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Mediu N, Mediu R, Alimehmeti R. Risk Factors of Colorectal Cancer in Hospitalized Patients in Regional Hospital Durrës. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction
Colorectal cancer (CRC) is the most common gastrointestinal cancer with an important global health problem. The study aims were to evaluate the risk factors of colorectal cancer in chirurgical ward in Regional Durres Hospital in Albania during two years.
Methods
We conducted a retrospective cohort study to explore risk factors of Colorectal Cancer at the Surgical ward of the Regional Hospital Durres is the second largest and a referral hospital center in Albania. In this paper we have collected medical records of 79 adults 18 years of age and older with primary diagnosis of CRC admitted to this hospital during the periods January 2009 until to December 2010. Data were analyzed using the statistical package for social science (SPSS) version 23.0. A p < 0.05 was accepted as statistically significant.
Results
Overall, 79 patients with CRC enrolled in our study, the male (58.2%) was the most predominant gender compared to female (41.8%) with a strong significance between them χ2 =79.0 and p value <0.0001. The average age was 69.43 ±10.6 where the minimum age resulted 42 years old and the maximum 85 years old. Patients between the age group 61-70 years old were 29.1% of CRC cases, them with age group 71-80 years old presented the higher number of CRC 34.2% of cases. A strong significance association has been seen between the age groups and presence of CRC. In multivariate logistic regression we also found a significance association for some of the other risk factor for CRC like gender, aging, marital status, education level BMI and physical activity. The p value in all these risk factor resulted <0.05.
Conclusion
The prevalence of this malignancy in our study increases after the age of 60 years. Our study findings show that the presence of CRC was in strength association with some of risk factors. But the number of our patients were low, so based on our observations, we suggest future studies should involve a large number of patients and focus on better understanding mechanisms for some of these associations and presence of CRC risk.
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Alqahtani MZ, Mohammed AG, Alsamghan AS, Bharti RK, Alsharm AA, Alshahrani MT, Alzahrani MA, Ayed AAN, Alsaleem MA, Ghazwani EY. Risk factors of colorectal cancer among Saudi Population: Case-control study. J Family Med Prim Care 2020; 9:5035-5040. [PMID: 33209840 PMCID: PMC7652174 DOI: 10.4103/jfmpc.jfmpc_895_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Colorectal cancer (CRC) incidence and related mortalities have been steadily increasing in KSA over the past 20 years. CRC in the Kingdom of Saudi Arabia (KSA) population presents in younger ages and in more advanced disease states as compared to other countries. This study was aimed to determine factors (demographic, habitual, environmental, nutritional, and genetic) associated with CRC in Riyadh, KSA. Materials and Methods: A matched case-control study conducted in the major hospitals in Riyadh (King Khalid university Hospital, King Faisal Specialist Hospital, Riyadh Military Hospital, Security Force Hospital, King Fahd Medical City). Here most of CRC cases are managed. The cases (n = 121) group included all recently diagnosed and pathologically confirmed Saudi cases of CRC identified during the period 1st of January 2017 till 31st of December 2018 who agreed to participate and fulfilled the inclusion criteria. A similar number of controls attending the study settings were selected consecutively from the clinics where cases were managed and matched on a 1:1 basis with cases based on age (+/-3 years) and gender. Data were collected using a structured questionnaire. Conditional logistic regression models were fitted to determine factors associated with risk of CRC. Result: This study included similar number of males and females in both groups: males 69 (57%) and females 52 (43%) in each group (Chi-square test P = 1.0). The mean (S.D) age in the cases group was 53.6 (S.D = 12.9) and 53.3 (S.D = 12.9) in the controls group (Student test P = 0.86). In the final multivariate conditional logistic regression model, variables independently associated with risk of colorectal cancer were body mass index (OR = 0.93; 95% CI 0.87–0.98; P = 0.011) employment status (inverse relation: OR = 0.33; 95% CI 0.14–0.77; P = 0.010), colon polyps (OR = 4.09; 95% CI 1.06–15.82; P = 0.041), and constipation (OR = 4.98; 95% CI 1.91–15.99; P = 0.001). Conclusion: Factors associated with CRC in the major referral hospitals in KSA were colon polyps, chronic constipation, and unemployment. These factors should be considered when screening for patients at risk for CRC.
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Affiliation(s)
- Mansour Z Alqahtani
- Department of Community, Ministry of Health, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ashry G Mohammed
- Department of Public Health, King Saud University, Abha, Kingdom of Saudi Arabia
| | - Awad S Alsamghan
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Rishi K Bharti
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Abdullah A Alsharm
- Department of Oncology, King Fahad Medical City, Abha, Kingdom of Saudi Arabia
| | - Mohammed T Alshahrani
- Department of Medical Service, Ministry of Defense, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed A Alzahrani
- Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Adil Ali N Ayed
- Department of Family Medicine, King Khalid University, Najran, Kingdom of Saudi Arabia
| | - Mohammed Abadi Alsaleem
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Eisa Y Ghazwani
- Department of Family and Community Medicine, College of Medicine, Najran University, Najran, Kingdom of Saudi Arabia
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Arnold AM, Morak M, Benet-Pagès A, Laner A, Frishman D, Holinski-Feder E. Targeted deep-intronic sequencing in a cohort of unexplained cases of suspected Lynch syndrome. Eur J Hum Genet 2019; 28:597-608. [PMID: 31822864 DOI: 10.1038/s41431-019-0536-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 12/28/2022] Open
Abstract
Lynch syndrome (LS) is caused by germline defects in DNA mismatch repair (MMR) pathway, resulting in microsatellite instability (MSI-H) and loss of immunohistochemical staining (IHC) of the respective protein in tumor tissue. However, not in all clinically suspected LS patients with MSI-H tumors and IHC-loss, causative germline alterations in the MMR genes can be detected. Here, we investigated 128 of these patients to possibly define new pathomechanisms. A search for large genomic rearrangements and deep-intronic regulatory variants was performed via targeted next-generation sequencing (NGS) of exonic, intronic, and chromosomal regions upstream and downstream of MLH1, MSH2, MSH6, PMS2, MLH3, MSH3, PMS1, and EPCAM. Within this cohort, two different large rearrangements causative for LS were detected in three cases, belonging to two families (2.3%). The sensitivity to detect large rearrangements or copy number variations (CNV) was evaluated to be 50%. In 9 of the 128 patients (7%), previously overlooked pathogenic single-nucleotide variants (SNV) and two variants of uncertain significance (VUS) were identified in MLH1, MSH2, and MSH6. Pathogenic aberrations were not found in MLH3, MSH3, and PMS1. A potential effect on regulation was exerted for 19% of deep-intronic SNVs, predominantly located in chromosomal regions where the modification of histone proteins suggests an enhancer function. In conclusion, conventional variation analysis of coding regions is missing rare genomic rearrangements, nevertheless they should be analyzed. Assessment of deep-intronic SNVs is so far non-conclusive for medical questioning.
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Affiliation(s)
- Anke Marie Arnold
- Medizinisch Genetisches Zentrum-MGZ, Munich, Germany.,Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technische Universität München, Freising, Germany
| | - Monika Morak
- Medizinisch Genetisches Zentrum-MGZ, Munich, Germany.,Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany
| | | | - Andreas Laner
- Medizinisch Genetisches Zentrum-MGZ, Munich, Germany
| | - Dimitrij Frishman
- Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technische Universität München, Freising, Germany.,Laboratory of Bioinformatics, RASA Research Center, St. Petersburg State Polytechnic University, St. Petersburg, Russia, 195251
| | - Elke Holinski-Feder
- Medizinisch Genetisches Zentrum-MGZ, Munich, Germany. .,Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.
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Zambirinis CP, Theodoropoulos G, Gazouli M. Undefined familial colorectal cancer. World J Gastrointest Oncol 2009; 1:12-20. [PMID: 21160768 PMCID: PMC2999090 DOI: 10.4251/wjgo.v1.i1.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 03/31/2009] [Accepted: 04/07/2009] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC), one of the most common cancers of the world, is actually a spectrum of several subtypes, with different molecular profiles, clinico-pathological characteristics and possibly separate pathways of progression. It is estimated that in approximately 25%-35% of cases, a familial component exists, so they are classified as familial CRC (fCRC). However the known hereditary CRC syndromes justify only up to 5%. The rest are attributed to some inherited genetic predisposition passed to offspring through low-penetrance genes, which in the proper environmental setting can bring on tumorigenesis. Furthermore, part of the familial clustering may be attributed to chance. Because of the complexity regarding the etiology of CRC, the clinician is sometimes faced with obscure patient data, and cannot be sure if they are dealing with fCRC or sporadic CRC. The elucidation of what is going on with the as yet “undefined” portion of CRC will aid not only in the diagnosis, classification and treatment of CRC, but more importantly in the proper adjustment of the screening guidelines and in genetic counselling of patients.
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Affiliation(s)
- Constantinos Pantelis Zambirinis
- Constantinos Pantelis Zambirinis, First Propaedeutic Surgical Department, Hippocration University Hospital, School of Medicine, University of Athens, 11527 Athens, Greece
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Khanifar E, Stamos MJ, Billings TL, Wu MLC. Contemporary Evaluation of Colorectal Carcinoma in Specimens from Endoscopic Biopsies. Lab Med 2009. [DOI: 10.1309/lm8trjp8jy7sstsu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Microsatellite instability (MSI) is the hallmark of a molecular pathway to carcinogenesis due to sporadic or inherited abnormalities of DNA mismatch repair genes. Inherited mutations are seen in hereditary nonpolyposis colorectal cancer syndrome. Endometrial carcinoma shows as high an incidence of MSI as does colorectal carcinoma. This review provides a framework for the gynecologic pathologist to understand the complexities of MSI in endometrial carcinoma, by discussing the basic mechanisms of mismatch repair and carcinogenesis, testing, the morphologic features of MSI endometrial cancer and the contradictory data regarding prognosis.
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Abstract
Over the last 20 years, the rapid expansion of genetic technology has allowed much progress to be made in understanding the molecular basis of inherited bowel cancer. At the same time, improvements in endoscopic and surgical techniques have meant that very effective surveillance can be offered to subjects known to be at high risk. The genes underlying the major polyposis syndromes have been identified and the genetic basis for Lynch Syndrome (Hereditary NonPolypsis Syndrome) is well understood. In Australia, this new knowledge has been incorporated in a multidisciplinary model of care involving clinical geneticists, gastroenterologists and gastrointestinal surgeons, pathologists, and family cancer registries. Challenges for the future include identifying families which would benefit from referral to these services but also encouraging the uptake of predictive testing and appropriate surveillance by at risk members of families where the genetic mutation is known. Surprisingly high numbers of individuals for whom a predictive blood test and surveillance program is freely available fail to participate and the reasons for this choice are still poorly understood. This has implications for the utilization of new genetic knowledge in other diseases. Another major challenge for the future is identifying the genes underlying the increased risk of bowel cancer in families which do not have the syndromes described above. Australian clinicians and scientists are actively participating in the global research effort to discover these genes.
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Affiliation(s)
- Barbara A Leggett
- Department of Gastroenterology and Hepatology, Level 9 Ned Hanlon Building, Royal Brisbane and Womens Hospital, Herston, Brisbane, Qld 4029, Australia.
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Kurnat-Thoma EL. Hereditary nonpolyposis colorectal cancer (Lynch syndrome): molecular pathogenesis and clinical approaches to diagnosis and management for nurses. Biol Res Nurs 2008; 9:185-99. [PMID: 18077771 DOI: 10.1177/1099800407308558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hereditary nonpolyposis colorectal cancer (HNPCC), also referred to as Lynch syndrome, is the most common form of hereditary colorectal cancer and is responsible for 2% to 4% of all colorectal cancers in the Western hemisphere. Generally characterized by early-onset colorectal carcinoma with a mean age of presentation of 40 to 45 years, it can also manifest with extracolonic adenocarcinomas and cancers of the endometrium, ovaries, stomach, pancreas, small intestine, hepatobiliary tract, upper uroepithelial tract, brain, and skin. HNPCC is autosomal dominant and carries an 80% lifetime risk of cancer development. This review addresses the molecular underpinnings of HNPCC while providing a concise approach to clinical detection, diagnosis, and management of patients who may or may not test positive for an HNPCC-causing mutation. Although applicable to any patient-care setting in which cancer may be observed, this review specifically addresses the role of nurses in detecting, diagnosing, and clinically managing HNPCC.
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Affiliation(s)
- Emma L Kurnat-Thoma
- National Institutes of Health/National Institute of Nursing Research Graduate Partnership Program Scholar, University of Utah, Salt Lake City, USA. kurnate@ mail.nih.gov
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Oman SA, Ballinger L, Cerilli LA. Small cell carcinoma: arising in Lynch syndrome: a previously undocumented occurrence. Int J Surg Pathol 2008; 17:46-50. [PMID: 18480399 DOI: 10.1177/1066896908315820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lynch syndrome is a genetic cancer predisposition syndrome caused by an inherited defect in 1 of 4 DNA mismatch repair genes (mutL homolog 1, mutS homolog 2, mutS homolog 6, and postmeiotic segregation 2). Despite the theoretically increased risk in all tissues, Lynch syndrome exhibits tissue specificity, with a particular tendency among affected individuals to develop colorectal and endometrial cancer at a young age. A number of other malignancies, including those derived from the ovary, stomach, small bowel, and urothelium, have also been linked to this syndrome. A growing body of evidence exists to support an association between mismatch repair mutations and a growing spectrum of hereditary nonpolyposis colon cancer-associated neoplasms. In this article, a previously undocumented mismatch repair-related malignancy in a patient with Lynch syndrome is reported.
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Affiliation(s)
- Sarah A Oman
- Department of Pathology, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, New Mexico, USA.
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Routinely assessed morphological features correlate with microsatellite instability status in endometrial cancer. Hum Pathol 2007; 39:116-25. [PMID: 17949789 DOI: 10.1016/j.humpath.2007.05.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/24/2007] [Accepted: 05/29/2007] [Indexed: 12/15/2022]
Abstract
Microsatellite instability (MSI) has been shown to be important in the molecular pathogenesis of both sporadic and inherited endometrial carcinomas of endometrioid type. It is likely prognostically significant as well. The aim of this study was to determine whether MSI phenotype in endometrial carcinoma was associated with specific morphologic patterns and therefore predictable by tumor morphology. The study subjects consisted of 102 patients with nearly equal representation of MSI high (MSI-H; n = 52) and non-MSI-H (n = 50) endometrial tumors. Microsatellite instability was determined by the standard polymerase chain reaction method using the National Cancer Institute-recommended set of 5 markers. The MSI-H and non-MSI-H groups were matched for patient age, race, histologic type (all endometrioid), International Federation of Gynecology and Obstetrics grade, and disease stage. Assessed morphological features included host inflammatory response (tumor infiltrating lymphocytes [TILs], peritumoral lymphocytes, peritumoral lymphoid follicles, and neutrophilic infiltration), tumor characteristics (cytologic grade, growth pattern, tumor heterogeneity, invasion pattern, metaplastic changes, necrosis, and lymphovascular invasion), and background endometrium (hyperplasia, atrophy, and polyp). Of all the features examined, TIL counts and peritumoral lymphocytes correlated significantly with MSI-H status. Their statistical relationship was strengthened in the presence of a nonpapillary growth pattern and endometrial hyperplasia. On multivariate analysis, TIL counts and peritumoral lymphocytes remained independent predictors for MSI-H status. At a cutoff point of 40 TILs/10 high power fields, TIL counts had a sensitivity of 85% in predicting MSI status in endometrioid endometrial carcinoma, with a specificity of 46%. This specificity increased as higher cutoff points were selected, but sensitivity decreased. Given that analogous features have been encountered in MSI-H colorectal cancers, our findings suggest a similar relationship between tumor phenotype and DNA mismatch repair abnormalities in both endometrial and colorectal tumors. Therefore, morphological patterns encountered in endometrial carcinoma may prove useful in screening tumors under consideration for MSI testing and identifying appropriate patients for referral to a genetic counseling service.
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Duffy MJ, van Dalen A, Haglund C, Hansson L, Holinski-Feder E, Klapdor R, Lamerz R, Peltomaki P, Sturgeon C, Topolcan O. Tumour markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines for clinical use. Eur J Cancer 2007; 43:1348-60. [PMID: 17512720 DOI: 10.1016/j.ejca.2007.03.021] [Citation(s) in RCA: 332] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 03/15/2007] [Accepted: 03/27/2007] [Indexed: 12/19/2022]
Abstract
The aim of this article is to present updated guidelines for the use of serum, tissue and faecal markers in colorectal cancer (CRC). Lack of specificity and sensitivity preclude the use of all existing serum markers for the early detection of CRC. For patients with stage II or stage III CRC who may be candidates for either liver resection or systemic treatment should recurrence develop, CEA should be measured every 2-3 months for at least 3 years after diagnosis. Insufficient evidence exists to recommend routine use of tissue factors such as thymidylate synthase, microsatellite instability (MSI), p53, K-ras and deleted in colon cancer (DCC) for either determining prognosis or predicting response to therapy in patients with CRC. Microsatellite instability, however, may be used as a pre-screen for patients with suspected hereditary non-polyposis colorectal cancer. Faecal occult blood testing but not faecal DNA markers may be used to screen asymptomatic subjects 50 years or older for early CRC.
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Affiliation(s)
- M J Duffy
- Department of Pathology and Laboratory Medicine, Nuclear Medicine Laboratory, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Chen CS, Phillips KD, Grist S, Bennet G, Craig JE, Muecke JS, Suthers GK. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) in familial colorectal cancer. Fam Cancer 2006; 5:397-404. [PMID: 16944273 DOI: 10.1007/s10689-006-0011-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Accepted: 05/26/2006] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a pigmented fundus lesion associated with familial adenomatous polyposis (FAP). CHRPE prevalence has been reported to be increased in subjects with familial or sporadic non-polyposis colorectal cancer (CRC), suggesting that some individuals with non-polyposis CRC have an attenuated form of FAP. Other studies have not confirmed these clinical observations and have failed to identify mutations in the gene responsible for FAP, but the reason for the discrepancy in relation to CHRPE prevalence has not been resolved. We determined the prevalence of CHRPE in subjects without CRC (negative control cohort), subjects with FAP (positive control cohort), and subjects with familial non-polyposis CRC (test cohort). METHOD A cohort study consisting of 37 negative control subjects, 9 positive control subjects with documented APC gene mutations, and 36 test subjects with familial non-polyposis CRC but no identified pathogenic APC gene mutation. The diagnosis of hereditary non-polyposis colon cancer was excluded in the test cohort by testing for microsatellite instability in tumour tissue. RESULTS None of the 37 people in the negative control group had CHRPE. Five of nine (56%) patients with FAP had multiple CHRPE lesions. None of the 36 subjects in the test cohort had CHRPE lesions. CONCLUSIONS Ophthalmoscopy may contribute to risk assessment in families with FAP but not in familial non-polyposis CRC. Care must be exercised when interpreting pigmented fundus lesions because 8-13% of subjects in each of the cohorts had pigmented retinal lesions that were not CHRPE. Bilateral lesions and lesions with a depigmented halo were the hallmarks of CHRPE associated with FAP.
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Affiliation(s)
- Celia S Chen
- Ocular Oncology Unit, Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Abstract
PURPOSE OF REVIEW Dramatic advances in the understanding of the genetic basis for inherited diseases and in diagnosis and treatment are particularly applicable to intestinal polyposis. Recent contributions have impacted our understanding of the molecular basis for the disease and improved our ability to treat them. RECENT FINDINGS Insights into the genetic basis of the spectrum of disease and refinement of genetic screening, diagnostic tests, and surgical management of intestinal polyposis and extraintestinal manifestations are reviewed. SUMMARY Our understanding of the genetic basis for the intestinal polyposis syndromes remains incomplete, but recent studies have contributed to filling in significant gaps in our knowledge. Specific genetic alterations have been identified in the majority of the 30% of patients with familial adenomatous polyposis that do not test positive for mutations in the APC gene with routine testing. A novel gene ENG has been identified in a subgroup of patients with Peutz-Jegher's syndrome and a hypothesis has been proposed to explain the pathogenesis of the mucosal defects. Technological advancements in diagnosis and treatment include the use of capsule endoscopy for screening and the minimally invasive approach to total colectomy with ileoanal pullthrough. Treatment of desmoid tumors remains a challenge, but new chemotherapy regimens show some promise in treating this rare, but devastating, extraintestinal manifestation.
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Affiliation(s)
- Daniel von Allmen
- Division of Pediatric Surgery, The University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7223, USA.
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