Colonic High-grade Tubular Adenomas Associated with Schistosoma japonicum

We reported a case of sigmoid colonic high grade tubular adenomas associated with deposited ova of Schistosoma japonicum. A 76-year-old Japanese man was referred to our colonoscopy due to a positive fecal occult blood test. He had a medical history of schistosomiasis japonica. The colonoscopy revealed that there were two sigmoid colon polyps, approximately 8 mm in diameter. These were removed by endoscopic mucosal resection (EMR). Pathological examination revealed high grade tubular adenomas and deposited some ova of Schistosoma japonicum with severe fibrotic change and granuloma formation in the submucosal layer. Colonic schistosomiasis is a probable independent risk factor for the development of colorectal carcinogenesis.

Comparison of non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer

AIM

To compare the clinicopathological features of patients with non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer.

METHODS

All the patients with rectosigmoid carcinoma who underwent laparoscopic radical surgical resection in the Shanghai Minimally Invasive Surgical Center at Ruijin Hospital affiliated to Shanghai Jiao-Tong University between October 2009 and October 2013 were included in this study. Twenty-six cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected. Symptoms, endoscopic findings and clinicopathological characteristics were evaluated retrospectively.

RESULTS

There were no significant differences between patients with and without schistosomiasis in gender, age, CEA, CA19-9, preoperative biopsy findings or postoperative pathology. Patients with rectosigmoid schistosomiasis had a significantly higher CA-125 level and a larger proportion of these patients were at an early tumor stage (P = 0.003). Various morphological characteristics of schistosomiasis combined with rectosigmoid cancer could be found by colonoscopic examination: 46% were fungating mass polyps, 23% were congestive and ulcerative polyps, 23% were cauliflower-like masses, 8% were annular masses. Only 27% of the patients were diagnosed with rectal carcinoma preoperatively after the biopsy. Computed tomography (CT) scans showed thickened intestinal walls combined with linear and tram-track calcifications in 26 patients.

CONCLUSION

Rectosigmoid carcinoma combined with schistosomiasis is associated with higher CA-125 values and early tumor stages. CA-125 and CT scans have a reasonable sensitivity for the accurate diagnosis.

Colorectal carcinoma associated with schistosomiasis: a possible causal relationship

The association between schistosomiasis and colorectal malignancy has long been suggested in the literature, but it is not uniformly accepted. In the Far East, considerable evidence supports an etiological link between Schistosoma japonicum and colorectal cancer. However, the available data regarding the role of Schistosoma mansoni in colorectal carcinogenesis are conflicting and most often do not show causality. We report on a patient with sigmoid colonic cancer coexisting with schistosomiasis, and we provide a comprehensive review of the literature regarding the epidemiology and pathobiology of this association.

Sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum: A case report

We report a case of sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloody stools. She had a significant past medical history of asymptomatic schistosomiasis japonica and constipation. A colonoscopy showed an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon. During the radical operative procedure, we noted the partially encircling tumor was located in the distal sigmoid colon, and extended into the serosa. Succedent pathological analysis demonstrated the diagnosis of sigmoid colonic ulcerative tubular adenocarcinoma, and showed deposited ova of Schistosoma japonicum in both tumor lesions and mesenteric lymph nodes. Three days after surgery the patient returned to the normal bowel function with one defecation per day. These findings reveal that deposited schistosome ova play a possible role in the carcinogenesis of colorectal cancer.

Amebiasis complicating carcinomas: a diagnostic dilemma

Two black African women and one black American man had carcinomas of cervix, perineum, and sigmoid colon, respectively. In each of these patients, trophozoites of Entamoeba histolytica had invaded the surface of the tumor, and in some areas had invaded more deeply into the stroma between the tumor cells. Although it is well known that cutaneous amebiasis of anus, penis, vulva, and cervix can mimic squamous cell carcinoma, it may be, perhaps, less well known that carcinomas at these sites may be colonized by trophozoites of E. histolytica. In patients with amebiasis but without an associated carcinoma, a correct diagnosis of amebiasis spares the patient unnecessary and sometimes mutilating surgery. But a diagnosis of amebiasis, when there is an unrecognized underlying carcinoma, delays effective treatment of the carcinoma. A smear that establishes a diagnosis of cutaneous amebiasis, therefore, should be followed by biopsy to exclude or confirm an underlying carcinoma.

[A case of metastatic lung tumor of the colon cancer with ova of schistosoma japonicum in the resected lung specimen]

A 69-year-old man underwent right middle lobectomy because of the tumor lesion in the right middle lung. He had ever been in Celebes and China (riverside area of the Yangtze), the infected area of schistosomiasis japonica, for military service during the World War II. Resected lung specimen was carefully examined at the department of pathology in our hospital. Several ova of Schistosoma japonicum were discovered scattered in the specimen, and the pathological feature of the lung lesion was revealed to be metastasis of the sigmoid colon cancer which was resected 4 years ago at a certain hospital. The ova of Schistosoma japonicum were also distributed near the colon lesion. Recently in Japan, it is said, acute infected case of schistosomiasis japonica has been ceased, however, in cases of chronic stage of this disease, hepatoma or lower intestinal cancers are still discovered through the careful follow up study.