1
|
Ullah A, Kenol GS, Lee KT, Yasinzai AQK, Wali A, Waheed A, Heneidi S, Ramamoorthy BU, Karki NR, Blakely AM. Colorectal Adenosquamous Carcinoma: Demographics, Tumor Characteristics, and Survival Benefits of Surgery with Chemoradiation. J Gastrointest Cancer 2024; 55:1079-1088. [PMID: 38607504 DOI: 10.1007/s12029-024-01052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Colorectal adenosquamous carcinoma (ASC) is a rare subtype of colorectal carcinoma. This study presents findings from a large database query to highlight the demographic, clinical, and pathological factors, prognosis, and survival of colorectal ASC. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients with colorectal ASC diagnosed between 2000 and 2020 and assess factors associated with overall survival (OS) and cause-specific survival (CSS). RESULTS Among 284 identified cases, the median age of diagnosis was 64 years. The majority of patients were White (69.0%), with income ≤ $70,000 ( 62.3%), and lived in metropolitan areas (85.6%). Regarding tumor characteristics, the majority of tumors were poorly differentiated (49.6%), regional stage (39.8%), size of > 4.0 cm ( 41.5%), and had a negative lymph node status (47.2%). Primary sites were the rectum (35.2%) and colon ( 64.8%). In patients with primary site to the rectum, the majority of treatment modality was multimodal therapy (40.0%). The main treatment modality for the primary site to the colon was surgery only (46.2%), followed by surgery + chemotherapy (34.2%). The overall 5-year survival was 31.3 (95% C.I. 28.4-34.2) and the 5-year cause-specific survival (CSS) was 40.1% (95% C.I. 36.9-43.3). Multivariate analysis showed age ≥ 60 years, regional stage, and distant stage were negative prognostic factors. An income of > $70,000, multimodal therapy, and surgery with chemotherapy were positive prognostic factors. CONCLUSION Colorectal adenosquamous carcinomas are more common in the non-Hispanic White populations and appear more frequently later in life (based on the median age of diagnosis at 64). Factors that contributed to a worse prognosis were an age of diagnosis ≥ 60 years, regional stage, and distant stage.
Collapse
Affiliation(s)
- Asad Ullah
- Department of Pathology, Texas Tech University Center, Lubbock, TX, 79430, USA.
| | | | | | | | - Agha Wali
- Department of Medicine, Bolan Medical College, Quetta, 83700, Pakistan
| | - Abdul Waheed
- Department of Surgery, San Joaquin General Hospital, French Camp, CA, 95231, USA
| | - Saleh Heneidi
- Department of Pathology, Kaiser Permanente Medical Center, Los Angeles, USA
| | | | - Nabin R Karki
- Division of Medical Oncology, Mitchel Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Andrew M Blakely
- Department of Surgical Oncology, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
2
|
Linardoutsos D, Frountzas M, Feakins RM, Patel NH, Simanskaite V, Patel H. Primary colonic squamous cell carcinoma: a case report and review of the literature. Ann R Coll Surg Engl 2020; 102:e1-e7. [PMID: 32538102 PMCID: PMC7591611 DOI: 10.1308/rcsann.2020.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
Colonic squamous cell carcinoma is extremely rare, with no clear pathogenesis. It usually presents as an emergency. We present the surgical management of a descending colon squamous cell carcinoma, together with a review of the available cases of colonic squamous cell carcinoma in the literature. A 69-year-old woman presented with a palpable mass and abdominal pain. She underwent ultrasound and colonoscopy, which revealed a large obstructing mass at the descending colon, the biopsies of which were not diagnostic. Unfortunately, she was readmitted with bowel obstruction and underwent extended right hemicolectomy with en-bloc excision of attached small bowel and omentum because of local mass expansion. Histopathological analysis demonstrated squamous cell carcinoma with lymph node metastases. Palliative chemotherapy followed, owing to liver and peritoneal deposits. Sixty-six cases of colonic squamous cell carcinoma have been reported in the literature. The most common location is the right colon. Most cases present at a late stage. Several theories for the pathogenesis of colonic squamous cell carcinoma have been reported; the most popular is the squamous transformation of a pluripotent stem cell.
Collapse
Affiliation(s)
- D Linardoutsos
- Department of Colorectal Surgery, Barts Health NHS Trust, London UK
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - M Frountzas
- First Propaedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
| | - RM Feakins
- Department of Histopathology, Barts Health NHS Trust, London UK
| | - NH Patel
- Department of Colorectal Surgery, Barts Health NHS Trust, London UK
| | - V Simanskaite
- Department of Histopathology, Barts Health NHS Trust, London UK
| | - H Patel
- Department of Colorectal Surgery, Barts Health NHS Trust, London UK
| |
Collapse
|
3
|
Di Prete M, Baciorri F, Franceschilli M, Bagaglini G, Sica G, Doldo E, Palmieri G, Orlandi A. Adenosquamous carcinoma of the right colon with diffuse signet-ring mucinous component. Clin J Gastroenterol 2020; 13:555-559. [PMID: 32026256 DOI: 10.1007/s12328-020-01101-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
Colorectal carcinoma is one of the most frequent human malignant neoplasms. Besides the most common histological types, colorectal adenosquamous carcinoma is very rare, being microscopically constituted by tumoural glandular and squamous components. The diagnosis of primary colon adenosquamous carcinoma requires the exclusion of a metastatic squamous cell carcinoma and the extension of a primary squamous cell carcinoma from the anal-rectum junction. We report a case of primary adenosquamous carcinoma of the ascending colon in a 62-year-old Caucasian man affected by long-standing ulcerative colitis. Peritumoural lymph nodes and distant metastasis were present. We reported also a diffuse signet-ring mucinous component, which has not been previously observed. Moreover, we investigated microsatellite and all-RAS/B-RAF status, p16 and p53 protein expression, and the molecular presence of human papillomavirus DNA in all the morphologically distinct components, in order to suggest pathogenetic factors influencing the aggressive prognosis of colon adenosquamous carcinoma.
Collapse
Affiliation(s)
- Monia Di Prete
- Anatomic Pathology, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy.
| | - Francesca Baciorri
- Anatomic Pathology, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | | | - Giulia Bagaglini
- Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Giuseppe Sica
- Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Elena Doldo
- Anatomic Pathology, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Giampiero Palmieri
- Anatomic Pathology, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133, Rome, Italy
| |
Collapse
|
4
|
Tastanova A, Folcher M, Müller M, Camenisch G, Ponti A, Horn T, Tikhomirova MS, Fussenegger M. Synthetic biology-based cellular biomedical tattoo for detection of hypercalcemia associated with cancer. Sci Transl Med 2019; 10:10/437/eaap8562. [PMID: 29669854 DOI: 10.1126/scitranslmed.aap8562] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 03/29/2018] [Indexed: 12/12/2022]
Abstract
Diagnosis marks the beginning of any successful therapy. Because many medical conditions progress asymptomatically over extended periods of time, their timely diagnosis remains difficult, and this adversely affects patient prognosis. Focusing on hypercalcemia associated with cancer, we aimed to develop a synthetic biology-inspired biomedical tattoo using engineered cells that would (i) monitor long-term blood calcium concentration, (ii) detect onset of mild hypercalcemia, and (iii) respond via subcutaneous accumulation of the black pigment melanin to form a visible tattoo. For this purpose, we designed cells containing an ectopically expressed calcium-sensing receptor rewired to a synthetic signaling cascade that activates expression of transgenic tyrosinase, which produces melanin in response to persistently increased blood Ca2+ We confirmed that the melanin-generated color change produced by this biomedical tattoo could be detected with the naked eye and optically quantified. The system was validated in wild-type mice bearing subcutaneously implanted encapsulated engineered cells. All animals inoculated with hypercalcemic breast and colon adenocarcinoma cells developed tattoos, whereas no tattoos were seen in animals inoculated with normocalcemic tumor cells. All tumor-bearing animals remained asymptomatic throughout the 38-day experimental period. Although hypercalcemia is also associated with other pathologies, our findings demonstrate that it is possible to detect hypercalcemia associated with cancer in murine models using this cell-based diagnostic strategy.
Collapse
Affiliation(s)
- Aizhan Tastanova
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Marc Folcher
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Marius Müller
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Gieri Camenisch
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Aaron Ponti
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Thomas Horn
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Maria S Tikhomirova
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland
| | - Martin Fussenegger
- Department of Biosystems Science and Engineering, ETH Zurich, Mattenstrasse 26, CH-4058 Basel, Switzerland. .,Faculty of Science, University of Basel, Mattenstrasse 26, CH-4058 Basel, Switzerland
| |
Collapse
|
5
|
Mohamed S. [Primary squamous cell carcinoma of the colon: about a case]. Pan Afr Med J 2017; 27:124. [PMID: 28904654 PMCID: PMC5567964 DOI: 10.11604/pamj.2017.27.124.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/30/2017] [Indexed: 01/06/2023] Open
Abstract
Primary squamous cell carcinoma (SCC) of the colon is an exceptional tumor. Less than 150 cases have been reported in the literature up to the year 2014. In addition to its rarity, it is distinguished by its frequent association with other digestive neoplasias. We report the case of a 54-year old patient with primary SCC of the colon. In the light of this case study, we will discuss the anatomo-clinical and therapeutic features as well as the etiopathogenic assumptions of this unusual entity.
Collapse
Affiliation(s)
- Sinaa Mohamed
- Laboratoire d'Anatomie Pathologique, Hôpital Militaire Moulay Ismail, Meknès, Maroc
| |
Collapse
|
6
|
Guerra GR, Kong CH, Warrier SK, Lynch AC, Heriot AG, Ngan SY. Primary squamous cell carcinoma of the rectum: An update and implications for treatment. World J Gastrointest Surg 2016; 8:252-265. [PMID: 27022453 PMCID: PMC4807327 DOI: 10.4240/wjgs.v8.i3.252] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/03/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide an update on the aetiology, pathogenesis, diagnosis, staging and management of rectal squamous cell carcinoma (SCC).
METHODS: A systematic review was conducted according to the preferred reporting items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE was performed with the reference list of selected articles reviewed to ensure all relevant publications were captured. The search strategy was limited to the English language, spanning from 1946 to 2015. A qualitative analysis was undertaken examining patient demographics, clinical presentation, diagnosis, staging, treatment and outcome. The quantitaive analysis was limited to data extracted on treatment and outcomes including radiological, clinical and pathological complete response where available. The narrative and quantitative review were synthesised in concert.
RESULTS: The search identified 487 articles in total with 79 included in the qualitative review. The quantitative analysis involved 63 articles, consisting of 43 case reports and 20 case series with a total of 142 individual cases. The underlying pathogenesis of rectal SCC while unclear, continues to be defined, with increasing evidence of a metaplasia-dysplasia-carcinoma sequence and a possible role for human papilloma virus in this progression. The presentation is similar to rectal adenocarcinoma, with a diagnosis confirmed by endoscopic biopsy. Many presumed rectal SCC’s are in fact an extension of an anal SCC, and cytokeratin markers are a useful adjunct in this distinction. Staging is most accurately reflected by the tumour-node-metastasis classification for rectal adenocarcinoma. It involves examining locoregional disease by way of magnetic resonance imaging and/or endorectal ultrasound, with systemic spread excluded by way of computed tomography. Positron emission tomography is integral in the workup to exclude an external site of primary SCC with metastasis to the rectum. While the optimal treatment remains as yet undefined, recent studies have demonstrated a global shift away from surgery towards definitive chemoradiotherapy as primary treatment. Pooled overall survival was calculated to be 86% in patients managed with chemoradiation compared with 48% for those treated traditionally with surgery. Furthermore, local recurrence and metastatic rates were 25% vs 10% and 30% vs 13% for the chemoradiation vs conventional treatment cohorts.
CONCLUSION: The changing paradigm in the treatment of rectal SCC holds great promise for improved outcomes in this rare disease.
Collapse
|
7
|
Funahashi K, Nemoto T, Koike J, Kurihara A, Shiokawa H, Ushigome M, Kaneko T, Arai K, Nagashima Y, Koda T, Suzuki T, Kagami S, Suitsu Y, Kaneko H, Shibuya T. Chemoradiation therapy with S-1 for primary squamous cell carcinoma of the rectum: report of three cases. Surg Case Rep 2015; 1:14. [PMID: 26943382 PMCID: PMC4747969 DOI: 10.1186/s40792-015-0025-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/27/2015] [Indexed: 12/24/2022] Open
Abstract
Purpose Although successful treatment of squamous cell carcinoma (SCC) of the rectum using chemoradiation therapy (CRT) has been reported, a standard protocol has yet to be established. The aim is to ascertain the effectiveness of CRT with S-1 for three patients with SCC of the rectum. Case presentation We treated three female patients complaining of rectal bleeding. The patients were diagnosed as having primary SCC of the rectum by means of routine examinations; one of them was a very rare case because of the presence of two lesions in the lower rectum. We treated the patients using CRT with S1 at a radiation dose of 1.8 Gy/fraction given five times weekly (Monday to Friday) to a median dose of 59.4 (45 to 59.4) Gy; S-1 (80 mg/m2/day) was administered orally during radiation therapy. One of three patients had an adverse event involving massive hemorrhage from the tumor. All patients exhibited an excellent response to CRT with S-1; two patients had a complete response, and one patient had a partial response and underwent a posterior pelvic exenteration with advancement flap reconstruction as a salvage treatment. Pathological examination of the resected specimen and lymph nodes revealed no tumor cells indicating a pathological complete response. In this series, the response rate was 100%. Conclusions We suggest that CRT with S-1 be chosen as the first-line therapy for SCC of the rectum. However, a large study will be required to establish a safe and effective regimen.
Collapse
Affiliation(s)
- Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Tetsuo Nemoto
- Department of Pathology, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Junichi Koike
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Hiroyuki Shiokawa
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Mistunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Kenichiro Arai
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Takamaru Koda
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Takayuki Suzuki
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Yu Suitsu
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Hironori Kaneko
- Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| | - Toshikazu Shibuya
- Department of Pathology, Toho University Medical Center, Omori Hospital, 6-11-1 Omorinishi, Otaku, Tokyo, 143-8541, Japan.
| |
Collapse
|
8
|
Wang JF, Wang ZX, Xu XX, Wang C, Liu JZ. Primary rectal squamous cell carcinoma treated with surgery and radiotherapy. World J Gastroenterol 2014; 20:4106-4109. [PMID: 24744603 PMCID: PMC3983470 DOI: 10.3748/wjg.v20.i14.4106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/13/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
Primary squamous cell carcinoma of the rectum is a rare malignancy, and the discrete dual lesions of rectum are even rarer. There is currently no effective and satisfactory treatment for this disease. Here we report a case of an elderly female with bi-primary squamous cell carcinoma of the rectum treated with radical resection and radiotherapy. The patient is still alive 43 mo after the initial curative resection of the tumor. We suggest that surgery as the primary treatment followed by concomitant radiotherapy may be an effective protocol for elderly patients with rectal squamous cell carcinoma.
Collapse
|
9
|
Ferreira AO, Loureiro AL, Marques V, Sousa HT. Primary squamous cell carcinoma of the most distal rectum: a dilemma in origin and management. BMJ Case Rep 2014; 2014:bcr2013201156. [PMID: 24695655 PMCID: PMC3987253 DOI: 10.1136/bcr-2013-201156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 02/06/2023] Open
Abstract
Squamous cell carcinoma (SCC) of the rectum is a rare malignant entity that has been classically managed with a surgery-based approach, which included abdominoperineal resection for distal lesions. Recently there have been reports on the favourable outcomes achieved with the non-surgical management of these patients. We report a case of a 52-year-old woman who was diagnosed with a stage IIIa SCC located on the distal rectum. The patient was managed conservatively with a chemoradiation regime with mitomycin and 5-fluorouracil. Complete remission was achieved and she is currently alive, asymptomatic and disease-free after 30 months. This case adds to the existing evidence that supports the role of chemoradiation as a first-line curative treatment for the rare rectal SCC.
Collapse
Affiliation(s)
| | - Ana Luisa Loureiro
- Department of Radiology Director: Dr. José Venâncio, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Vasco Marques
- Department of Radiology Director: Dr. José Venâncio, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Helena Tavares Sousa
- Department of Gastroenterology and Hepatology, Centro Hospitalar do Algarve, Portimão, Portugal
| |
Collapse
|
10
|
Bressenot A, Cahn V, Danese S, Peyrin-Biroulet L. Microscopic features of colorectal neoplasia in inflammatory bowel diseases. World J Gastroenterol 2014; 20:3164-3172. [PMID: 24696602 PMCID: PMC3964388 DOI: 10.3748/wjg.v20.i12.3164] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/28/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
The risk of developing dysplasia leading to colorectal cancer (CRC) is increased in both ulcerative colitis and Crohn’s disease. The prognosis of CRC may be poorer in patients with inflammatory bowel disease (IBD) than in those without IBD. Most CRCs, in general, develop from a dysplastic precursor lesion. The interpretation by the pathologist of the biopsy will guide decision making in clinical practice: colonoscopic surveillance or surgical management. This review summarizes features of dysplasia (or intraepithelial neoplasia) with macroscopic and microscopic characteristics. From an endoscopic (gross) point of view, dysplasia may be classified as flat or elevated (raised); from a histological point of view, dysplasia is separated into 3 distinct categories: negative for dysplasia, indefinite for dysplasia, and positive for dysplasia with low- or high-grade dysplasia. The morphologic criteria for dysplasia are based on a combination of cytologic (nuclear and cytoplasmic) and architectural aberrations of the crypt epithelium. Immunohistochemical and molecular markers for dysplasia are reviewed and may help with dysplasia diagnosis, although diagnosis is essentially based on morphological criteria. The clinical, epidemiologic, and pathologic characteristics of IBD-related cancers are, in many aspects, different from those that occur sporadically in the general population. Herein, we summarize macroscopic and microscopic features of IBD-related colorectal carcinoma.
Collapse
|
11
|
Choi JW, Park HU. Adenosquamous carcinoma of the ascending colon: a case report and review of the literature. Ann Coloproctol 2013; 29:83-6. [PMID: 23700577 PMCID: PMC3659249 DOI: 10.3393/ac.2013.29.2.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 03/16/2013] [Indexed: 12/24/2022] Open
Abstract
An adenosquamous carcinoma is a malignancy that has both glandular and squamous histologic components. Both components are malignant and have potential to metastasize. An adenosquamous carcinoma of the large bowel is rare, and its clinicopathologic behavior is not fully understood. It is reported to be more aggressive and have a worse prognosis when it is compared with an adenocarcinoma alone. We present a case of an adenosquamous carcinoma in the ascending colon which was laparoscopically resected and followed by adjuvant chemotherapy.
Collapse
Affiliation(s)
- Jae Won Choi
- Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | | |
Collapse
|
12
|
Abstract
BACKGROUND Information about adenosquamous carcinoma of the colon and rectum is scarce because of its extremely low incidence. OBJECTIVE The aim of this study was to examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma in comparison with adenocarcinoma of the colon and rectum. DESIGN This study was retrospective in design. SETTING California Cancer Registry data from 1994 through 2004 with follow-up through 2008 were analyzed. PATIENTS Patients were included whose cancer of the colon and rectum, excluding the anus with a tumor histology of adenocarcinoma and adenosquamous carcinoma, was surgically treated. MAIN OUTCOME MEASURES The primary outcomes measured were histology-specific survival analyses (with the use of the Kaplan-Meier method), and overall and colorectal-specific mortality (with the use of multivariable Cox proportional hazards regression analyses). RESULTS A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma, 99.91%; adenosquamous carcinoma, 0.09%). There was no significant difference in sex, age, race, and socioeconomic status between the 2 groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right and transverse colon. The adenosquamous carcinoma group was significantly associated with a higher rate of metastasis at the time of operation (adenosquamous carcinoma, 36.56% vs adenocarcinoma, 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma, 65.96% vs adenocarcinoma, 19.74%) in comparison with the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) in comparison with the adenosquamous carcinoma group (35.3 months). With the use of multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (hazard ratio, 1.67) and colorectal-specific mortality (hazard ratio, 1.69) in comparison with adenocarcinoma. CONCLUSIONS This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal-specific mortality in comparison with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic feature.
Collapse
|
13
|
|
14
|
Sameer AS, Syeed N, Chowdri NA, Parray FQ, Siddiqi MA. Squamous cell carcinoma of rectum presenting in a man: a case report. J Med Case Rep 2010; 4:392. [PMID: 21118539 PMCID: PMC3014960 DOI: 10.1186/1752-1947-4-392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 11/30/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary squamous cell carcinomas of the colorectum are very uncommon. Until now, to the best of our knowledge, only 114 cases of squamous cell carcinoma in the colorectum exist in the reported literature. Here we report a case of squamous cell carcinoma of the rectum in the ethnic Kashmiri population in northern India. CASE PRESENTATION The case of a 60-year-old male patient (Asian) with a pure squamous cell carcinoma of the rectum is presented here. The patient underwent a curative surgery with concomitant chemotherapy. Two years after the initial curative resection of the tumor he is still alive. CONCLUSION The prognosis for squamous cell carcinoma of the colorectum is worse than for that of adenocarcinoma, because of the delayed diagnosis. The etiopathogenicity of squamous cell carcinoma of the colorectum is discussed. Surgical resection of the lesion seems to be the treatment of choice. Chemotherapy also helps in improvement of the prognosis.
Collapse
Affiliation(s)
- A Syed Sameer
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
- Department of Clinical Biochemistry, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Nidda Syeed
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
| | - Nissar A Chowdri
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Fazl Q Parray
- Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 190011, India
| | - Mushtaq A Siddiqi
- Department of Immunology and Molecular Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, 90011, India
| |
Collapse
|
15
|
Iannacone E, Dionisi F, Musio D, Caiazzo R, Raffetto N, Banelli E. Chemoradiation as definitive treatment for primary squamous cell cancer of the rectum. World J Radiol 2010; 2:329-33. [PMID: 21160687 PMCID: PMC2999332 DOI: 10.4329/wjr.v2.i8.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/29/2010] [Accepted: 07/06/2010] [Indexed: 02/06/2023] Open
Abstract
In this report, we present a case of advanced squamous cell cancer located in the rectum of a 78-year-old woman treated with chemoradiation with curative intent. The patient showed a complete clinical response to chemoradiation; multiple biopsies were performed at the site of the previous mass 5 mo after the end of treatment and histological examination showed no residual tumour in the specimens. Surgical intervention was avoided and the patient was free of disease 12 mo after the diagnosis of cancer. Primary chemoradiation should be considered as the treatment of choice for this rare malignancy.
Collapse
|
16
|
Matsuda A, Takahashi K, Yamaguchi T, Matsumoto H, Miyamoto H, Kawakami M, Kawachi H, Suzuki H, Furukawa K, Tajiri T, Mori T. HPV infection in an HIV-positive patient with primary squamous cell carcinoma of rectum. Int J Clin Oncol 2009; 14:551-4. [PMID: 19967495 DOI: 10.1007/s10147-009-0890-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 02/23/2009] [Indexed: 12/13/2022]
Abstract
Primary squamous cell carcinoma (SCC) of the colorectum is a rare malignancy of unknown etiology and pathogenesis. We report a case of primary SCC of the rectum. A 55-year-old man with a rectal tumor and human immunodeficiency virus (HIV) infection was referred to our hospital. Histopathology of biopsy specimens showed characteristics of SCC. We diagnosed the patient as having primary moderately differentiated SCC of the rectum according to the criteria proposed by Cooper. Human papillomavirus (HPV) DNA was amplified by polymerase chain reaction analysis of unfixed tumor biopsy specimens. In addition, no p53 overexpression or nuclear staining of retinoblastoma protein (Rb) was observed in neoplastic cells by immunohistochemical staining. We suggest from our case that HPV infection following the inactivation of the cellular tumor suppressor Rb and the immune suppression induced by HIV infection play an etiologic role in the pathogenesis of rectal SCC, consistent with the well-established concept of HPV-associated anal carcinogenesis.
Collapse
Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Okabayashi K, Hasegawa H, Ishii Y, Endo T, Kitagawa Y. Adenosquamous carcinoma of the sigmoid colon treated by the less invasive procedures of endoscopy and laparoscopy: report of a case. Surg Today 2009; 39:994-7. [PMID: 19882324 DOI: 10.1007/s00595-009-3961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 01/29/2009] [Indexed: 11/24/2022]
Abstract
A 51-year-old man demonstrated a positive finding for a fecal occult blood test during a screening examination. Total colonoscopy was therefore performed, and a semi-pedunculated polyp was detected in the sigmoid colon. Although this polyp was suspected of invading the submucosal layer, it was removed endoscopically because the preoperative diagnosis was well-differentiated adenocarcinoma. The pathological findings revealed adenosquamous carcinoma that had invaded the submucosal layer with lymphatic invasion. A laparoscopic bowel resection was then performed and a histopathological examination of the surgical specimen showed metastasis to two regional lymph nodes. The patient is alive and recurrence-free 22 months after the operation. Adenosquamous carcinoma has been reported to be rare and to possess a highly metastatic potential. It consists of both squamous cells and glandular cell components. We report a case of adenosquamous carcinoma of the sigmoid colon treated by less invasive approaches consisting of an endoscopic mucosal resection and a subsequent laparoscopic colectomy.
Collapse
Affiliation(s)
- Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | | | | | | | | |
Collapse
|
18
|
Ghigna MR, Drak Alsibai K, Porras J, Palazzo L, Godchaux JM, Fabre M. Deep-seated rectal/anal basaloid carcinoma: useful immunocytochemistry in rare squamous cell carcinoma variants. Cytopathology 2009; 20:315-20. [DOI: 10.1111/j.1365-2303.2008.00560.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Abstract
Squamous cell carcinoma of the rectum is a rare malignancy. It appears to be associated with chronic inflammatory conditions and infections. The clear association seen between Human Papilloma Virus and various squamous cancers has not been firmly established for the squamous cell cancer of the rectum. The presentation is nonspecific and patients tend to present with advanced stage disease. Diagnosis relies on endoscopic examination with biopsy of the lesion. Distinction from squamous cell cancer of the anus can be difficult, but can be facilitated by immunohistochemical staining for cytokeratins. Staging of the cancer with endoscopic ultrasound and computed tomography provides essential information on prognosis and can guide therapy. At present, surgery remains the main therapeutic option; however recent advances have made chemoradiation a valuable therapeutic addition. Squamous cell carcinoma of the rectum is a distinct entity and it is of crucial importance for the practicing Gastroenterologist to be thoroughly familiar with this disease. Compared to adenocarcinoma of the rectum and squamous cell cancer of the anal canal, squamous cell carcinoma of the rectum has different epidemiology, etiology, pathogenesis, and prognosis but, most importantly, requires a different therapeutic approach. This review will examine and summarize the available information regarding this disease from the perspective of the practicing gastroenterologist.
Collapse
|
20
|
Leung KK, Heitzman J, Madan A. Squamous cell carcinoma of the rectum 21 years after radiotherapy for cervical carcinoma. Saudi J Gastroenterol 2009; 15:196-8. [PMID: 19636183 PMCID: PMC2841421 DOI: 10.4103/1319-3767.54745] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the rectum is an extremely rare malignancy, accounting for 0.1-0.2% of rectal malignancies. It is associated with ulcerative colitis, prior radiation, schistosomiasis, ovarian cancer, endometrial cancer, human papilloma virus, colocutaneous fistulas and colonic duplication. Prior reported cases of SCC of the rectum have involved treatment with brachytherapy and external beam radiation. This case is particularly interesting because of the remote exposure of radiation (21 years previously) and the subsequent development of SCC of the rectum. Although extremely rare, SCC of the rectum can occur decades after radiation exposure.
Collapse
Affiliation(s)
- Kevin K. Leung
- Department of Gastroenterology, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - Joseph Heitzman
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA
| | - Anand Madan
- Department of Gastroenterology, The University of Texas Health Science Center, Houston, TX 77030, USA,Address for correspondence: Dr. Anand Madan, Division of Gastroenterology, The University of Texas Health Science Center, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA. E-mail:
| |
Collapse
|
21
|
Rasheed S, Yap T, Zia A, McDonald PJ, Glynne-Jones R. Chemo-radiotherapy: an alternative to surgery for squamous cell carcinoma of the rectum--report of six patients and literature review. Colorectal Dis 2009; 11:191-7. [PMID: 18462236 DOI: 10.1111/j.1463-1318.2008.01560.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Since 1943 [1], only 45 patients of squamous cancer of the rectum have been reported in the published reports and the largest series to date consists of 12 patients. Reports suggest that the primary treatment is surgical resection but, in the light of nonsurgical advances in the treatment of anal squamous cell carcinoma (SCC), we present a review of the literature and report six patients treated by chemoradiation therapy (CRT). METHOD A literature search was undertaken using the keywords squamous cell, epidermoid, basaloid and cloacagenic and cancer of rectum and colon to provide evidence for this discussion from studies of surgery, radiation therapy and CRT in rectal SCC. A prospective database of the Mount Vernon Cancer Centre, UK was searched from 1995 to 2005 for patients diagnosed with pure SCC of the rectum. RESULTS Six patients with histologically confirmed primary SCC of the rectum were treated with primary combination chemo-radiotherapy according to protocols used for SCC of the anal canal over a 15-year period. Surgery was avoided in four, and they remain disease-free on follow-up. CONCLUSIONS Primary CRT, as currently utilized in anal cancer, can be extended to primary SCC of the rectum.
Collapse
Affiliation(s)
- S Rasheed
- Northwick Park and St Mark's Hospitals, Harrow, Middlesex, UK
| | | | | | | | | |
Collapse
|
22
|
Bognár G, István G, Ledniczky G, Ondrejka P. [Detection of human papilloma virus type 16 in squamous cell carcinoma of colon and its lymph node metastases]. Magy Seb 2008; 61:225-9. [PMID: 18799406 DOI: 10.1556/maseb.61.2008.4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The etiological role of human papilloma virus (HPV) in a number of squamous cell malignant tumours is well known. Squamous cell carcinoma of colon (SCC) is a rare disease with uncertain etiology. Our objective was to detect possible HPV infection in a colon SCC patient. The 94-year-old female patient was operated for an obstructive colon tumour. Histology confirmed SCC. Tumour tissue and the removed lymph nodes were examined with polymerase chain reaction and Southern blot hybridization techniques. From HPV types 16 and 18, which most commonly associated with malignant tumours, the presence of HPV type 16 could be confirmed in the primary tumour and in 4 out of the 9 surrounding lymph nodes (of which 2 were metastatic). HPV-16 infection was detected in a colon cancer patient with SCC histological type in the primary tumour and in surrounding lymph nodes. According to our knowledge, no similar study has been published yet.
Collapse
|
23
|
Bognár G, István G, Bereczky B, Ondrejka P. Detection of Human Papillomavirus Type 16 in Squamous Cell Carcinoma of the Colon and Its Lymph Node Metastases with PCR and Southern Blot Hybridization. Pathol Oncol Res 2008; 14:93-6. [DOI: 10.1007/s12253-008-9011-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 12/04/2006] [Indexed: 12/14/2022]
|
24
|
|
25
|
Pikarsky AJ, Belin B, Efron J, Woodhouse S, Weiss EG, Wexner SD, Nogueras JJ. Squamous cell carcinoma of the rectum in ulcerative colitis: case report and review of the literature. Int J Colorectal Dis 2007; 22:445-7. [PMID: 16932927 DOI: 10.1007/s00384-006-0110-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2006] [Indexed: 02/04/2023]
Abstract
The majority of colorectal carcinomas diagnosed are adenocarcinomas. Squamous cell carcinomas (SCC) of the rectum are rare tumors, and were reported as rare complication of inflammatory bowel disease. Surgery is the most effective therapy; and adjuvant chemotherapy and radiotherapy should also be considered. We report two cases of ulcerative colitis-associated SCC of the rectum. The lesions were treated with chemoradiotherapy with complete response.
Collapse
Affiliation(s)
- Alon J Pikarsky
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
Morphologic identification of dysplasia in mucosal biopsies is the best and most reliable marker of an increased risk for malignancy in patients who have inflammatory bowel disease, and it forms the basis of the recommended endoscopic surveillance strategies that are in practice for patients who have this illness. In ulcerative colitis (UC) and Crohn's disease (CD), dysplasia is defined as unequivocal neoplastic epithelium that is confined to the basement membrane, without invasion into the lamina propria. Unfortunately, unlike in UC, only a few studies have evaluated the pathologic features and biologic characteristics of dysplasia and carcinoma in CD specifically. As a result, this article focuses mainly on the pathologic features, adjunctive diagnostic methods, and differential diagnosis of dysplasia in UC.
Collapse
Affiliation(s)
- Robert D Odze
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School Boston, MA 02115, USA.
| |
Collapse
|
27
|
Theodosopoulos TK, Marinis AD, Dafnios NA, Vassiliou JG, Samanides LD, Carvounis EE, Smyrniotis VE. Aggressive treatment of metastatic squamous cell carcinoma of the rectum to the liver: a case report and a brief review of the literature. World J Surg Oncol 2006; 4:49. [PMID: 16895595 PMCID: PMC1555584 DOI: 10.1186/1477-7819-4-49] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 08/08/2006] [Indexed: 12/13/2022] Open
Abstract
Background Rectal squamous cell carcinoma (SCC) is a rare tumor. The incidence of this malignancy has been reported to be 0.25 to 1 per 1000 colorectal carcinomas. From a review of the English literature 55 cases of SCC of the rectum have been published. In this study we report a rectal metastatic SCC to the liver, discussing the efficacy of aggressive adjuvant and neo-adjuvant therapies on survival and prognosis. Case presentation A 39-year-old female patient with a pure SCC of the rectum diagnosed endoscopically is presented. The patient underwent initially neoadjuvant chemo-radiotherapy and then abdominoperineal resection with concomitant bilateral oophorectomy and hysterectomy, followed by adjuvant chemo-radiotherapy. Five months after the initial operation liver metastasis was demonstrated and a liver resection was carried out, followed by adjuvant chemotherapy. Eighteen months after the initial operation the patient is alive. Conclusion Although prognosis of rectal SCC is worse than that of adenocarcinoma, an aggressive therapeutic approach with surgery as the primary treatment, followed by combined neo- and adjuvant chemo-radiotherapy, may be necessary in order to improve survival and prognosis.
Collapse
Affiliation(s)
- Theodosios K Theodosopoulos
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Athanasios D Marinis
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Nikolaos A Dafnios
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - John G Vassiliou
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Lazaros D Samanides
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Eleni E Carvounis
- Department of Pathology, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| | - Vassilios E Smyrniotis
- Second Department of Surgery, Areteion University Hospital, Athens Medical School, University of Athens, 76 Vasilisis Sofias av., 11528, Athens, Greece
| |
Collapse
|
28
|
Abstract
Adenosquamous carcinoma of the colon is rare. A paraneoplastic syndrome presenting as hypercalcemia may occasionally occur in association with these tumors. Survival for more advanced stages of disease is lower than for patients with adenocarcinoma at a corresponding stage. We report a patient who presented with a primary adenosquamous carcinoma of the rectosigmoid junction and we review the literature regarding the clinical presentation, management, and prognosis of this tumor.
Collapse
Affiliation(s)
- Ravi P. Kiran
- Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - Guiseppe Tripodi
- Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | - William Frederick
- Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut
| | | |
Collapse
|
29
|
Anagnostopoulos G, Sakorafas GH, Kostopoulos P, Grigoriadis K, Pavlakis G, Margantinis G, Vugiouklakis D, Arvanitidis D. Squamous cell carcinoma of the rectum: a case report and review of the literature. Eur J Cancer Care (Engl) 2005; 14:70-4. [PMID: 15698388 DOI: 10.1111/j.1365-2354.2005.00523.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Squamous cell carcinoma of the colon and rectum are extremely rare neoplasms. Many questions regarding their histogenesis and biological behaviour remain unanswered. Surgery is the most effective therapy, and adjuvant chemotherapy and radiotherapy should be considered, especially for node-positive patients. We present a patient with squamous cell carcinoma of the middle rectum who underwent abdominoperineal resection and postoperative adjuvant chemotherapy. The pertinent literature is reviewed.
Collapse
Affiliation(s)
- G Anagnostopoulos
- Department of Gastroenterology, 251 Hellenic Air Force Hospital, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Audeau A, Han HW, Johnston MJ, Whitehead MW, Frizelle FA. Does human papilloma virus have a role in squamous cell carcinoma of the colon and upper rectum? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:657-60. [PMID: 12359204 DOI: 10.1053/ejso.2002.1304] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM To determine if Human Papilloma Virus (HPV) has a role in the aetiology of adenosquamous and squamous cell carcinoma of the colon and upper rectum, and to describe the clinical features seen in our patients with this condition. METHODS Patients were identified with squamous cell carcinoma (SCC), adenosquamous carcinoma (Ad-SCC), or adenocarcinoma with squamous metaplasia (AA) of the colon and upper rectum over the 10 years from 1/1/1990 to 31/12/1999. Patients were identified from a prospective pathology database. All tumours were at least 5cm above the dentate line. Pathology blocks were stained using the Peroxidase labelled Streptavidin technique using mouse monoclonal antibody NCL-HPV-4C4, which identifies HPV 6, 11, 16 and 18. Age, gender and site matched controls (colorectal adenocarcinomas) were also stained. The clinical presentation and management was reviewed from the case notes. RESULTS Twenty patients were identified from a pathological database of 2351 colorectal cancers (0.85% of colorectal cancers). 0/20 of the study patients (SCC, Ad-SCC, AA) or adenocarcinoma controls stained positively for HPV 6, 11, 16, 18. The clinical presentation was similar to patients presenting with adenocarcinomas. CONCLUSIONS The peroxidase labelled streptavidin technique is an immunohistochemical technique with high specificity but lower sensitivity. There was no apparent association between HPV 6, 11, 16, 18 and squamous cell and adenosquamous carcinoma of the colon and rectum using this technique. Clinical features are similar in squamous and adenosquamous colorectal carcinomas to colorectal adenocarcinomas.
Collapse
Affiliation(s)
- A Audeau
- Department of Surgery, Christchurch Hospital, New Zealand
| | | | | | | | | |
Collapse
|
31
|
Schlegel RD, Dehni N, Cravino AT, Tiret E, Prevot S, Waisman HJ, Parc R. Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature. Colorectal Dis 2001; 3:201-3. [PMID: 12790990 DOI: 10.1046/j.1463-1318.2001.00225.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease. MATERIALS AND METHODS Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery. RESULTS Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment. CONCLUSIONS Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.
Collapse
Affiliation(s)
- R D Schlegel
- Department of Surgery, Hospital de Clínicas José de San Martín, University of Buenos Aires, Argentina.
| | | | | | | | | | | | | |
Collapse
|
32
|
Frizelle FA, Hobday KS, Batts KP, Nelson H. Adenosquamous and squamous carcinoma of the colon and upper rectum: a clinical and histopathologic study. Dis Colon Rectum 2001; 44:341-6. [PMID: 11289278 DOI: 10.1007/bf02234730] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Squamous and adenosquamous carcinoma of the colon and proximal rectum are rare neoplasms in which the clinicopathologic behavior and the most appropriate management are unknown. The purpose of this study was to review the histology and clinical course of the largest series of cases ever reported from a single center on this rare condition. METHOD The Mayo Clinic tissue registry was searched for all primary cases of squamous and adenosquamous carcinoma of the colon or rectum proximal to 8 cm from the dentate and presenting before December 31, 1992. Of the 52 identified cases there was adequate histologic material for review in 44 cases. These cases were divided into pure squamous-cell carcinoma (n = 11), mixed adenosquamous carcinoma (n = 31), and adenocarcinoma with benign-appearing squamous metaplasia (adenoacanthoma; n = 2). Squamous-cell carcinomas were examined for evidence of human papilloma virus by in situ hybridization. A retrospective review of medical records was undertaken in all 52 cases with respect to predisposing factors, clinicopathologic behavior, prognostic features, and treatment with adjuvant therapy. RESULTS The charts of 52 patients (20 females), with a mean age of 58.6 (range, 19-90) years, were reviewed. Right-sided lesions were the most common (43 percent). Metastatic disease was evident at presentation in 49 percent of patients, the most common sites in order being liver, peritoneal, and lung. The five-year overall survival rate was 34 percent, Stage I to III disease had a 65 percent five-year survival rate, and Stage IV mean survival time was 8.5 months. For node-positive and node-negative disease, 23 and 85 percent, respectively, survived five years. There was no evidence of human papilloma virus in the six squamous-cell carcinomas examined. CONCLUSION Squamous and adenosquamous carcinomas of the colon and rectum are rare neoplasms. Although a poor prognosis can be expected for node-positive disease, patients with negative nodes do generally the same as patients with adenocarcinoma histology. Based on advances made with multimodality therapy of squamous-cell cancer of the anus and adenocarcinoma of the rectum, further studies should define the role of postoperative therapies for these lesions.
Collapse
Affiliation(s)
- F A Frizelle
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
33
|
Lortholary AH, Cadeau SD, Bertrand GM, Guerin-Meyer VI, Gamelin EC, Audran MJ. Humoral hypercalcemia in patients with colorectal carcinoma. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19991201)86:11<2217::aid-cncr7>3.0.co;2-v] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
34
|
Ngo N, Villamil C, Macauley W, Cole SR. Adenosquamous carcinoma of the small intestine. Report of a case and review of the literature. Arch Pathol Lab Med 1999; 123:739-42. [PMID: 10420235 DOI: 10.5858/1999-123-0739-acotsi] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary adenosquamous carcinomas of the intestine are rare tumors, particularly those occurring in the small bowel. We report the third case of an adenosquamous carcinoma of the ileum in a 55-year-old-man. Histologically, the tumor consisted of malignant glandular and squamous elements. A review of the literature is presented.
Collapse
Affiliation(s)
- N Ngo
- Department of Pathology and Laboratory Medicine, Hartford Hospital, Conn. 06102, USA
| | | | | | | |
Collapse
|
35
|
Cagir B, Nagy MW, Topham A, Rakinic J, Fry RD. Adenosquamous carcinoma of the colon, rectum, and anus: epidemiology, distribution, and survival characteristics. Dis Colon Rectum 1999; 42:258-63. [PMID: 10211505 DOI: 10.1007/bf02237138] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE There have been 49 cases of adenosquamous carcinoma of the colon, rectum, and anus reported in the English literature. We have reviewed 145 cases of adenosquamous carcinoma to better define epidemiologic and survival characteristics of this extremely rare colon carcinoma. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results program public use CD-ROM file for the years 1973 through 1992 were reviewed. This represents approximately 9.5 percent of the United States population. Adenosquamous carcinomas arising in the colon, rectum, and anus were identified using the International Classification of Diseases-O codes. The Astler-Coller tumor classification was used for staging. Two-tailed Student's t-test, Mantel-Haenszel chi-squared tests, and generalized Wilcoxon's tests were used for comparisons of means, proportions, and actuarial survival rates, respectively. Survival curves were calculated by the Kaplan-Meier method. RESULTS One hundred forty-five cases of adenosquamous carcinoma were identified, representing 0.06 percent of all colorectal malignancies. The mean age of patients was 67 years. Eighty-four percent of patients were Caucasians, 15 percent were Afro-Americans, and 1 percent were other races. Afro-Americans were diagnosed at a significantly younger age (median age, 62 years; P = 0.03). Fifty-three percent of the carcinomas were located in the sigmoid colon, rectum, and anus, 28 percent in the right colon, and the rest in the middle segment. Seventy-four percent of distal cases were staged A through C, compared with 44 percent of proximal cases. Patients with adenosquamous carcinoma of the sigmoid colon, rectum, and anus survived longer than all other patients (P = 0.001). Patients with adenosquamous carcinoma Stages A and B1 had survival rates similar to patients with comparably staged adenocarcinomas. Fifty percent of the patients, including most of the patients with D stage, died in the first year. Patients with Stages B2, C, and D adenosquamous carcinomas had a significantly shorter survival than the comparably staged adenocarcinomas (P < or = 0.02). The overall adjusted five-year survival rate was 30.7 percent. In those patients who survived more than 24 months, the five-year survival was 84 percent. CONCLUSIONS The survival rates for patients with adenosquamous carcinoma Stages A and B1 are similar to patients with comparably staged colorectal adenocarcinomas. However, we found that patients with colorectal and anal adenosquamous carcinomas staged B2 through D have significantly poorer survival than patients with comparably staged adenocarcinomas, supporting the previous reports of a poor prognosis associated with adenosquamous carcinomas.
Collapse
Affiliation(s)
- B Cagir
- Department of Surgery, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE Adenosquamous carcinomas of the colon and rectum are rare tumors. These tumors have malignant glandular and squamous components capable of metastasizing. We report seven patients with adenosquamous carcinoma of the colon and rectum and their clinical outcomes. METHODS Retrospective review was undertaken of seven patients who were identified by the tumor registry at Roswell Park Cancer Institute between 1971 and 1994. RESULTS These represent a 0.18 percent incidence of adenocarcinomas in our institution. There were five tumors located in the rectum and two in the colon. All patients were Stage III or IV on presentation. Median overall survival was 23 months. In three patients, the tumor was associated with ulcerative colitis; in one of these patients, hypercalcemia was present. All patients died of their disease or with the disease. CONCLUSIONS Previously reported aggressive behavior of this cancer is confirmed in our series.
Collapse
Affiliation(s)
- N J Petrelli
- Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
| | | | | | | |
Collapse
|
37
|
Kulaylat MN, Doerr R, Butler B, Satchidanand SK, Singh A. Squamous cell carcinoma complicating idiopathic inflammatory bowel disease. J Surg Oncol 1995; 59:48-55. [PMID: 7745978 DOI: 10.1002/jso.2930590113] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Squamous cell carcinoma of the colon and rectum, originating proximal to the transitional zone, is a rare complication of idiopathic inflammatory bowel disease (IIBD). To date there are only 15 single case reports of such an occurrence. This carcinoma develops more commonly in females and in patients with pancolonic disease of more than 8 years' duration. The rectum is affected in two thirds of the cases. Squamous cell changes, in the vicinity of the primary adenocarcinoma, are present in 27% of cases. The carcinoma is in a pathologically advanced stage in one third of the cases. Colectomy is the main therapeutic modality. Survival following surgical resection ranged from 7 months to 21 years. We present an additional case of rectal squamous cell carcinoma (SCC) complicating chronic ulcerative colitis in a 33-year-old woman who had the disease for 15 years. Multiple biopsies of a gross lesion located 5 cm above the dendate line were consistent with invasive basaloid cell carcinoma. The patient received 5-FU, mitomycin C, and radiotherapy prior to a proctocolectomy and ileostomy. The only histopathologic finding at pathologic review of the surgical specimen was severe squamous dysplasia.
Collapse
Affiliation(s)
- M N Kulaylat
- Department of Surgery, State University of New York, School of Medicine and Biomedical Sciences, Buffalo, USA
| | | | | | | | | |
Collapse
|
38
|
Maruoka T, Hasegawa K, Nagasako K. Squamous cell metaplasia without dysplasia of the colonic mucosa in ulcerative colitis. Gastrointest Endosc 1990; 36:65-6. [PMID: 2311886 DOI: 10.1016/s0016-5107(90)70929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- T Maruoka
- Institute of Gastroenterology, Tokyo Women's Medical College, Japan
| | | | | |
Collapse
|