,000 deaths worldwide in 2018. The epidemiology of CRC varies significantly between different regions in the world as well as between different age, gender and racial groups. Multiple factors are involved in this variation, including risk factor exposure, demographic variations in addition to genetic susceptibility and genetic mutations and their effect on the prognosis and treatment response. In this mini-review, we discuss the recent epidemiological trend including the incidence and mortality of colorectal cancer worldwide and the factors affecting these trends.
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Affiliation(s)
- Firas Baidoun
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | | | - Yasmine Elkeraie
- High institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Zahi Merjaneh
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - George Khoudari
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Muhammad Talal Sarmini
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Mohamed Gad
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Muneer Al-Husseini
- Department of Medicine, Ascension St John Hospital, Detroit, Michigan, United States
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
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Faisal MS, Burke CA, Achkar JP, Click B, O'Malley M, LaGuardia L, Milicia S, Leach B, Liska D, Church J, Kalady M, Mankaney G. Malignancy risk in individuals with familial adenomatous polyposis receiving biologics and immunomodulators. Fam Cancer 2021; 21:189-195. [PMID: 33822277 DOI: 10.1007/s10689-021-00250-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
Clinicians may be hesitant to prescribe biologics or immunomodulators to individuals with familial adenomatous polyposis (FAP) and comorbid inflammatory disease (CID) because of increased cancer risk. Our aim was to compare the risk of malignancy in FAP individuals with inflammatory bowel (IBD) and/or rheumatic disease that received biologics/immunomodulators to those who did not. Individuals with FAP and CID were included in the study. We compared the incidence of cancer between individuals exposed to biologics/immunomodulators compared to unexposed from the date of diagnosis of comorbid disease till last follow up or death. Hazard ratio (HR) for cancer was computed using Cox regression model and compared by exposure status to biologic/immunomodulators. 25 individuals with FAP and a comorbid inflammatory disease were identified including 9 (36%) with IBD and 16 (64%) with rheumatic disease. 14 (56%) were exposed to a biologic and or immunomodulator. Median duration of biologic/immunomodulator exposure was 48 (2-180) months. 3 (21.4%) in the exposed group compared to 1 (9.1%) in the unexposed group developed cancer with a HR for exposure of 1.92 (CI 0.2-18.5, p = 0.57). Median duration of follow up after the diagnosis of inflammatory disease was 10 (5.5-17.0) years in the exposed and 6 (3.0-15.0) years in the unexposed group. In the exposed group, 1 patient developed gastric and 2 developed colon cancer. One unexposed patient developed medullary thyroid cancer. There is a possible trend of more cancers in the group that received biologics/immunomodulators-but given the small number of patients and p-value, there may be no difference at all. This preliminary finding warrants study in a larger cohort.
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Affiliation(s)
- Muhammad Salman Faisal
- Department of Internal Medicine, Cleveland Clinic Foundation, Lerner Research Institute, 2111 East 96th Street, Cleveland, OH, 44195, USA.
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, USA
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, USA
| | - Margaret O'Malley
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Lisa LaGuardia
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Susan Milicia
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Brandie Leach
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - David Liska
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Matthew Kalady
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
| | - Gautam Mankaney
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, USA
- Sanford R. Weiss M.D. Center for Inherited Colorectal Neoplasia, Cleveland Clinic Foundation, Cleveland, USA
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3
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Park JJ, Kim BC, Hong SP, Seo Y, Lee HS, Park YS, Na SY, Park SC, Park J, Kim JH, Moon CM, Huh KC, Park SJ, Cheon JH, Kim WH, Kim TI. The Effect of Metformin in Treatment of Adenomas in Patients with Familial Adenomatous Polyposis. Cancer Prev Res (Phila) 2021; 14:563-572. [PMID: 33509804 DOI: 10.1158/1940-6207.capr-20-0580] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022]
Abstract
Familial adenomatous polyposis (FAP) is a hereditary disease characterized by the development of numerous colorectal adenomas in young adults. Metformin, an oral diabetic drug, has been shown to have antineoplastic effects and a favorable safety profile. We performed a randomized, double-blind, controlled trial to evaluate the efficacy of metformin on the regression of colorectal and duodenal adenoma in patients with FAP. Thirty-four FAP patients were randomly assigned in a 1:2:2 ratio to receive placebo, 500 mg metformin, or 1,500 mg metformin per day orally for 7 months. The number and size of polyps and the global polyp burden were evaluated before and after the intervention. This study was terminated early based on the results of the interim analysis. No significant differences were determined in the percentage change of colorectal and duodenal polyp number over the course of treatment among the three treatment arms (P = 0.627 and P = 1.000, respectively). We found no significant differences in the percentage change of colorectal or duodenal polyp size among the three groups (P = 0.214 and P = 0.803, respectively). The overall polyp burdens of the colorectum and duodenum were not significantly changed by metformin treatment at either dosage. Colon polyps removed from the metformin-treated patients showed significantly lower mTOR signal (p-S6) expression than those from patients in the placebo arm. In conclusion, 7 months of treatment with 500 mg or 1,500 mg metformin did not reduce the mean number or size of polyps in the colorectum or duodenum in FAP patients (ClinicalTrials.gov ID: NCT01725490). PREVENTION RELEVANCE: A 7-month metformin treatment (500 mg or 1,500 mg) did not reduce the number or size of polyps in the colorectum or duodenum of FAP patients as compared to placebo. These results do not support the use of metformin to promote regression of intestinal adenomas in FAP patients.
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Affiliation(s)
- Jae Jun Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Cancer Prevention Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, Center for Cancer Prevention & Detection, Division of Cancer Epidemiology and Management, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
| | - Sung Pil Hong
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoojeong Seo
- Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sook Park
- Department of Internal Medicine, Nowon Eulji University Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Soo-Young Na
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jongha Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Hak Kim
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyu Chan Huh
- Department of Internal Medicine, Konyang University College of Medicine, Konyang University Hospital, Daejeon, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. .,Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei Cancer Prevention Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Endoscopic Papillectomy for Major and Minor Papillary Adenoma in Familial Adenomatous Polyposis. ACG Case Rep J 2019; 6:1-4. [PMID: 31620503 PMCID: PMC6658031 DOI: 10.14309/crj.0000000000000019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 12/21/2018] [Indexed: 12/30/2022] Open
Abstract
Ampullary adenomas can occur sporadically or in the patients with adenomatous polyposis syndrome, including familial adenomatous polyposis (FAP) and MUTYH-associated polyposis. The potential for malignant transformation is high in the setting of FAP. Although endoscopic resection of major papillary adenoma has been well described, minor papilla adenomas are exceptionally rare. This is the second documented case of an endoscopic papillectomy in a patient with FAP with simultaneous ampullary adenoma of the major and minor papilla.
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Cancer in an unexpected site post pouch surgery for familial adenomatous polyposis (FAP). Int J Surg Case Rep 2017; 42:266-268. [PMID: 29324375 PMCID: PMC5766745 DOI: 10.1016/j.ijscr.2017.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/16/2017] [Indexed: 01/29/2023] Open
Abstract
Restorative proctocolectomy is the mainstay in the management of Familial Adenomatous Polyposis (FAP). Post-op surveillance is mainly to monitor for recurrence. There are no clear guidelines to how frequent or for how long should the surveillance last. The usual site of recurrence is usually at the Anal Transitional Zone (ATZ). Cancer within the ileal pouch has been reported before. Despite surveillance and follow up cancer can occur.
Introduction Familial Adenomatous Polyposis (FAP) is a hereditary condition characterized by multiple colorectal adenomatous polyps. FAP is the most common adenomatous polyposis syndrome. Restorative proctocolectomy is the most commonly performed surgical procedure performed for patients suffering from FAP with different options for anastomosis, namely ileorectal anastomosis (IRA) or ileal pouch anal anastomosis (IPAA). The occurrence of adenomas is a common finding during follow up and surveillance post surgery for these patients. Although there are a few cases of carcinoma that were namely at the anal transitional zone (ATZ), there are only a few cases of ileal pouch related adenocarcinoma reported. This work has been reported in line with the SCARE criteria (Agha et al., 2016) [1]. Presentation of case We report a case of a 34-year-old man diagnosed with FAP who underwent proctocolectomy with IPAA, and subsequently referred to our center, who, despite appropriate measures and surveillance, developed adenocarcinoma in the ileal pouch. Discussion Restorative proctocolectomy for Familial Adenomatous Polyposis (FAP) is the mainstay of treatment. There are different surgical options, each with its own set of advantages and disadvantages. The most favored option is proctocolectomy with ileal pouch anal anastomosis (IPAA) due to because it involves resection of the rectum. Despite these interventions, adenomas and/or carcinomas have been reported on follow up post surgery. Conclusion Although the risk of developing adenomas or carcinomas in the ileal pouch post proctocolectomy with IPAA is low it should not be neglected as cancer occurrence or recurrence is unpredictable even with appropriate measures.
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Prenner S, Levitsky J. Comprehensive Review on Colorectal Cancer and Transplant. Am J Transplant 2017; 17:2761-2774. [PMID: 28471512 DOI: 10.1111/ajt.14340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 01/25/2023]
Abstract
Colorectal cancer (CRC) is a common malignancy worldwide. Some studies suggest that organ recipients are at a higher risk for CRC than the general population. The underlying transplant indications and their inherent risk factors for CRC may drive the variation in incidence rates that are seen in patients receiving different allografts. Recipients with cystic fibrosis are now recognized as a population at high risk for CRC at a young age. Transplant recipients have high mortality following a CRC diagnosis, even if it is detected at an early stage. Certain types of immunosuppression have been shown to accelerate cancer transformation and may contribute to the more aggressive phenotype seen in organ recipients. Given the high incidence and progressive nature of posttransplant CRC, shorter screening intervals with a modality that can detect early-stage polyps may be essential to prevent mortality. Future research is needed to better elucidate the role of immunosuppression in carcinogenesis. This comprehensive review examines CRC risk, screening, and management specific to organ transplant candidates and recipients.
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Affiliation(s)
- S Prenner
- Division of Gastroenterology & Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - J Levitsky
- Division of Gastroenterology & Hepatology, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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The Rising Incidence of Younger Patients With Colorectal Cancer: Questions About Screening, Biology, and Treatment. Curr Treat Options Oncol 2017; 18:23. [DOI: 10.1007/s11864-017-0463-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
While most colorectal cancers (CRCs) originate from nonhereditary spontaneous mutations, one-third of cases are familial or hereditary. Hereditary CRCs, which account for < 5% of all CRCs, have identifiable germline mutations and phenotypes, such as Lynch syndrome and familial adenomatous polyposis (FAP). Familial CRCs, which account for up to 30% of CRCs, have no identifiable germline mutation or specific pattern of inheritance, but higher-than-expected incidence within a family. Since the discovery that certain genotypes can lead to development of CRC, thousands of mutations have now been implicated in CRC. These new findings have enhanced our ability to identify at-risk patients, initiate better surveillance, and take preventative measures. Given the large number of genes now associated with hereditary and familial CRCs, clinicians should be familiar with the alphabet soup of genes to provide the highest quality of care for patients and families.
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Affiliation(s)
- Matthew D Giglia
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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9
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A Patient With Gardner's Syndrome and Familial Adenomatous Polyposis Presenting With Extra-abdominal Desmoid Tumors and Diffuse Intestinal Polyposis. ACG Case Rep J 2015; 2:133-4. [PMID: 26157940 PMCID: PMC4435396 DOI: 10.14309/crj.2015.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/28/2015] [Indexed: 12/11/2022] Open
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Boskovic A, Djuricic S, Grujic B, Stankovic I. Early onset of dysplasia in polyps in children with familial adenomatous polyposis: case report and literature review. Arab J Gastroenterol 2014; 15:88-90. [PMID: 25097054 DOI: 10.1016/j.ajg.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/28/2013] [Accepted: 01/11/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Familial adenomatous polyposis (FAP) is one of the most common hereditary syndromes associated with an increased risk of colorectal cancer. Onset of polyp formation and cancer in childhood is very unusual but has recently been associated with a specific mutation at codon 1309 in exon 15 where a more severe phenotype is sometimes observed .We report a 12-year-old girl who presented with haematochezia. The girl's mother and aunt had died of colon cancer which developed from untreated FAP. The other two aunts also had FAP and underwent colectomy. Endoscopy showed extensive polyps presented on the luminal surface of the entire colon. Histomorphology confirmed a low grade of intraepithelial neoplasia (IEN) in three polyps and the patient underwent colectomy. We present a review of the literature focussed on early onset of IEN in polyps in children with FAP. CONCLUSION Clinicians should take note of the family history and be prepared to consider much earlier intervention if symptoms occur in a child with a family history of FAP.
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Affiliation(s)
- Aleksandra Boskovic
- Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia.
| | - Slavisa Djuricic
- Department of Pathology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
| | - Blagoje Grujic
- Department of Abdominal Surgery, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
| | - Ivica Stankovic
- Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Faculty of Medicine, University of Belgrade, Serbia
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11
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Aihara H, Kumar N, Thompson CC. Diagnosis, surveillance, and treatment strategies for familial adenomatous polyposis: rationale and update. Eur J Gastroenterol Hepatol 2014; 26:255-62. [PMID: 24161962 PMCID: PMC5019104 DOI: 10.1097/meg.0000000000000010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Familial adenomatous polyposis is characterized by the development of multiple (>100) colorectal adenomas throughout the colorectum. This disorder can be caused by a germline mutation in the adenomatous polyposis coli gene and can be diagnosed either clinically or genetically. After diagnosis with the condition, patients should undergo prophylactic proctocolectomy with a neoreservoir, usually an ileoanal pouch, at an appropriate time. Individuals with a family history of this disease who have not been diagnosed should be advised to attend genetic counseling and to enroll in appropriate clinical and genetic surveillance programs. Recent progress in endoscopic technology, including high-resolution endoscopy, capsule endoscopy, and double-balloon endoscopy, has made possible more detailed and wide-ranging investigation of the gastrointestinal tract. Although there has been limited evidence, further studies on these new endoscopic technologies might alter the surveillance strategies for familial adenomatous polyposis.
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Affiliation(s)
- Hiroyuki Aihara
- Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Zeichner SB, Raj N, Cusnir M, Francavilla M, Hirzel A. A De Novo Germline APC Mutation (3927del5) in a Patient with Familial Adenomatous Polyposis: Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2012; 6:315-23. [PMID: 23115482 PMCID: PMC3474461 DOI: 10.4137/cmo.s10178] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Characterized by the development of hundreds to thousands of colonic
adenomas, classic familial adenomatous polyposis (FAP) is one of the most
common hereditary syndromes associated with an increased risk of colorectal
cancer. Several studies have attempted to correlate specific APC mutations
with clinical phenotype.6 However, there is considerable variability in the expression
of specific phenotypes within families and among individuals with identical
mutations.7 Case presentation A 30 year-old Hispanic female presented to the emergency department with a
2-week history of persistent, worsening, left lower quadrant abdominal pain.
She had no family history of malignancy. Sigmoidoscopy revealed innumerable
polyps in the rectum and sigmoid colon and a large mass in the sigmoid
colon. Biopsy of the mass revealed a moderately differentiated
adenocarcinoma invading the subserosa. Endoscopy revealed innumerable
polyps. Genetic testing of the patient via southern blot revealed a germline
APC mutation 3927del5, resulting in a premature truncation of the APC
protein at amino acid position 1312. Conclusion Genetic information has only recently started being incorporated into
clinical care. More research and randomized clinical trials need to be
conducted to definitively characterize random mutations. Once these
mutations are further understood, FAP patients may be able to be risk
stratified and this may ultimately improve the screening, diagnosis, and
treatment of this rare condition.
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Affiliation(s)
- Simon B Zeichner
- Department of Internal Medicine, Mount Sinai Medical Center Florida
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13
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Hoekstra E, Peppelenbosch MP, Fuhler GM. The role of protein tyrosine phosphatases in colorectal cancer. Biochim Biophys Acta Rev Cancer 2012; 1826:179-88. [PMID: 22521639 DOI: 10.1016/j.bbcan.2012.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/03/2012] [Accepted: 04/04/2012] [Indexed: 01/17/2023]
Abstract
Colorectal cancer is one of the most common oncogenic diseases in the Western world. Several cancer associated cellular pathways have been identified, in which protein phosphorylation and dephosphorylation, especially on tyrosine residues, are one of most abundant regulatory mechanisms. The balance between these processes is under tight control by protein tyrosine kinases (PTKs) and protein tyrosine phosphatases (PTPs). Aberrant activity of oncogenic PTKs is present in a large portion of human cancers. Because of the counteracting role of PTPs on phosphorylation-based activation of signal pathways, it has long been thought that PTPs must act as tumor suppressors. This dogma is now being challenged, with recent evidence showing that dephosphorylation events induced by some PTPs may actually stimulate tumor formation. As such, PTPs might form a novel attractive target for anticancer therapy. In this review, we summarize the action of different PTPs, the consequences of their altered expression in colorectal cancer, and their potential as target for the treatment of this deadly disease.
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Affiliation(s)
- Elmer Hoekstra
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Gallagher DJ, Smith JD, Offit K, Stadler ZK. Diagnosing hereditary colorectal cancer. Clin Colorectal Cancer 2011; 9:205-11. [PMID: 20920991 DOI: 10.3816/ccc.2010.n.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although progress in the treatment of patients with colorectal cancer (CRC) has resulted in improved median survival, most patients with metastatic CRC still die of their disease, and essentially all patients with early-stage disease must undergo surgical resection and subsequently face the possibility of adjuvant chemotherapy. As effective screening and prevention strategies for CRC have been developed, identification of individuals with a hereditary predisposition to developing CRC is especially important and provides the opportunity to reduce disease burden in this high-risk population. Increased awareness and improved diagnostic techniques for hereditary CRC syndromes have facilitated more frequent diagnosis and management of a small number of highly penetrant syndromes within families. However, known high-penetrance genetic predisposition syndromes account for a minority of all familial CRC, leaving much of the genetic basis of CRC unexplained. Recent advances in high-throughput genotyping have made possible genome-wide association studies, which have identified novel genetic variants associated with modest increases in CRC risk. While these associations have helped to identify potentially important pathways in CRC carcinogenesis, at the current time, the clinical use of such genetic risk variants in colon cancer risk stratification remains limited.
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Affiliation(s)
- David J Gallagher
- Department of Medicine, Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Hematochezia in the young patient: a review of health-seeking behavior, physician attitudes, and controversies in management. Dig Dis Sci 2010; 55:233-9. [PMID: 19238544 DOI: 10.1007/s10620-009-0750-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/27/2009] [Indexed: 12/09/2022]
Abstract
Hematochezia, defined as the passage of blood or clots from the rectum, is common and can be quite alarming. Few patients in general consult their physicians for this symptom. Various reasons have been explored for this behavior. Physician attitudes also shed some light onto why some patients are referred and others are not. Hematochezia may be associated with an anal cause in most healthy young adults (<50 years of age), but some may end up being diagnosed with colorectal cancer (CRC). Many studies have looked at the usefulness of clinical presentation in helping to decide which patients need further evaluation and what the optimal mode of investigation should be. Of note, studies on patients less than 50 years of age presenting with rectal bleeding have been few and far between. The results of these studies have been contradictory to the point where, today, there is no single set of consensus guidelines on the approach to hematochezia in young patients. In this review, the value of clinical symptoms and the underlying risk of CRC in guiding this clinical decision will be discussed.
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Santos Jr. JCM. Câncer ano-reto-cólico: aspectos atuais II - câncer colorretal - fatores de riscos e prevenção. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-98802007000400016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O câncer colorretal é curável e passível de prevenção. A chave para o alcance desses objetivos é relativamente simples e pode ser aplicada em escala populacional. Basta, para tanto, que sejamos capazes de conscientizar os médicos, independente da sua área especial de atuação, e proporcionar às pessoas o mais fácil alcance às informações médicas expressas em termos simples sobre a profilaxia e o diagnóstico precoce dessa neoplasia maligna, sobretudo, destacando os fatores protetores e os de riscos, principalmente os que são suscetíveis de ser modificados.
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17
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Dionigi G, Bianchi V, Rovera F, Boni L, Annoni M, Castano P, Villa F, Dionigi R. Genetic alteration in hereditary colorectal cancer. Surg Oncol 2007; 16 Suppl 1:S11-5. [PMID: 18023570 DOI: 10.1016/j.suronc.2007.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Colorectal cancer is a major cause of morbidity and mortality. Both genetic and environmental factors contribute to cancer aetiology. About 15-20% of all colorectal cancers are familial. Approximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. The discovery of genes responsible for inherited forms of colorectal cancer have the potential to improve cancer risk assessment and counselling. Genetic testing for hereditary forms of colorectal cancer can confirm or reject diagnoses at the molecular level, determine surveillance intervals for at-risk persons, decrease the cost of surveillance by risk stratification, aid in surgical and chemoprevention decision-making, and help patients in family and career planning. This paper reviews the genetics behind genes and molecular study of the hereditary colorectal cancer. This may help the medical professionals especially internists, gastroenterologists, and oncologists to update their knowledge in this field.
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Affiliation(s)
- G Dionigi
- Department of Surgical Sciences, University of Insubria, Viale Borri 57, 21100 Varese, Italy.
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18
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Smud D, Augustin G, Kekez T, Kinda E, Majerovic M, Jelincic Z. Gardner's syndrome: Genetic testing and colonoscopy are indicated in adolescents and young adults with cranial osteomas: A case report. World J Gastroenterol 2007; 13:3900-3. [PMID: 17657852 PMCID: PMC4611230 DOI: 10.3748/wjg.v13.i28.3900] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative procto-colectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.
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Affiliation(s)
- Dubravko Smud
- Clinical Hospital Center Zagreb, Department of Surgery, Division of Abdominal Surgery, Kispaticeva 12, Zagreb 10000, Croatia
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Mehenni H, Friedl W, Nelen MR, Hutter P, Brundler MA. An unexpected Cowden syndrome case found among members of a large familial adenomatous polyposis kindred. Eur J Gastroenterol Hepatol 2005; 17:1407-12. [PMID: 16292097 DOI: 10.1097/01.meg.0000184983.38398.b6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Genetic testing is now considered the standard of care in the management of familial adenomatous polyposis (FAP). Non-carriers of mutations are excluded from endoscopic surveillance. During the systematic screening of the relatives of an affected member with FAP, one non-carrier of APC mutations was unexpectedly found with the typical Cowden syndrome phenotype. One large Algerian family with FAP was screened for an APC germline mutation. Moreover, we also performed a mutation search in the Cowden syndrome member for PTEN, BMPR1A or MADH4 (SMAD4) germline mutations. We identified a mutation in the APC gene that results in a truncated protein (Y935X) in the FAP proband, and subsequently in 12 FAP-affected members. Among the 12 APC mutation-negative members of this family, we found one member with the Cowden disease phenotype. However, the mutation analysis in the PTEN gene and the two other genes involved in juvenile polyposis, namely BMPR1A and MADH4 (SMAD4), in the Cowden syndrome patient failed to show any pathogenic mutation. Genetic testing is a powerful tool that can provide a definitive diagnosis for FAP. However, not all polyposes in the FAP family are adenomatous polyposes.
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Affiliation(s)
- Hamid Mehenni
- Department of Cell Biology, University of Geneva, Switzerland.
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20
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Jones DH, Silberstein PT, Lynch H, Ternet C. Regression of Colorectal Adenomas With Intravenous Cytotoxic Chemotherapy in a Patient With Familial Adenomatous Polyposis. J Clin Oncol 2005; 23:6278-80. [PMID: 16135505 DOI: 10.1200/jco.2005.00.0570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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21
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Abstract
The principal Mendelian disorders predisposing to colorectal cancer are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). FAP is due to mutations in the APC gene. HNPCC is due to a mutation in one of at least five mismatch repair genes. Identification of individuals with these conditions is important because colon cancer will occur in approximately 80% and onset is early. For FAP, protein truncation testing will identify the vast majority of mutations. For HNPCC, 80%-95% can be identified by microsatellite instability testing. A current U.S. study reports that 12% of consecutive colorectal cancers have high microsatellite instability and that, of this 12%, 25% have detectable mutations of MLH1, MSH2, or MSH6. Potential benefits of identification include improved compliance with recommended surveillance, early detection of polyps, reduction in cancer mortality, offering of testing to relatives, and reassurance for relatives found to be negative with attendant savings in the time and expense of surveillance.
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Affiliation(s)
- Peter T Rowley
- Department of Medicine and Division of Genetics, University of Rochester, Rochester, New York 14642, USA.
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22
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Abstract
The principal Mendelian disorders predisposing to colorectal cancer are familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). FAP is caused by mutations in the adenomatous polyposis coli (APC) gene. HNPCC is caused by a mutation in one of at least five mismatch repair genes. It is important to identify individuals with these conditions because colon cancer will occur in at least 80% and onset is earlier than in the general population. Potential benefits of identification include improved compliance with recommended surveillance, early detection of polyps, reduction in cancer mortality, and reassurance for relatives found to be negative with attendant savings in the time and expense of surveillance. For classic FAP, the large number of polyps readily identifies affected persons. For HNPCC, identification of individuals meriting DNA sequencing requires either recognition of a suspect family history or finding high microsatellite instability in a tumor. Individuals accepting the offer of genetic counseling and DNA testing often have more cancers in their family, are motivated to inform relatives, have a larger social network, and have more confidence in their coping ability. Individuals who decline are often concerned about their own or their family's emotional reaction or fear discrimination.
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Affiliation(s)
- Peter T Rowley
- Department of Medicine and Division of Genetics, University of Rochester, Rochester, NY 14642, USA.
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23
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Abstract
This contribution presents clinical and technical aspects of combining positron emission tomography (PET) and computed tomography (CT) for patients with colorectal tumors and characterization of unclear liver foci. In which manner and for which patients combined PET/CT is superior to PET or CT alone is also discussed. PET/CT can fulfil most prerequisites for imaging in pre- and postoperative management of patients with colorectal tumors and best meets the desire for optimal imaging procedures. Some of the disadvantages encountered in frequently employed CT can be overcome by the combination of PET and CT while increasing both sensitivity in detecting lesions and specificity in their characterization. Questions regarding treatment response offer an opportunity for devising novel study concepts and initiating research on new PET tracers. Although few publications are available, we are of the opinion that the combination of functional and anatomical imaging provided by PET/CT can improve both preoperative management and aftercare. To this end, however, optimum cooperation between practitioners of nuclear medicine and radiology is imperative.
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Affiliation(s)
- J Stollfuss
- Institut für Röntgendiagnostik, Klinikum rechts der Isar der TU München.
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24
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Affiliation(s)
- Marcia Cruz-Correa
- Divisions of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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25
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Cruz-Correa M, Giardiello FM. Diagnosis and management of hereditary colon cancer. Hematol Oncol Clin North Am 2003. [DOI: 10.1016/s0889-8588(03)00009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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26
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Boardman LA. Heritable colorectal cancer syndromes: recognition and preventive management. Gastroenterol Clin North Am 2002; 31:1107-31. [PMID: 12489281 DOI: 10.1016/s0889-8553(02)00049-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Familial CRC syndromes account for a small yet important portion of colorectal malignancies. HNPCC, FAP, JPS, and Peutz-Jeghers syndrome are the four major conditions to r to consider if an hereditary condition is suspected in an individual with CRC. A multidisciplinary team comprised of a medical geneticist, gastroenterologist, pathologist, radiologist, and colorectal surgeon with expertise in recognizing and establishing the diagnosis of a specific familial cancer condition is crucial to implementing the proper management and prevention strategies unique to each of these syndromes. Genetic testing for each of these coniditions is available and useful for presymptomatic diagnosis and for indicated surveillance regimens. Vigilant endoscopic surveillance and careful timing of surgery are the mainstays of prevention for gastrointestinal malignancies. But with the advancement of genetic evaluation, improved cancer surveillance for intestinal as well as extraintestinal cancer, and chemopreventive strategies, the management of patients with a familial CRC syndrome will continue to evolve and, hopefully, significantly reduce their cancer burden.
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Affiliation(s)
- Lisa A Boardman
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
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27
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Abstract
Colorectal cancer is the second leading cause of cancer death, after lung cancer, in the USA. The great majority (80%) of patients with colorectal cancer have sporadic disease with no evidence of having inherited the disorder. In the remaining 20%, a potentially definable genetic component exists. With the discovery of gene mutations related to hereditary colorectal cancer, risk assessment based on genetic test results is now feasible. The following review focuses on the two well-described colorectal cancer genetic syndromes-familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, the process of genetic counselling, currently available genetic tests, and indications for their use.
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Affiliation(s)
- J D Trimbath
- Department of Medicine, The John Hopkins University School of Medicine, Baltimore, MD 21205, USA
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28
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Abstract
Colorectal cancer is the third leading cause of cancer and the second leading cause of cancer death in the United States. About 130,000 new cases are diagnosed each year in North America, and 56,600 persons die annually from this disease. Approximately 5% of patients with colorectal cancer have clearly defined inherited syndromes such as familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer. These conditions are well described both genetically and phenotypically, and are characterized by autosomal dominant inheritance, high penetrance, and high risk of colorectal cancer. We review the current recommendations for the diagnosis and management of these two hereditary forms of colorectal cancer.
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Affiliation(s)
- Marcia Cruz-Correa
- Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1830 East Monument Street, Room 431, Baltimore, MD 21205, USA
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29
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Mori T, Nagase H, Horii A, Miyoshi Y, Shimano T, Nakatsuru S, Aoki T, Arakawa H, Yanagisawa A, Ushio Y. Germ-line and somatic mutations of the APC gene in patients with Turcot syndrome and analysis of APC mutations in brain tumors. Genes Chromosomes Cancer 1994; 9:168-72. [PMID: 7515658 DOI: 10.1002/gcc.2870090304] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The Turcot syndrome (TS) is a rare, probably autosomal recessive, disorder characterized by development of primary neuroepithelial tumors of the central nervous system (CNS) and numerous adenomatous colorectal polyps. To examine the possible involvement of mutations of the APC gene, which is responsible for familial adenomatous polyposis (FAP), in Turcot syndrome, we examined DNAs from TS patients for alterations in this gene by means of ribonuclease protection analysis. Germ-line APC mutations were detected in each of three unrelated cases of TS, and additional (somatic) mutations were observed in colonic adenomas that had developed in one of these patients. However, no somatic mutations in APC were found among 91 neuroepithelial tumors (medulloblastoma, glioblastoma, astrocytoma, and oligodendroglioma), whether sporadic or associated with TS. These results suggest that the APC gene is associated with pathogenesis of one feature of TS, but that at least one other gene is responsible for the genesis of neuroepithelial tumors in the CNS.
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Affiliation(s)
- T Mori
- Department of Biochemistry, Cancer Institute, Tokyo, Japan
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30
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Abstract
In a case-control study of cancer of the colon it was found that 96 out of 332 (29%) cases had a positive family history of cancer of the colon (2 cases and more) as compared with 19 out of 473 (4%) controls. 3 colon cancer cases reported that 6 of their respective relatives were also affected with the same cancer. We were able to do a complete follow-up study of one family where 7 out of 12 sibling (P < 0.05) had confirmed pathological diagnoses of cancer of the colon. The mean age at diagnosis among these familial colon cancer cases was 64 years (60 years for females and 73 years for males) and all tumours were located in the caecum or right colon (a common characteristic of colon cancer in this family). There was no history of familial adenomatous polyposis in this family. It is unlikely that the significantly high proportion of familial colon cancer found could be due to chance. This suggests that both environmental and genetic factors play an important role in the aetiology of colon cancer.
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Affiliation(s)
- P Ghadirian
- Faculty of Medicine, Department of Nutrition, Hôtel-Dieu de Montréal Hospital, Canada
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31
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Kropilak M, Jagelman DG, Fazio VW, Lavery IL, McGannon E. Brain tumors in familial adenomatous polyposis. Dis Colon Rectum 1989; 32:778-82. [PMID: 2547552 DOI: 10.1007/bf02562128] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Familial adenomatous polyposis was always believed to be a colonic disease of genetic determination with a high risk of development of cancer of the large bowel. Over the years the list of extracolonic manifestations of this disease, both benign and malignant, has amplified. Brain tumors and, in particular, medulloblastoma have not become recognized as major malignant extracolonic manifestations of familial adenomatous polyposis. They are of particular significance because, unlike most of the other manifestations, they occur prior to or early in the development of the colonic manifestations of this disease. This report documents the investigation of 168 kindreds in The Cleveland Clinic Familial Adenomatous Polyposis Registry in a search for those at-risk individuals who developed brain tumors.
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Affiliation(s)
- M Kropilak
- Familial Polyposis Registry, Cleveland Clinic Foundation, Ohio
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32
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Traboulsi EI, Krush AJ, Gardner EJ, Booker SV, Offerhaus GJ, Yardley JH, Hamilton SR, Luk GD, Giardiello FM, Welsh SB. Prevalence and importance of pigmented ocular fundus lesions in Gardner's syndrome. N Engl J Med 1987; 316:661-7. [PMID: 3821797 DOI: 10.1056/nejm198703123161104] [Citation(s) in RCA: 145] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We examined 134 members of 16 families with Gardner's syndrome for pigmented ocular fundus lesions. Of 41 patients with documented Gardner's syndrome, 37 (90.2 percent) had such lesions. The lesions were bilateral in 32 of the patients (78.1 percent) and in 2 of 42 controls (4.8 percent). Twenty (46.5 percent) of 43 first-degree relatives at 50 percent risk for Gardner's syndrome had bilateral pigmented fundus lesions, indicating that they had probably inherited the abnormal gene. The presence of bilateral lesions, multiple lesions (more than four), or both appeared to be a specific (specificity, 0.952) and sensitive (sensitivity, 0.780) clinical marker for Gardner's syndrome. The lesions are probably congenital; they were observed in a three-month-old baby at risk. The multiplicity of the pigmented fundus lesions and their association with diffuse disturbances of the retinal pigment epithelium in the same eye suggest a widespread expression of the abnormal gene in the retinal pigment epithelial cells.
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33
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Castello MA, Operamolla P, Clerico A, Taucci M, Mazzoni G, Gallo P, Imperato C. Nonfamilial intestinal polyposis and brain tumor in a 5-year-old girl. Pediatr Hematol Oncol 1987; 4:247-60. [PMID: 2856363 DOI: 10.3109/08880018709141275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 5-year-old girl with glioblastoma multiforme and simultaneous adenocarcinoma in one of multiple colonic polyps is the youngest reported case of Turcot's syndrome. A literature survey and a classification based on family pedigree and pattern of inheritance are proposed.
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Affiliation(s)
- M A Castello
- 1st Pediatric Department, Rome University, Italy
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34
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Schlaen I, Bocanera R, Figueroa-Casas P. Endometrial cancer and its precursors: a comparison of histological and clinical features. Maturitas 1986; 8:335-44. [PMID: 3574142 DOI: 10.1016/0378-5122(86)90041-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this study, the histological definition of endometrial cancer precursor (ECP) lesions is discussed and a comparison is made of clinical and histological parameters of ECP patients and endometrial cancer (EC) patients. ECP lesions were divided in 3 types: adenomatous hyperplasia, atypical hyperplasia and in situ adenocarcinoma. The following parameters were analyzed: age, menopausal status, gynecological and extragynecological familiar cancer incidence, other cancers in the proband, diabetes, obesity, primary infertility, fertility and previous estrogen therapy. Results give support to the hypothesis of the existence of a common biological pathway between ECP and EC. The high frequency of coexistence of both types of lesions in hysterectomy specimens from EC patients studied by step sections adds a confirmatory supporting argument. Measures for primary and secondary prevention of these lesions are proposed.
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35
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Giltman LI. Epithelial polyps of the large intestine. A classification based on biologic behavior. Postgrad Med 1986; 80:113-6, 119. [PMID: 3020534 DOI: 10.1080/00325481.1986.11699561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Classifications of colonic polypoid lesions are often based on their pathogenesis. Little attention is paid to the biologic behavior (or predicted behavior, based on experience) of these lesions. Classification based on biologic behavior separates these lesions, regardless of histogenesis, according to possible malignant potential. This helps the clinician to explain the implications of the histopathologic diagnosis to the patient and to understand when aggressive or prophylactic therapy should be pursued.
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36
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Abstract
A 30-year-old woman developed proptosis secondary to a left ethmoidal compact osteoma. At age 29 years, a mandibular eburnated (ivory) osteoma was excised. At age 25 years, multiple adenomatous polyps of the colon were resected. Her father, age 61 years, had multiple intestinal polyps and bilateral mandibular osteoma. A 24-year-old sister had an osteoma of the forehead. Gardner's syndrome is an autosomal dominantly inherited disorder characterized by intestinal polyposis, various skin and soft tissue tumors, and osteomas of the bony skeleton. Orbital osteomas occur rarely.
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37
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Burt RW, Bishop DT, Cannon LA, Dowdle MA, Lee RG, Skolnick MH. Dominant inheritance of adenomatous colonic polyps and colorectal cancer. N Engl J Med 1985; 312:1540-4. [PMID: 4000184 DOI: 10.1056/nejm198506133122403] [Citation(s) in RCA: 168] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Except in the rare polyposis syndromes, the contribution of heritable factors to the genesis of colorectal cancer and adenomatous polyps is not well understood. We examined the inheritance of susceptibility to colonic polyps and cancer in a large Utah pedigree with multiple cases of common colorectal cancer but no recognizable inheritance pattern among them. Inheritance was clarified, however, by systematic screening for colonic polyps in pedigree members and spouse controls, using flexible proctosigmoidoscopy. One or more adenomatous polyps were found in 21 per cent of family members (41 of 191) but in only 9 per cent of controls (12 of 132) (P less than 0.005). Pedigree analysis was performed with likelihood methods that compared random occurrence of cancer and polyps with autosomal recessive and autosomal dominant patterns of inheritance. The analysis suggested that the observed excess of discrete adenomatous polyps and colorectal cancers was the result of an inherited autosomal dominant gene for susceptibility, rather than an inherited recessive gene for susceptibility or a chance occurrence. This type of inheritance of colorectal polyps and cancer may be more common than previously recognized.
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38
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Lewis RA, Crowder WE, Eierman LA, Nussbaum RL, Ferrell RE. The Gardner syndrome. Significance of ocular features. Ophthalmology 1984; 91:916-25. [PMID: 6493700 DOI: 10.1016/s0161-6420(84)34213-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Gardner syndrome is a dominantly inherited familial cancer syndrome characterized by intestinal polyposis, bony hamartomata, and various soft tissue tumors. The risk of malignancy during adult life is essentially 100%, but as yet no phenotypic marker nor biochemical or serological linkage have been useful to identify the presence of the gene in early life. We studied three families in which multiple and bilateral patches of congenital hypertrophy of the retinal pigment epithelium are related uniquely to other phenotypic features of the Gardner gene. This readily identifiable characteristic may be useful to identify early in life individuals at risk for malignancy. We also suggest that the Gardner syndrome may be genetically heterogeneous.
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39
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Abstract
Electrophoretic analysis of glucose-6-phosphate dehydrogenase was performed on polyp tissue from three black female patients with Gardner syndrome and who are heterozygous for the A and B forms of this enzyme. Polyp tissues from the three patients displayed the AB phenotype. This finding suggests a multiclonal origin of polyps in Gardner syndrome. Studies of tumors originating from such polyps may provide information about the sequence of cellular events leading to malignant transformation.
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40
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Case 50-1982: familial polyposis of the colon and extracolonic tumors. N Engl J Med 1983; 308:906-7. [PMID: 6835294 DOI: 10.1056/nejm198304143081519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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41
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Abstract
A case of Turcot's syndrome (colonic polyposis plus a malignant central nervous system tumor) occurring in a kindred with autosomal dominant colonic polyposis is presented. It is proposed that Turcot's syndrome patients can be classified into Type I where only siblings are affected and Type II where two or more generations have colonic polyposis. A third nonfamilial group cannot be classified into Type I or II based on available information. Evidence is presented suggesting Turcot's syndrome is best considered an additional phenotype of familial polyposis and is most likely inherited in an autosomal dominant manner.
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42
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Li FP, Little JB, Bech-Hansen NT, Paterson MC, Arlett C, Garnick MB, Mayer RJ. Acute leukemia after radiotherapy in a patient with Turcot's syndrome. Impaired colony formation in skin fibroblast cultures after irradiation. Am J Med 1983; 74:343-8. [PMID: 6572034 DOI: 10.1016/0002-9343(83)90643-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Colonic polyposis and carcinoma developed in a woman with Turcot's syndrome at the age of 31 years; astrocytoma developed when she was 37. Her brother and sister had died of astrocytoma at the ages of 18 and 33 years, respectively. Progressive neutropenia developed in the patient three months after radiotherapy for her brain tumor and acute myelomonocytic leukemia 19 months after treatment. Three laboratories independently evaluated cultures of her skin fibroblasts for in vitro sensitivity to cell killing (loss of colony-forming ability) by x-rays. Survival assays consistently revealed slight but significant radiosensitivity in an early-passage (six to 10 doublings) fibroblast subculture. A later subculture (21 to 29 doublings) showed no abnormality, a possible effect of selective in vitro loss of radiosensitive cells.
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43
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 50-1982. Liver dysfunction after total colectomy for intestinal polyposis. N Engl J Med 1982; 307:1566-73. [PMID: 7144838 DOI: 10.1056/nejm198212163072508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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44
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Cantú JM, Rivera H, Ocampo-Campos R, Bedolla N, Cortés-Gallegos V, González-Mendoza A, Díaz M, Hernández A. Peutz-Jeghers syndrome with feminizing sertoli cell tumor. Cancer 1980; 46:223-8. [PMID: 6770991 DOI: 10.1002/1097-0142(19800701)46:1<223::aid-cncr2820460137>3.0.co;2-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A case involving a 6-year-old boy with Peutz-Jeghers syndrome and an unilateral feminizing Sertoli cell tumor is described. Endocrinologic studies revealed consistently high plasma and urine levels of estrogens and normal levels of testosterone and dihydrotestosterone. The increased levels of estrogens did not show changes that could be correlated with exogenous gonadotropin administration, thus indicating an autonomous nature. The histopathologic studies of nontumorous testicular tissue revealed changes in the seminiferous tubules which suggested that estrogens, directly or indirectly, may have had both stimulating and atrophying effects. It is concluded that gonadal tumors are in additional manifestation of the Peutz-Jeghers syndrome gene in both male and female patients.
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Cochet B, Carrel J, Desbaillets L, Widgren S. Peutz-Jeghers syndrome associated with gastrointestinal carcinoma. Report of two cases in a family. Gut 1979; 20:169-75. [PMID: 428830 PMCID: PMC1419453 DOI: 10.1136/gut.20.2.169] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients with the Peutz-Jeghers syndrome carry a slight, though definite, increased risk of gastrointestinal carcinoma. The malignant potentiality of Peutz-Jeghers hamartomatous polyps, generally considered benign, is supported by this report. Two cases of metastasising gastrointestinal carcinoma associated with the Peutz-Jeghers syndrome are described in a 56 year old female and her 29 year old son. Both mother and son died from duodenal and gastric carcinomas respectively, which developed in hamartomatous polyps with extensive metastases. Both cases also showed dysplastic areas within hamartomatous polyps. These features indicate that hamartomatous polyps may, in some cases, be the precursors of digestive tract carcinomas.
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Bolwell JS, James PD. Peutz--Jeghers syndrome with pseudoinvasion of hamartomatous polyps and multiple epithelial neoplasms. Histopathology 1979; 3:39-50. [PMID: 428921 DOI: 10.1111/j.1365-2559.1979.tb02980.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The risk of malignant change developing in the hamartomatous polyps in Peutz-Jeghers syndrome is widely held to be negligible. However an association with tumours of the upper gastro-intestinal tract, ovary and other diverse multiple neoplasms is now recognized. Previously reported cases of malignant change in Peutz--Jeghers polyps may represent 'pseudoinvasion' and we report such a case. This was associated with carcinomas of the bile ducts, left tonsil and a papillary adenoma of the pancreatic duct. It lends further support to the view that there may be a genetic predisposition to the development of neoplasms in this condition. Pathologists and clinicians must be aware of this entity of 'pseudoinvasion' in order to avoid unnecessarily radical surgery in Peutz-Jeghers syndrome.
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Restrepo C, Moreno J, Duque E, Cuello C, Amsel J, Correa P. Juvenile colonic polyposis in Colombia. Dis Colon Rectum 1978; 21:600-12. [PMID: 738175 DOI: 10.1007/bf02586408] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
The lack of an improvement in the gross survival statistics for colorectal cancer during the last decade and the negative results of randomized trials, suggests that 5-FU used as an adjuvant treatment has not increased survival. Current chemotherapeutic drug combinations, however, may prove effective in the adjuvant situation. The adjuvant use of preoperative radiation has shown improved survival in one randomized study and no change in the second study. Current preoperative radiotherapy studies using a more effective radiation dose will confirm the effect of preoperative radiation both on the primary tumor control and on metastases. Current postoperative adjuvant trials incorporating radiation, chemotherapy or a combination of the two, when completed, will provide clear indications for the physician as to the optimum treatment of Duke's B and C cancer of the colorectum. Three national randomized studies for inoperable, recurrent or residual carcinoma of the colorectum are testing the effect of radiation alone or in combination with chemotherapy or chemotherapy followed by immunotherapy.
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Abstract
The case report of a 72-year-old man with the characteristic clinical and pathologic-anatomic picture of the Cronkhite-Canada syndrome is presented. The clinical features and the radiographic appearance of the gastrointestinal tract suggested Ménétrier's disease. Subtotal gastrectomy was performed and at the subsequent pathologic-anatomic examination, the diagnosis of Cronkhite-Canada syndrome was made. The patient slowly recovered over the following five months while being treated with the so-called astronaut diet (Vivasorb) supplemented with vitamins, iron and electrolytes. He died five months after surgery from intercurrent disease. The differential diagnosis of gastrointestinal polyposis with or without mucocutaneous pigmentation is briefly discussed. The histochemical characteristics of the epithelium in the gastric and colonic polyps was studied in some detail. The authors believe that the gastrointestinal polyps in the Cronkhite-Canada syndrome are regenerative and non-neoplastic in nature.
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