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Bigliardi R, Morici M, Messere G, Ortiz G, Fernandez J, Varela A, Vidal J, Diaz F, Salas J, Riccheri MC. Colorectal adenocarcinoma in children and adolescents. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024:S2255-534X(24)00077-X. [PMID: 39353787 DOI: 10.1016/j.rgmxen.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/09/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION Colorectal adenocarcinoma is rare in children and adolescents and tends to present with nonspecific signs and symptoms, leading to late diagnoses. OBJECTIVES Our aim was to describe the clinical presentation and progression in children and adolescents with colorectal adenocarcinoma treated at our hospital and detect possible predisposing conditions of this disease. MATERIALS AND METHODS Eight patients with colorectal adenocarcinoma were followed at the Hospital Posadas within the time frame of January 2000 and December 2021. We searched for diseases predisposing to this cancer. RESULTS The mean patient age was 16 years (between 11 and 17 years of age). Clinical presentation was abdominal pain in the 8 patients; 4 of them had pain in the right hypochondrium, 3 had abdominal tumor, 4 had rectal bleeding, and 3 had weight loss. Mean symptom duration was 9 weeks (range: 1-24 weeks). None of the patients showed predisposing illnesses. One patient presented with polyposis, with no cases in any other family member. Histology showed mucinous adenocarcinoma in all the patients, 4 of whom had the signet ring cell subtype. The primary tumor was located in the right colon in 6 patients. At diagnosis, staging according to the modified Dukes classification was: I: one patient; IIb: one patient; IIIb: one patient; IIIc: one patient; and IV: 4 patients. All patients except 2 received chemotherapy and one patient received radiotherapy. Overall survival at 3 years was 25%. CONCLUSIONS All patients presented with mucinous adenocarcinoma, no predisposing diseases were found, and the children with colorectal cancer had a very poor prognosis. Colorectal cancer diagnosis should be considered in children presenting with acute abdominal pain, abdominal tumor, or lower gastrointestinal bleeding, especially if there is weight loss.
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Affiliation(s)
- R Bigliardi
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina.
| | - M Morici
- Servicio de Hematooncología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - G Messere
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - G Ortiz
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - J Fernandez
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - A Varela
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - J Vidal
- Servicio de Gastroenterología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - F Diaz
- Servicio de Cirugía Infantil, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - J Salas
- Servicio de Anatomía Patológica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
| | - M C Riccheri
- Servicio de Hematooncología Pediátrica, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
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Stetson A, Saluja S, Cameron DB, Mansfield SA, Polites SF, Honeyman JN, Dahl JP, Austin MT, Aldrink JH, Christison-Lagay ER. Surgical management of rare tumors (Part 1). Pediatr Blood Cancer 2024:e31287. [PMID: 39185712 DOI: 10.1002/pbc.31287] [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: 06/11/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 08/27/2024]
Abstract
With an annual cumulative occurrence of approximately 15,000 in North America, all childhood cancers are rare. Very rare cancers as defined by both the European Cooperative Study Group for Rare Pediatric Cancers and the Children's Oncology Group fall into two principal categories: those so uncommon (fewer than 2 cases/million) that their study is challenging even through cooperative group efforts (e.g., pleuropulmonary blastoma and desmoplastic small round cell tumor) and those that are far more common in adults and therefore rarely studied in children (e.g., thyroid, melanoma, and gastrointestinal stromal tumor). Treatment strategies for these latter tumors are typically based on adult guidelines, although the pediatric variants of these tumors may harbor different genetic signatures and demonstrate different behavior. If melanoma and differentiated thyroid cancer are excluded, other rare cancer types account for only 2% of the cancers in children aged 0 to 14. This article highlights several of the most common rare tumor types.
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Affiliation(s)
- Alyssa Stetson
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Saurabh Saluja
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danielle B Cameron
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara A Mansfield
- Division of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Joshua N Honeyman
- Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John P Dahl
- Division of Otolaryngology, Division of Pediatric Otolaryngology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Mary T Austin
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston and Department of Surgical Oncology and Pediatrics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer H Aldrink
- Division of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
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3
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Nofi CP, Siskind S, Deutsch GB, Ricci JP, Lipskar AM. NCCN Guideline Concordance Improves Survival in Pediatric and Young Adult Rectal Cancer. J Pediatr Surg 2024; 59:464-472. [PMID: 37903675 DOI: 10.1016/j.jpedsurg.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Although management guidelines in adult rectal cancer are widely studied, no consensus guidelines exist for the management of pediatric and young adult rectal cancer. METHODS The National Cancer Database (2004-2018) was queried for pediatric (age 0-21) and young adult (age 22-40) patients with rectal cancer. Patients were analyzed for receipt of National Comprehensive Cancer Network (NCCN) guideline-concordant therapy. Impact on survival was evaluated using Cox regression and Kaplan-Meier analysis. RESULTS 6655 patients (108 pediatric and 6547 young adult patients) with rectal cancer were included. Similar to previously published NCCN quality measures with overall guideline concordance approaching 90 % in adults, 89.6 % of pediatric and 84.6 % of young adult patients were classified as receiving pre-operative guideline-concordant therapy. However, pediatric patients were significantly less likely to receive post-operative guideline-concordant therapy than young adult patients (65.3 % verse 76.7 %, respectively, p = 0.008). Risk of death was significantly lower for pediatric patients who received post-operative guideline-concordant therapy (HR, 0.313; CI, 0.168-0.581; p < 0.001). In young adult patients, risk of death was significantly lower for those who received pre-operative guideline-concordant therapy (HR, 0.376, CI 0.338-0.417, p < 0.001), and post-operative guideline-concordant therapy (HR, 0.456; CI 0.413-0.505; p < 0.001). DISCUSSION NCCN-based guidelines may reasonably guide peri-operative management decisions and improve survival in pediatric and young adult rectal cancer. Given the rarity of this cancer in young patients, employment of an experienced surgical and oncologic multidisciplinary team, along with discussion and involvement of the patient and family, are keys for balancing risks and benefits to offering the best therapeutic strategy. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Colleen P Nofi
- Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA.
| | - Sara Siskind
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA
| | - Gary B Deutsch
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
| | - John P Ricci
- Northwell North Shore/Long Island Jewish, Department of Surgery, 300 Community Drive, Manhasset NY 11030, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
| | - Aaron M Lipskar
- Cohen Children's Medical Center, Division of Pediatric General, Thoracic, and Endoscopic Surgery, 269-01 76th Avenue, Queens NY 11040, USA; Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead NY 11548, USA
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Schultz KAP, Chintagumpala M, Piao J, Chen KS, Shah R, Gartrell RD, Christison-Lagay E, Pashnakar F, Berry JL, O’Neill AF, Vasta LM, Flynn A, Mitchell SG, Seynnaeve BKN, Rosenblum J, Potter SL, Kamihara J, Rodriguez-Galindo C, Hawkins DS, Laetsch TW. Rare Tumors: Opportunities and challenges from the Children's Oncology Group perspective. EJC PAEDIATRIC ONCOLOGY 2023; 2:100024. [PMID: 37829670 PMCID: PMC10566015 DOI: 10.1016/j.ejcped.2023.100024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
While all childhood cancers are rare, tumors that are particularly infrequent or underrepresented within pediatrics are studied under the umbrella of the Children's Oncology Group Rare Tumor committee, divided into the Retinoblastoma and Infrequent Tumor subcommittees. The Infrequent Tumor subcommittee has traditionally included an emphasis on globally rare tumors such as adrenocortical carcinoma, nasopharyngeal carcinoma, or those tumors that are rare in young children, despite being common in adolescents and young adults, such as colorectal carcinoma, thyroid carcinoma, and melanoma. Pleuropulmonary blastoma, gonadal stromal tumors, pancreatic tumors including pancreatoblastoma, gastrointestinal stromal tumor, nonmelanoma skin cancers, neuroendocrine tumors, and desmoplastic small round cell tumors, as well as other carcinomas are also included under the heading of the Children's Oncology Group Rare Tumor committee. While substantial challenges exist in rare cancers, inclusion and global collaboration remain key priorities to ensure high quality research to advance care.
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Affiliation(s)
| | - Murali Chintagumpala
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Jin Piao
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Kenneth S. Chen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Rachana Shah
- University of Southern California Keck School of Medicine, Los Angeles, CA
- Division of Hematology-Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Robyn D Gartrell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | | | - Farzana Pashnakar
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jesse L. Berry
- University of Southern California Keck School of Medicine, Los Angeles, CA
- The Vision Center, Children’s Hospital Los Angeles, The Saban Research Institute, Children’s Hospital Los Angeles, USC Roski Eye Institute, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Allison F. O’Neill
- Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA
| | - Lauren M. Vasta
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Ashley Flynn
- Hematology/Oncology, Children’s Mercy Kansas City, Kansas City, MO
| | - Sarah G. Mitchell
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University, Atlanta, GA
| | | | - Jeremy Rosenblum
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Westchester Medical Center, New York Medical College, Valhalla, New York, NY
| | - Samara L. Potter
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children’s Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Junne Kamihara
- Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center and Harvard Medical School, Department of Pediatric Oncology, Boston, MA
| | - Carlos Rodriguez-Galindo
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Douglas S. Hawkins
- Division of Hematology-Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Theodore W. Laetsch
- Division of Oncology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Zhang D, Muensterer O, Neumann J, Dorman K, Rassner M, Schmid I, Heinemann V. A rare case of locally advanced DNA mismatch-repair-deficient adenocarcinoma of the colon in a 16-year-old male treated with neoadjuvant immunotherapy and single-incision laparoscopic resection. Pediatr Blood Cancer 2023; 70:e30653. [PMID: 37669240 DOI: 10.1002/pbc.30653] [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] [Received: 07/28/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Danmei Zhang
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Jens Neumann
- Faculty of Medicine, Institute of Pathology, LMU, Munich, Germany
| | - Klara Dorman
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mark Rassner
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Irene Schmid
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Harshini C, Harsha TS, Rajkumar B, Shaikh H, Habib N, Anand A. Emergency management of colon adenocarcinoma in an adolescent female: A rare case report. Clin Case Rep 2023; 11:e7930. [PMID: 37731969 PMCID: PMC10507279 DOI: 10.1002/ccr3.7930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
Key Clinical Message Colorectal carcinoma (CRC) should be suspected in pediatric patients with a bowel obstruction in an emergency setting. Evidence-based surgical management with chemotherapy is crucial to prevent adverse outcomes. Abstract CRC should be suspected in pediatric patients presenting to the emergency with unspecified abdominal pain. An erect X-ray abdomen and a colonoscopy should be initial diagnostic tests. If colonoscopy raises suspicion of CRC, a biopsy during colonoscopy is indicated. A computed tomography scan of the chest, abdomen, and pelvis will also aid in diagnosis, staging, and planning intervention. In advanced cases, the intervention includes proximal diversion, bypass, and bowel resection with anastomosis. Sometimes postoperative chemotherapy may be required.
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Affiliation(s)
| | - T. Sri Harsha
- Department of SurgerySVS Medical CollegeYenugondaIndia
| | | | - Humaira Shaikh
- Shadan Hospital and Institute of Medical SciencesHyderabadIndia
| | - Nooreen Habib
- Shadan Hospital and Institute of Medical SciencesHyderabadIndia
| | - Ayush Anand
- B. P. Koirala Institute of Health SciencesDharanNepal
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Schultz KAP, Chintagumpala M, Piao J, Chen KS, Gartrell R, Christison-Lagay E, Berry JL, Shah R, Laetsch TW. Children's Oncology Group's 2023 blueprint for research: Rare tumors. Pediatr Blood Cancer 2023; 70 Suppl 6:e30574. [PMID: 37458616 PMCID: PMC10529839 DOI: 10.1002/pbc.30574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
The Children's Oncology Group (COG) Rare Tumor Committee includes the Infrequent Tumor and Retinoblastoma subcommittees, encompassing a wide range of extracranial solid tumors that do not fall within another COG disease committee. Current therapeutic trial development focuses on nasopharyngeal carcinoma, adrenocortical carcinoma, pleuropulmonary blastoma, colorectal carcinoma, melanoma, and thyroid carcinoma. Given the rarity of these tumors, novel strategies and international collaborative efforts are necessary to advance research and improve outcomes.
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Affiliation(s)
| | - Murali Chintagumpala
- Division of Hematology-Oncology, Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Jin Piao
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Kenneth S. Chen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Robyn Gartrell
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Emily Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale New-Haven Children’s Hospital, New Haven, CT
| | - Jesse L. Berry
- The Vision Center, Children's Hospital Los Angeles, The Saban Research Institute, Children's Hospital Los Angeles, USC Roski Eye Institute, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rachana Shah
- Division of Hematology-Oncology, Department of Pediatrics, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Theodore W. Laetsch
- Division of Oncology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Bergamaschi L, Chiaravalli S, Signoroni S, Di Bartolomeo M, Ferrari A. Management and pharmacotherapy of pediatric colorectal carcinoma: a review. Expert Opin Pharmacother 2023; 24:1527-1535. [PMID: 37358925 DOI: 10.1080/14656566.2023.2230123] [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] [Received: 04/05/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Colorectal carcinoma (CRC) is one of the most common tumors in adult, but is extremely rare in children. In childhood, CRC often presents unfavorable aggressive histotypes, advanced clinical stage at onset and a worse prognosis. Pediatric CRC series are limited and include few patients, therefore information about treatment strategy and pharmacotherapy is scarce. For this reason, management of these patients represents a real challenge for pediatric oncologists. AREAS COVERED The authors provide an overview of the general features and management strategies of pediatric CRC with specific attention to systemic treatment. Literature data regarding pharmacotherapy in published pediatric series are summarized and analyzed in detail, according to adult treatment standards. EXPERT OPINION In the absence of specific recommendations for pediatric CRC, the general therapeutic strategy should follow the same principles as for adults and should be the result of a multidisciplinary discussion. Patient access to optimal treatment is difficult due to the lack of new drugs approved for the pediatric age group and non-availability of clinical trials. Collaboration between pediatric and adult oncologists is considered crucial in order to overcome these issues and find solutions to increase knowledge and improve the outcome of such a rare disease in children.
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Affiliation(s)
- Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maria Di Bartolomeo
- Gastrointestinal Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Fukui S, Umeda K, Kubota H, Iwai A, Akazawa R, Isobe K, Tanaka K, Kouzuki K, Kawabata N, Saida S, Kato I, Hiramatsu H, Itatani Y, Funakoshi T, Adachi S, Takita J. Use of Cabozantinib to Treat MET -amplified Pediatric Colorectal Cancer. J Pediatr Hematol Oncol 2023; 45:e423-e426. [PMID: 35536994 DOI: 10.1097/mph.0000000000002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Pediatric colorectal cancer (CRC) is extremely rare, with little information about genetic profiles compared with adult CRC. Here, a 13-year-old male with advanced CRC underwent cancer gene panel testing, which detected 4 genetic abnormalities ( MET amplification in addition to TP53 , SMAD4 , and CTNNA1 mutations) that might be associated with a poor prognosis. Based on high-level MET amplification, he received a multikinase inhibitor, cabozantinib, after failure of first-line and second-line chemotherapy, resulting in transient disease stabilization. Tailored targeted therapy based on molecular profiling can be an effective treatment strategy for rare cancers such as pediatric CRC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Souichi Adachi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Cao X, Luo J, Zhao B, Fu H, Kang W. Pathological complete response after neoadjuvant immunotherapy combined with chemotherapy in pediatric rectal carcinoma: A case report. Front Immunol 2022; 13:1036181. [PMID: 36544760 PMCID: PMC9760745 DOI: 10.3389/fimmu.2022.1036181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Background Pediatric colorectal carcinoma (PCRC) is a rare non-embryonal tumor with an incidence of 0.1% to 1% of adults. Immune checkpoint inhibitors (ICIs) targeting programmed death-1 (PD-1) have shown significant efficacy in defective mismatch repair/Microsatellite instability-high (dMMR/MSI-H) metastatic CRC (mCRC). Although several studies have reported neoadjuvant immunotherapy (NIT) in MSI-H/dMMR non-mCRC patients, not all patients achieved pathological complete remission (pCR). There are differences between PCRC and adult colorectal carcinoma (CRC), and the role of NIT in PCRC remains to be further defined. Case presentation We report the case of a 12-year-old child who was admitted to the hospital with abdominal pain and vomiting for more than 3 months. The child's diagnosis was difficult and complex. He was initially diagnosed with intestinal obstruction, eventually diagnosed with a rare PCRC and identified as locally advanced colorectal cancer (LACRC) with genetic sequencing results showing MSI-H. After a thorough evaluation by clinicians, he received 4 cycles of Camrelizumab (anti-PD-1 antibody) + CapeOx (capecitabine and oxaliplatin) NIT combination chemotherapy. Repeat imaging and all tumor markers were unremarkable, and R0 resection was achieved. Postoperative pathology showed a tumor regression grade (TRG) of 0 grade determined as pCR. Postoperative review has not shown any recurrence or metastasis to date and the prognosis is good. Conclusion PCRC should improve the diagnostic efficiency to prevent misdiagnosis and miss the best time for treatment. NIT and or chemotherapy can be a reasonable and effective treatment option for dMMR/MSI-H locally advanced PCRC. Our report provides some support and evidence for neoadjuvant immunotherapy for locally advanced PCRC, while highlighting the importance of preoperative detection of microsatellite status for locally advanced PCRC.
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Affiliation(s)
- Xiaomeng Cao
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China,Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, Gansu, China
| | - Jianwei Luo
- Department of Radiology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Baoyin Zhao
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, Gansu, China,Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, Gansu, China
| | - Hongjiang Fu
- Hulunbuir Clinical Medical College, Inner Mongolia University for Nationalities, Hulunbuir, Inner Mongolia Autonomous Region, China
| | - Wendi Kang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Wendi Kang,
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Levy L, Smiley A, Latifi R. Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159203. [PMID: 35954556 PMCID: PMC9368534 DOI: 10.3390/ijerph19159203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
Background: Colorectal cancer, among which are malignant neoplasms of the rectum and rectosigmoid junction, is the fourth most common cancer cause of death globally. The goal of this study was to evaluate independent predictors of in-hospital mortality in adult and elderly patients undergoing emergency admission for malignant neoplasm of the rectum and rectosigmoid junction. Methods: Demographic and clinical data were obtained from the National Inpatient Sample (NIS), 2005−2014, to evaluate adult (age 18−64 years) and elderly (65+ years) patients with malignant neoplasm of the rectum and rectosigmoid junction who underwent emergency surgery. A multivariable logistic regression model with backward elimination process was used to identify the association of predictors and in-hospital mortality. Results: A total of 10,918 non-elderly adult and 12,696 elderly patients were included in this study. Their mean (standard deviation (SD)) age was 53 (8.5) and 77.5 (8) years, respectively. The odds ratios (95% confidence interval, P-value) of some of the pertinent risk factors for mortality for operated adults were 1.04 for time to operation (95%CI: 1.02−1.07, p < 0.001), 2.83 for respiratory diseases (95%CI: 2.02−3.98), and 1.93 for cardiac disease (95%CI: 1.39−2.70), among others. Hospital length of stay was a significant risk factor as well for elderly patients—OR: 1.02 (95%CI: 1.01−1.03, p = 0.002). Conclusions: In adult patients who underwent an operation, time to operation, respiratory diseases, and cardiac disease were some of the main risk factors of mortality. In patients who did not undergo a surgical procedure, malignant neoplasm of the rectosigmoid junction, respiratory disease, and fluid and electrolyte disorders were risk factors of mortality. In this patient group, hospital length of stay was only significant for elderly patients.
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Affiliation(s)
- Lior Levy
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA;
| | - Abbas Smiley
- Westchester Medical Center, New York Medical College, Valhalla, NY 10595, USA;
| | - Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, AZ 85721, USA
- Correspondence:
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Graziano F, Busè M, Di Pisa M, Citrano M. A rare case of sporadic colorectal adenocarcinoma in a child. Dig Liver Dis 2022; 54:986-987. [PMID: 33893041 DOI: 10.1016/j.dld.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Graziano
- Pediatric Unit, Villa Sofia - Cervello Hospital, Via Trabucco, 180, Palermo 90146, Italy.
| | - Martina Busè
- UOSD Medical Genetics, Villa Sofia - Cervello Hospital, Palermo, Italy
| | - Marta Di Pisa
- Gastroenterology Unit, Villa Sofia - Cervello Hospital, Palermo, Italy
| | - Michele Citrano
- Pediatric Unit, Villa Sofia - Cervello Hospital, Via Trabucco, 180, Palermo 90146, Italy
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Maity P, Halder A, Ghosh R, Chatterjee U, Barman S, Sarkar R. Immunohistochemistry as a Surrogate Marker of Underlying Molecular Derangements in Sporadic Colorectal Carcinoma in Children - A Series of Three Cases. Fetal Pediatr Pathol 2022; 41:98-106. [PMID: 32441577 DOI: 10.1080/15513815.2020.1765918] [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] [Indexed: 10/24/2022]
Abstract
Background: Colorectal carcinomas (CRCs) are uncommon tumors in children. Here, we elucidate three cases of childhood CRCs with their underlying molecular derangements using immunohistochemistry (IHC) with emphasis on BRAF mutation. Case summary: All three CRCs were sporadic tumors involving the left colon with two of them having a mucinous phenotype. We performed IHC for BRAF, p53 and β-catenin along with markers of microsatellite instability (MSI) in all three tumors. All the tumors had diffuse strong cytoplasmic BRAF positivity, with focal p53 positivity in two cases and cytoplasmic β-catenin staining in one case. One case showed CpG island hypermethylation with isolated loss of PMS2 staining. None of the cases had any family history of CRC. Conclusions: IHC can be used as a surrogate marker for determining the underlying molecular derangements in CRC. Sporadic CRCs in children are a cumulative effect of multiple mutations, of which BRAF mutation is significant and critical for planning targeted therapy.
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Affiliation(s)
- Priyanka Maity
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Aniket Halder
- Department of GI Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Ranajoy Ghosh
- Department of GI Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Uttara Chatterjee
- Department of Pathology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Shibsankar Barman
- Department of Pediatric Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Ruchirendra Sarkar
- Department of Pediatric Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, India
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14
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van der Heide DM, Turaga KK, Chan CHF, Sherman SK. Mismatch Repair Status Correlates with Survival in Young Adults with Metastatic Colorectal Cancer. J Surg Res 2021; 266:104-112. [PMID: 33989889 DOI: 10.1016/j.jss.2021.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Young adults with metastatic colorectal cancer (mCRC) may have higher rates of deficient mismatch repair (dMMR) than older patients. This study sought to assess patterns of MMR-testing and survival among young adult mCRC patients in the National Cancer Database (NCDB), hypothesizing that dMMR correlates with worse survival than in MMR-proficient (pMMR) patients. METHODS Stage-IV colorectal cancers were identified in NCDB (2010-2016). Demographic and clinical features were compared between younger (age ≤ 30) and older mCRC patients and tested for association with overall survival. Stage-IV disease without other recorded metastatic sites defined peritoneal metastasis (PM). Fisher-exact tests compared proportions and Cox models tested association with overall survival. RESULTS Of 124,587 stage-IV colorectal cancers, 1,123 (0.9%) were in young patients. Young patients were more likely to have mucinous histology, high-grade, rectal primaries, and isolated peritoneal metastases (P < 0.001). Younger patients more often had MMR-testing (29.1 versus 16.6%), with dMMR found at similar rates in young and older patients (21.7 versus 17.1% of those tested, P= 0.4). Despite higher rates of adverse prognostic features, younger patients had better survival (median 20.7 versus 14.8 months, P < 0.001). In MMR-tested patients, dMMR correlated with higher mortality risk compared to pMMR (median 16.6 months versus 25.5 months, P = 0.01). On multivariable analysis, grade and MMR-status remained independently associated with survival. CONCLUSIONS Median survival was worse with dMMR by 8.9 months compared to pMMR in young adults with mCRC. Despite higher rates of familial syndromes in young patients and recommendations for universal MMR-testing, over 70% of young mCRC patients had no MMR-status recorded.
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Affiliation(s)
- Dana M van der Heide
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, 5841 S Maryland Ave, Chicago, Illinois
| | - Carlos H F Chan
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Scott K Sherman
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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15
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Tan SS, Wang K, Pang W, Wu D, Peng C, Wang Z, Zhang D, Chen Y. Etiology and surgical management of pediatric acute colon perforation beyond the neonatal stage. BMC Surg 2021; 21:212. [PMID: 33902548 PMCID: PMC8077714 DOI: 10.1186/s12893-021-01213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Acute colon perforation is a pediatric surgical emergency. We aimed to analyze the different etiologies and clinical characteristics of acute non-traumatic colon perforation beyond the neonatal period and to identify surgical management and outcomes. METHODS This retrospective study included 18 patients admitted with acute colon perforation and who received surgical treatment. RESULTS Age of patients ranged between 1 month and 15 years. Five patients swallowed foreign objects (two swallowed magnets), two had colon perforation secondary to a malignant tumor (both colorectal adenocarcinoma) and two were iatrogenic (one prior colonoscopy, one air enema for intussusception). There was one perforation due to chemotherapy and Amyand's hernia respectively. The remaining seven patients had unknown etiologies; five of them were diagnosed with colitis. Fifteen (83.3 %) patients underwent open laparotomy, among which four attempted laparoscopy first. Three (16.7 %) patients underwent laparoscopic surgery. Fourteen (77.8 %) patients received simple suture repairs and four (22.2 %) received colonic resections and anastomosis. Four (22.2 %) patients received a protective diverting colostomy and three (16.7 %) received an ileostomy. CONCLUSIONS There is a wide range of etiology besides necrotizing enterocolitis and trauma, but a significant portion of children present with unknown etiology. Type of surgery elected should be dependent on the patient's etiology, disease severity and experience of surgeons.
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Affiliation(s)
- Sarah Siyin Tan
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Kai Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, 100045, Beijing, China.
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16
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Akinkuotu AC, Maduekwe UN, Hayes-Jordan A. Surgical outcomes and survival rates of colon cancer in children and young adults. Am J Surg 2021; 221:718-724. [PMID: 33678398 DOI: 10.1016/j.amjsurg.2021.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Colon cancer in children and young adults is rare. We sought to compare outcomes and survival between patients ≤and>25 years of age with colon cancer. METHODS Using the National Cancer Database, patients with colon cancer between 2004 and 2016 were identified. We included patients with histological codes consistent with invasive colon adenocarcinoma and excluded those missing data about treatment. Post-surgical outcomes and survival were compared. RESULTS Of 531,462 patients meeting criteria, 947 were ≤25 years. Patients ≤25 had more advanced disease (stage III:44.4%vs33.4%, stage IV:27.5%vs.15.3%) and higher rates of total colectomy (8.9%vs.2.7%) and proctocolectomy (5.0%vs.0.0%) than those >25 years. Stage for stage, 5-year survival was higher in patients ≤25 than those >25years. On multivariate regression, age was not associated with increased risk of mortality while male sex and uninsured status were. CONCLUSIONS Despite presenting with more advanced disease, patients ≤25 years with colon cancer had better survival than those >25 years.
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Affiliation(s)
- Adesola C Akinkuotu
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | - Ugwuji N Maduekwe
- Division of Surgical Oncology & Endocrine Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hayes-Jordan
- Division of Pediatric Surgery, Department of Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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17
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Polat E, Bayrak NA, Tutar E, Celikel C, Tokuc G, Ertem D. Colorectal Carcinoma in Childhood. JPGN REPORTS 2021; 2:e039. [PMID: 37206941 PMCID: PMC10191540 DOI: 10.1097/pg9.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/20/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Esra Polat
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition
| | | | - Engin Tutar
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition
| | | | - Gulnur Tokuc
- Department of Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deniz Ertem
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition
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18
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Tian X, Wang Q, Cai W. <p>A Novel Mutation in <em>MYH</em> Gene Associated with Aggressive Colorectal Cancer in a Child: A Case Report and Review of Literature</p>. Onco Targets Ther 2020; 13:8557-8565. [PMID: 32904697 PMCID: PMC7457591 DOI: 10.2147/ott.s259587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/03/2020] [Indexed: 12/05/2022] Open
Abstract
Colorectal cancer is a rare pediatric tumor. Pediatric patients with colorectal cancer present with more aggressive tumor biology and at later stages of the disease, higher proportions of signet ring and mucinous histology, and less differentiation. The effective treatment is same as that received by adults. The overall prognosis of pediatric colorectal cancer is generally poor. Genetic mutations have been identified as the cause of inherited cancer risk in some colorectal cancers. Here, we presented a case of a pediatric patient carrying a maternally derived, heterozygous MYH germline mutation (c.934–2A>G,intron), the mutation was not reported in pediatric patients before. Also, the patient carried somatic mutations of proto-oncogene SMAD4 (R361C) and TP53 (Y234H). The patient underwent surgical resection, chemotherapy and targeted therapy, but the prognosis was not good. We also review the literature to summarize clinical features, gene mutations, management, and outcomes of pediatric colorectal cancer patient. Our results suggest that the genetic mutation of MYH together with somatic mutations of proto-oncogene SMAD4 and TP53 may lead to the early onset colorectal cancer of the patient. Although the overall prognosis of pediatric colorectal cancer is generally poor, the pathogenesis may be related to hereditary genetic mutations as was found with the MYH gene mutation in our case. Genetic screening can provide early diagnosis and improve prognosis.
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Affiliation(s)
- Xin Tian
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
| | - Qian Wang
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
| | - Weisong Cai
- Department of Clinical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning110022, People’s Republic of China
- Correspondence: Weisong CaiDepartment of Clinical Oncology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Shenyang110022, People’s Republic of China Email
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Colon Cancer in Patients Under 25 Years Old: A Different Disease? J Am Coll Surg 2020; 230:648-656. [PMID: 32092356 DOI: 10.1016/j.jamcollsurg.2019.12.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to compare the stage-for-stage overall (OS) and recurrence-free (RFS) survival between adult and pediatric/adolescent colon cancer patients. STUDY DESIGN A retrospective review of pediatric/adolescent patients less than 25 years old, treated between 1991 and 2017 at University of Texas MD Anderson Cancer Center, was compared with a prospectively maintained database of adult patients. Outcomes variables were compared, and OS and RFS were estimated using the Kaplan-Meier method and compared between groups using the log rank test and multivariable Cox models. RESULTS The cohort contained 94 pediatric patients and 765 adult patients. Overall, the 3-year OS rates for adult and pediatric patients, respectively, were 90% and 41.92% (95% CI 87% to 92%) (p < 0.0001), and the 3-year RFS rates were 78% and 32% (p < 0.0001). The stage-for-stage 5-year OS rates for adult vs pediatric patients were: Stage 1: 96% vs 100% (p = 0.793); stage 2: 90% vs 64% (p < 0.0001); stage 3: 85% vs 58% (p < 0.0001); stage 4; 55% vs 16% (p < 0.0001). The stage-for-stage 5-year RFS rates for adults vs children were: stage 1: 95% vs 100%; stage 2: 85% vs 55% (p = 0.0002); stage 3: 73% vs 31% (p < 0.0001); stage 4: 27% vs 5% (p < 0.0001). Pediatric/adolescent patients had a higher risk of recurrence or death than adult patients on multivariate analysis (hazard ratio [HR] 2.312, 95% CI: 1.615 to 3.313 (p < 0.0001). Peritoneal metastasis was significantly higher in pediatric patients. (p = 0.00001) CONCLUSIONS: Stage-for-stage, pediatric/adolescent patients had shorter 3- and 5-year OS and RFS rates than adult patients. Peritoneal disease and carcinomatosis were significantly higher in pediatric, adolescent, and young adult patients less than 25 years old. Predisposing conditions, such as polyposis or congenital colon disease, did not contribute to this difference.
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20
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Nakamoto S, Tanaka K, Watanabe E, Takeda N, Nakamura T, Kumamoto Y. Colorectal cancer with peritoneal carcinomatosis in a teenager. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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21
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Aitchison A, Hakkaart C, Whitehead M, Khan S, Siddique S, Ahmed R, Frizelle FA, Keenan JI. CDH1 gene mutation in early-onset, colorectal signet-ring cell carcinoma. Pathol Res Pract 2020; 216:152912. [PMID: 32147272 DOI: 10.1016/j.prp.2020.152912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Abstract
AIM Colorectal signet-ring cell carcinomas (SRCC) are highly malignant tumours with poor prognosis that disproportionately affect younger patients. There is growing evidence of a unique set of molecular features that separate SRCC from conventional colorectal adenocarcinoma. Identification of these distinct features may have diagnostic and prognostic significance for patients and families. CDH1, which encodes E-cadherin, a cell adhesion protein, is commonly mutated in gastric SRCC and our study aimed to identify whether CDH1 mutation was also a common phenomenon in colorectal SRCC. METHODS DNA was extracted from formalin-fixed paraffin embedded tumour tissue, the CDH1 gene was analysed by next generation sequencing and the pathogenicity of mutations assessed in silico. Sections cut from the same blocks were immunostained to identify the presence of the E-cadherin protein. RESULTS We found 8 CDH1 mutations that meet our inclusion criteria in seven of 11 samples. Of these, five (from four patients), were likely to be germline mutations. E-cadherin staining was absent or markedly reduced in all of the seven samples with CDH1 mutation. CONCLUSION Our finding of CDH1 mutations in a proportion of signet-ring cell carcinomas and associated reduction in E-cadherin in these tumours supports previous findings of a role for mutation of this gene in the development of this disease. In addition, the finding of likely germline mutations suggests that a subset of these tumours may be familial. Loss of E-cadherin staining in the absence of CDH1 mutations however also suggests a role for environmental factors in a subset of these tumours.
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Affiliation(s)
- Alan Aitchison
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand.
| | - Christopher Hakkaart
- Department of Pathology, University of Otago Christchurch, Christchurch, New Zealand
| | - Martin Whitehead
- Anatomical Pathology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Sadaf Khan
- Aga Khan University Medical College, Karachi, Pakistan
| | | | - Rashida Ahmed
- Aga Khan University Medical College, Karachi, Pakistan
| | - Frank A Frizelle
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
| | - Jacqueline I Keenan
- Department of Surgery, University of Otago Christchurch, Christchurch, New Zealand
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22
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De Pasquale MD, Crocoli A, Caldaro T, Rinelli M, Spinelli GP, Francalanci P, Cozza R, Inserra A, Miele E. Targeting Epidermal Growth Factor Receptor (EGFR) in Pediatric Colorectal Cancer. Cancers (Basel) 2020; 12:E414. [PMID: 32053874 PMCID: PMC7072611 DOI: 10.3390/cancers12020414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Colorectal carcinoma (CRC) is very rare in the pediatric and adolescent age range and clinical management is performed according to adult protocols. We report, for the first time in the literature, a case of a child with metastatic CRC successfully treated with panitumumab associated to chemotherapy. Methods: A twelve-year-old male was diagnosed with CRC with nodal metastasis and peritoneal neoplastic effusion. After performing a genetic evaluation, in light of the absence of mutations in RAS family genes, anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody, panitumumab, was added to chemotherapy FOLFOXIRI. Results: The child successfully responded to therapy with normalization of the Carbohydrate Antigen (CA) 19.9 value after the third cycle of treatment. After the sixth cycle, he underwent surgery that consisted in sigmoid resection with complete D3 lymphadenectomy. At histological evaluation, no residual neoplastic cells were detectable in the surgical specimen. He completed 12 cycles of chemotherapy plus panitumomab and he is alive without disease 14 months from diagnosis. Conclusions: Our results suggest performing mutational screening for colorectal cancer also in the pediatric setting, in order to orient treatment that should include targeted therapies.
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Affiliation(s)
- Maria Debora De Pasquale
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (M.D.D.P.); (R.C.)
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.C.); (A.I.)
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Department of Surgery, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy;
| | - Martina Rinelli
- Department of Laboratories, Genetic Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Gian Paolo Spinelli
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Giustiniano, 04011 Aprilia, Italy;
| | - Paola Francalanci
- Department of Laboratories, Pathology Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Raffaele Cozza
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (M.D.D.P.); (R.C.)
| | - Alessandro Inserra
- Surgical Oncology Unit, Department of Surgery, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (A.C.); (A.I.)
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (M.D.D.P.); (R.C.)
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Polyp Characteristics of Nonsyndromic and Potentially Syndromic Juvenile Polyps: A Retrospective Cohort Analysis. J Pediatr Gastroenterol Nutr 2019; 69:668-672. [PMID: 31765335 PMCID: PMC6882539 DOI: 10.1097/mpg.0000000000002477] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Juvenile polyps (JPs) are the most common gastrointestinal polyps diagnosed in children. There is paucity of evidence differentiating polyp burden groups and the presence and significance of neoplastic changes. METHODS A retrospective chart review of patients, ages birth through 18 years with nonsyndromic JPs was performed from 2003 to 2017. Abstracted data included basic demographics, age, clinical presentation, colonoscopy findings, and pathology report. Slides of polyps with neoplasia were reviewed by a pathologist. RESULTS A total of 213 subjects underwent 326 procedures and 435 polypectomies. Subjects with positive family history, positive gene mutations, or numerous (>10) polyps were excluded. Groups were defined by polyp number (1, 2-4, 5-10). Polyp recurrence on repeat colonoscopy was significantly related to polyp burden (1 polyp: 1.5%/2-4 polyps 19.2%/5-10 polyps 82.6%: P < 0.001). Polyp distribution was significantly different amongst different groups with isolated polyps favoring a distal distribution. JPs harboring adenomatous foci were reported in 26 (12%) patients. JPs harboring adenomatous foci were significantly more likely to be proximally distributed but the presence of adenomatous transformation within the polyps did not correlate with polyp number or the likelihood of polyp recurrence on repeat colonoscopy. CONCLUSIONS JP recurrence is positively and significantly related to polyp burden. JP harbored adenomatous changes independent of polyp number, underscoring a possible malignant potential in JPs. In the absence of a consistent genotype or pedigree, the presence of adenomatous transformation within JPs cannot be construed as a biomarker for syndromic juvenile polyposis.
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Tessler RA, Dellinger M, Richards MK, Goldin AB, Beierle EA, Doski JJ, Goldfarb M, Langer M, Nuchtern JG, Raval MV, Vasudevan S, Gow KW. Pediatric gastric adenocarcinoma: A National Cancer Data Base review. J Pediatr Surg 2019; 54:1029-1034. [PMID: 30824240 DOI: 10.1016/j.jpedsurg.2019.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE We sought to compare the presentation, management, and outcomes in gastric adenocarcinoma cancer for pediatric and adult patients. METHODS Using the 2004 to 2014 National Cancer Database (NCDB), patients ≤21 years (pediatric) were retrospectively compared to >21 years (adult). Chi-squared tests were used to compare categorical variables, and Cox regression was used to estimate hazard ratios (HR) for survival differences. RESULTS Of the 129,024 gastric adenocarcinoma cases identified, 129 (0.10%) occurred in pediatric patients. Pediatric cases presented with more advanced disease, including poorly differentiated tumors (81% vs 65%, p = 0.006) and stage 4 disease (56% vs 41%, p = 0.002). Signet ring adenocarcinoma comprised 45% of cases in the pediatric group as compared to 20% of cases in the adults (P < 0.001). Similar proportions in both groups underwent surgery. However, near-total gastrectomy was more common in the pediatric group (16% vs 6%, p < 0.001). The proportions of patients with negative margins, nodal examination, and presence of positive nodes were similar. There was no overall survival difference between the two age groups (HR 0.92, 95% Confidence interval 0.73-1.15). CONCLUSION While gastric adenocarcinoma in pediatric patients present with a more advanced stage and poorly differentiated tumors compared to adults, survival appears to be comparable. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Robert A Tessler
- Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA; University of Washington Harborview Injury Prevention and Research Center, Seattle, WA; University of Pittsburgh, Department of Surgery, Pittsburgh, PA
| | - Matthew Dellinger
- Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA
| | - Morgan K Richards
- Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA
| | - Adam B Goldin
- Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA
| | | | - John J Doski
- UT Health Science Center San Antonio, San Antonio, TX
| | | | - Monica Langer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatric Surgery, Chicago, IL
| | - Jed G Nuchtern
- Texas Children's Hospital, Pediatric Surgery, Houston, TX
| | | | | | - Kenneth W Gow
- Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA.
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25
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Shi T, Huang M, Han D, Tang X, Chen Y, Li Z, Liu C, Xiang D, Wang T, Chen Y, Wang R, Lei Z, Chu X. Chemotherapy is associated with increased survival from colorectal signet ring cell carcinoma with distant metastasis: A Surveillance, Epidemiology, and End Results database analysis. Cancer Med 2019; 8:1930-1940. [PMID: 30864303 PMCID: PMC6488115 DOI: 10.1002/cam4.2054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Colorectal signet ring cell carcinoma (SRCC) is a rare histological subtype of colorectal adenocarcinoma with high metastatic frequency compared to non‐SRCC colorectal cancer (NOS). The aim of this study was to analyze prognostic factors of colorectal SRCC with different metastatic sites and evaluate impacts of various therapies for metastatic colorectal SRCC. Methods Patients with NOS and SRCC were from the Surveillance, Epidemiology, and End Results (SEER) database during 2010‐2014. χ2 tests were used to compare data significance. Kaplan‐Meier and COX models were used to analyze the differences in the survival. Propensity‐matched analyses were used to adjust numerical differences. Results Among the 173 460 patients, 1932 (1.11%) patients had colorectal SRCC. In univariate analysis, older age, male sex, and peritoneum metastasis were associated with higher mortality risk. The peritoneum was both the site with the highest metastatic frequency and the site with the worst prognosis in SRCC. In the COX regression model, peritoneum‐metastatic SRCC patients receiving chemotherapy had better survival than patients treated with surgery. Conclusions Our study analyzed the unique metastatic pattern of colorectal SRCC toward different sites and found that compared to surgery, chemotherapy was associated with better survival for colorectal SRCC patients with distant metastasis, which provided insights for future SRCC patient treatment.
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Affiliation(s)
- Tao Shi
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Mengxi Huang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Dong Han
- Department of Medical Oncology, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xinyi Tang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yanyan Chen
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Zhiping Li
- Department of Medical Oncology, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Chao Liu
- Department of Medical Oncology, Jinling Hospital, Nanjing Clinical School of Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Dan Xiang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Ting Wang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yitian Chen
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Rui Wang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Zengjie Lei
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China.,Department of Medical Oncology, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiaoyuan Chu
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China.,Department of Medical Oncology, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing, Jiangsu Province, People's Republic of China
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26
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Zhang T, Zhang H, Fang T, Xu A, Chen MW. [Intermittent abdominal pain and abdominal distension with fatigue and massive ascites in a 13-year-old boy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:277-281. [PMID: 30907354 PMCID: PMC7389353 DOI: 10.7499/j.issn.1008-8830.2019.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
A 13-year-old boy was admitted due to intermittent abdominal pain for one year with massive ascites. The purified protein derivative (PPD) test after admission yielded positive results (3+), and ascites examination revealed a yellow color. There were 634×109 nucleated cells/L in the ascites, among which 82.2% were mononuclear cells and 17.8% were multinuclear cells. The Rivalta test yielded a positive result and revealed that the ascites was exudate, suggesting the possibility of tuberculosis infection. The symptoms were not relieved after isoniazid-rifampicin anti-tuberculosis therapy and symptomatic/supportive treatment. Plain CT scan of the abdomen and contrast-enhanced CT showed that the lesion was located at the left wall of the transverse colon, with uneven thickening of the peritoneum and heterogeneous enhancement. Colonoscopic biopsy found signet ring cells in the mucosa and immunohistochemical examination revealed Syn (-), CgA (-), CD56 (-), CK(pan) (+), CDX-2 (+), CK20 (+), Muc-1 (+) and Ki-67 (+, about 80%). PET-CT scan showed an abnormal increase in fluorodeoxyglucose metabolism, which was shown as a mass near the splenic flexure of the transverse colon, with a maximum standard uptake value of 9.9, indicating a highly active lesion; this was consistent with the metabolic changes of malignant tumors. Surgical operation was performed and intraoperative exploration revealed massive ascites, a hard mass located at the hepatic flexure of the colon, involvement of the serous coat and surrounding tissues, stenosis of the bowel, lymph node enlargement around the superior mesenteric vessels and the gastrocolic ligament, and multiple metastatic nodules in the greater omentum, the abdominal wall and the pelvic cavity. The results of postoperative pathology were consistent with those of colonoscopic biopsy, i.e., poorly differentiated mucinous adenocarcinoma of the transverse colon and partly signet-ring cell carcinoma. Therefore, the boy was diagnosed with colon signet-ring cell carcinoma with peritoneal metastasis and tuberculosis infection. When a child is suffering from intractable abdominal pain, unexplained intestinal obstruction and massive intractable ascites, the possibility of malignancy should be considered. Abdominal plain CT scan as well as contrast-enhanced CT scan should be performed as early as possible, and enteroscopy should be performed when necessary.
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Affiliation(s)
- Tian Zhang
- Department of Pediatrics, First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China.
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27
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Attard TM, Lawson CE. Comparison of the demographic characteristics of pediatric and adult colorectal cancer patients: a national inpatient sample based analysis. World J Pediatr 2019; 15:37-41. [PMID: 30259389 DOI: 10.1007/s12519-018-0187-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Colorectal cancer in children is rare, but characterized by late presentation, unfavorable histology and poor prognosis. Risk factors for colorectal cancer in children overlap with those for adults with greater influence of hereditary syndromes. The epidemiology of colon cancer in children is poorly understood; the aim of this study was to characterize and compare the demographics and relevant clinical characteristics of pediatric and adult colon cancer, using a national inpatient sample. METHODS The AHRQ online resource HCUPnet/KID database was queried for children, under the age of 18 admitted with ICD 9 CM diagnoses relating to colorectal cancer, at the time of discharge. For comparison, the corresponding diagnoses in adult patients were queried for each successive year. Patient demographics including residential type and median income by zip-code, tumor localization; if recorded, and mean hospital charges were all accrued and analyzed. RESULTS Inpatient admissions for pediatric colorectal cancer were more likely male (54%), in the 15-17 years age bracket (57%). They were significantly more likely from Southwestern regions of the Unites States, and were significantly more likely from residential zip-codes identified as at or below the lowest income quartile than adult CRC patients or pediatric patients as a whole. Hospital charges have more than quadrupled over the time period studied (1997-2012). CONCLUSIONS Pediatric colorectal cancer is the most common primary gastrointestinal malignancy in children. Better understanding associated risk factors including those associated with gender, geographic region and social economic status may contribute to future prevention or early detection strategies.
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Affiliation(s)
- Thomas M Attard
- University of Missouri Kansas City, Kansas City, MO, USA. .,Pediatric Gastroenterology, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
| | - Caitlin E Lawson
- Division of Genetics, Children's Mercy Hospital, Kansas City, MO, USA
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28
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Kelley KA, Tsikitis VL. Review of Colorectal Studies Using the National Cancer Database. Clin Colon Rectal Surg 2019; 32:69-74. [PMID: 30647548 DOI: 10.1055/s-0038-1673356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The National Cancer Database (NCDB) is a large clinical oncology database developed with data collected from Commission on Cancer (CoC)-accredited facilities. The CoC is managed under the American College of Surgeons, and is a multidisciplinary team that maintains standards in cancer care delivery in health care settings. This database has been used in multiple cancer-focused studies and reports on cancer diagnosis, hospital-level, and patient-related demographics. The focus of this review is to explore and discuss the use of NCDB in colorectal surgery research. Furthermore, our aim for this review is to formulate a guide for researchers who are interested in using the NCDB to complete colorectal research.
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Affiliation(s)
- Katherine A Kelley
- Division of Gastrointestinal and General Surgery, Department of General Surgery, Oregon Health and Science University Portland, Portland, OR
| | - V Liana Tsikitis
- Division of Gastrointestinal and General Surgery, Department of General Surgery, Oregon Health and Science University Portland, Portland, OR
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29
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Jacobs D, Zhu R, Luo J, Grisotti G, Heller DR, Kurbatov V, Johnson CH, Zhang Y, Khan SA. Defining Early-Onset Colon and Rectal Cancers. Front Oncol 2018; 8:504. [PMID: 30460196 PMCID: PMC6232522 DOI: 10.3389/fonc.2018.00504] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Colorectal cancer (CRC) incidence is rising in the young, yet the age of those affected is not clearly defined. In this study, we identify such cohorts and define clinicopathological features of early-onset colon and rectal cancers. Methods: The Surveillance, Epidemiology and End Results Program (SEER) database was queried to compare clinicopathological characteristics of colon and rectal cancers diagnosed during 1973–1995 with those diagnosed during 1995–2014. Results: We identified 430,886 patients with colon and rectal cancers. From 1973–1995 to 1995–2014, colon cancer incidence increased in patients aged 20–44 years, while rectal cancer incidence increased in patients aged ≤54 years. The percent change of cancer incidence was greatest for rectal cancer with a 41.5% (95% confidence interval (CI): 37.4–45.8%) increase compared to a 9.8% (CI: 6.2–13.6%) increase in colon cancer. Colon cancer has increased in tumors located in ascending, sigmoid, and rectosigmoid locations. Adenocarcinoma histology has increased in both colon and rectal cancers (P < 0.01), but mucinous and signet ring cell subtypes have not increased (P = 0.13 and 0.08, respectively). Incidence increases were race-specific, with rectal cancer seeing similar rises in white (38.4%, CI: 33.8–43.1%) and black populations (38.0%, CI: 26.2–51.2%), while colon cancer as a whole saw a rise in white (11.5%, CI: 7.2–15.9%) but not black populations (−6.8%, CI: −14.6–1.9%). Conclusions: Our study underscores the existence of key differences between early-onset colon (20–44 years) and rectal cancers (≤54 years) and provides evidence-based inclusion criteria for future investigations. We recommend that future research of CRC in the young should avoid investigating these cases as a single entity.
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Affiliation(s)
- Daniel Jacobs
- Yale University School of Medicine, New Haven, CT, United States
| | - Rebecca Zhu
- Yale University School of Medicine, New Haven, CT, United States
| | - Jiajun Luo
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Gabriella Grisotti
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Danielle R Heller
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Vadim Kurbatov
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Caroline H Johnson
- Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT, United States.,Yale Cancer Center New Haven, CT, United States
| | - Yawei Zhang
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States.,Department of Environmental Health Sciences, Yale University School of Public Health, New Haven, CT, United States
| | - Sajid A Khan
- Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
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30
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Early onset colon cancer affected by Lynch syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Sabree S, Berg D, Sato M. Treatment of a pediatric patient with MET-amplified signet ring cell adenocarcinoma of the stomach with crizotinib. Pediatr Blood Cancer 2018; 65:e26984. [PMID: 29380521 DOI: 10.1002/pbc.26984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/25/2017] [Accepted: 12/27/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Shakoora Sabree
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Daniel Berg
- Department of Internal Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Mariko Sato
- Department of Pediatric Hematology Oncology, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa
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Indini A, Bisogno G, Cecchetto G, Vitellaro M, Signoroni S, Massimino M, Riccipetitoni G, Zecca M, Dall'Igna P, De Pasquale MD, Inserra A, Chiaravalli S, Basso E, Virgone C, Sorbara S, Di Bartolomeo M, D'Angelo P, Ferrari A. Gastrointestinal tract carcinoma in pediatric and adolescent age: The Italian TREP project experience. Pediatr Blood Cancer 2017; 64. [PMID: 28561949 DOI: 10.1002/pbc.26658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 05/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gastrointestinal (GI) carcinomas are very rare in the pediatric and adolescent age range. We report the clinical features, treatment, and outcome of a series of children and adolescents with GI carcinoma prospectively registered in the Italian Tumori Rari in Età Pediatrica (TREP) project. METHODS The TREP project developed diagnostic and therapeutic guidelines based on recommendations currently in use for adults. Clinical data were centrally registered and reviewed. RESULTS Fifteen patients were registered over the years 2000-2016. Most of the tumors were colorectal carcinomas (12 cases). All but one patient had advanced-stage disease (American Joint Committee on Cancer stages III-IV), and the majority of patients had aggressive histological subtypes, i.e. poorly differentiated (G3) (five patients), mucinous (four patients), and signet ring (two patients) adenocarcinomas. Surgery was performed in 13 of 15 patients, and was radical in nine of 13 patients. Only one patient received postoperative radiotherapy. All patients received chemotherapy, with the addition of bevacizumab in two cases. Nine patients were still alive at the time of the present report, but two of them had only just completed their treatment program and one patient is still on treatment. Six patients died due to disease progression. CONCLUSIONS This prospective report on pediatric GI tract carcinomas confirms the rarity and biological aggressiveness of these diseases in pediatric and adolescent age. Further prospective studies are needed to explore the distinct biology of tumor in this age group in order to find new therapeutic targeted agents.
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Affiliation(s)
- Alice Indini
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Giovanni Cecchetto
- Division of Pediatric Surgery, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumours, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Colorectal Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Signoroni
- Unit of Hereditary Digestive Tract Tumours, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Dall'Igna
- Department of Women's and Children's Health, Pediatric Surgery Unit, Padova University Hospital, Padova, Italy
| | | | - Alessandro Inserra
- Department of Pediatric Surgery, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stefano Chiaravalli
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Basso
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Calogero Virgone
- Division of Pediatric Surgery, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Silvia Sorbara
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padova, Italy
| | - Maria Di Bartolomeo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo D'Angelo
- Pediatric Oncology Unit, G. Di Cristina Children's Hospital, Palermo, Italy
| | - Andrea Ferrari
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Fresneau B, Dourthe ME, Jouin A, Laurence V, de Lambert G, Colas C, Coret M, Laprie A, Rebours C, Orbach D, Demoor-Goldschmidt C. Carcinomes des adolescents et jeunes adultes : quelles spécificités ? Bull Cancer 2017; 104:267-280. [DOI: 10.1016/j.bulcan.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/23/2023]
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Early-Onset Signet-Ring Cell Adenocarcinoma of the Colon: A Case Report and Review of the Literature. Case Rep Oncol Med 2017; 2017:2832180. [PMID: 28326211 PMCID: PMC5343248 DOI: 10.1155/2017/2832180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/22/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States. While a decline has been observed in the older population, the occurrence of CRC in the adolescent and young adult (AYA) population has increased over the past two decades. The histopathologic characteristics and clinical behavior of CRC in AYA patients have been shown to be distinct from those of CRC in older adults. The rarer subtypes of CRC such as mucinous adenocarcinoma and signet-ring cell carcinoma are associated with a poorer prognosis compared to the more common subtypes. Here we report a case of a 20-year-old man who was diagnosed with stage IVB (T4 N2 M1, with peritoneal carcinomatosis) signet-ring cell adenocarcinoma of the colon. The scarcity of information on these rarer subtypes merits further study and investigation.
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35
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Richards MK, Goldin AB, Beierle EA, Doski JJ, Goldfarb M, Langer M, Nuchtern JG, Vasudevan S, Gow KW, Javid SH. Breast Malignancies in Children: Presentation, Management, and Survival. Ann Surg Oncol 2017; 24:1482-1491. [DOI: 10.1245/s10434-016-5747-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 11/18/2022]
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