Family History Of Colon Cancer Research Articles

Asymptomatic endometrial cancer with Lynch syndrome; in a woman with primary infertility-A case report and literature review.

Lynch syndrome, also called hereditary non-polyposis colorectal cancer, is an autosomal dominant disorder characterized by germline pathogenic mutations in DNA mismatch repair genes-resulting in increased susceptibility to colorectal, endometrial, and other tumors. This case report presents an incidental finding of endometrial cancer with Lynch syndrome during investigation for primary infertility. A 34-year-old woman presented to the fertility clinic with unexplained primary infertility. Investigations showed possible endometrial polyp, 13 × 11 mm in size. Hysteroscopic polypectomy and endometrial biopsy revealed complex endometrial hyperplasia amounting to endometroid adenocarcinoma. The case was discussed at the West of Scotland Gynecology-Oncology MDT meeting-management options including fertility-sparing treatment or radical surgery were presented to the patient and she opted for the latter. A total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed with pathology results consistent with well-differentiated endometroid adenocarcinoma Stage 1A. Peritoneal washings showed no malignant cells. Genetic testing confirmed a diagnosis of Lynch syndrome. On further questioning, it was revealed that the patient had a strong family history of colon cancer but had not previously met the criteria for genetic testing. She was referred to colorectal surgeons and underwent colonoscopy. This showed no abnormality; she was therefore scheduled for 2-yearly colonoscopic surveillance.

Abstract 1011: A comprehensive comparative analysis of African Americans’ early onset and late onset colorectal cancer: A 60 year study in underserved population serving hospital

Abstract Background: The incident of early onset of colorectal cancer (EOCRC) is increasing in adults including in African Americans (AA). Aim: To investigate differences between EOCRC compared to late onset colorectal cancer (LOCRC) in AA patients. Methods: We reviewed demography, pathology and colonoscopy records of patients seen at Howard University Hospital from 1959 to 2023. This retrospective cohort consists of 175 EOCRC cases (<45 years) and 2025 LOCRC cases (>45 years). The age-adjusted rates for EOCRC and LOCRC were calculated for the age categories <45 and above 45. Results: The cohort comprised predominantly AA individuals (>85%). Gender distribution showed slightly more females (1074, 53%) than males, with no significant difference observed between EOCRC and LOCRC groups (p=0.94). Initial symptoms at presentation were prevalent in both EOCRC (93.8%) and LOCRC (92.6%). Notably, EOCRC exhibited a higher incidence of abdominal pain (23.3% vs. 17.2%, p=0.05) and changes in bowel habits (24.4% vs. 14%, p=0.05) compared to LOCRC. However, other symptoms such as melena, hematochezia, weight loss, and anemia were less prevalent in EOCRC than in LOCRC. Additionally, comorbidities like hypertension (HTN), diabetes mellitus (DM), and inflammatory bowel disease (IBD) were less frequent in EOCRC compared to LOCRC. Family history of colon cancer in first-degree relatives was notably higher in EOCRC (15.5%) compared to LOCRC (3.2%, p=0.01). Pathology reports indicated a higher occurrence of neuroendocrine tumors in EOCRC (2.8%) than in LOCRC (1.4%). Complications such as gastrointestinal bleeding and abdominal CT abnormalities were more frequent in EOCRC. Location-wise, EOCRC was primarily observed in the left sigmoid and rectosigmoid regions (p=0.01). Metastasis to other organs was more prevalent in EOCRC than in LOCRC (p=0.04) suggesting more aggressive and advanced lesions. Surgical interventions were slightly more common in EOCRC (80.4%) than in LOCRC (79.1%). Type of polyps and stage distribution showed some variations between the two groups. Interestingly, the incidence of colorectal cancer showed fluctuations over the years, peaking between 1980 and 1989 before declining in recent years, probably as a result of colonoscopy popularization. Conclusion: CRC incidence is increasing among young AA who display highly advanced and more metastatic tumors in comparison with LOCRC. While current screening programs seems to have decreased CRC prevalence in individuals older than 45, special attention needs to be addressed to young AA adults as well, to counter the observed trend, as they have the highest incidence of CRC among young population groups by race/ethnicity. Detailed analysis of the molecular landscape of EOCRC AA tumors is needed to understand the differential pathways and mechanisms defining these early onset cancers. Citation Format: Suryanarayana Reddy Challa, Mrinalini Deverapalli, Nasrin Farjana, Lakshmi Gayathri Chirumamilla, Reza Oskrouchi, Swetha Mynedi, Mudasir Rashid, Karthikeyan Senthilvelan, Babak Shokrani, Rabia Zafar, Angesom Kibreab, Farshad Aduli, Adeyinka Laiyemo, Zaki Sharif, Hassan Brim, Hassan Ashktorab. A comprehensive comparative analysis of African Americans’ early onset and late onset colorectal cancer: A 60 year study in underserved population serving hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1011.

Comparative genomic analysis to identify a signature of sporadic colorectal cancer development in young adults.

208 Background: Young-onset sporadic CRC is an important yet understudied heterogeneous group of aggressive cancers with distinct clinical and histopathological features. There is a steady increase in the incidence of cancer in this group of patients and currently, there are no screening guidelines to identify these patients due to a lack of understanding of the molecular mechanisms driving cancer in this patient group. Introduction: Despite screening guidelines and recent advances in cancer treatment, colorectal cancer (CRC) remains the second most diagnosed cancer and the second and third leading cause of cancer-related mortality in Canadian men and women, respectively [Canadian Cancer Statistics 2017.]. More striking is the rise in incidence of CRC in young adults in the United States [Siegel, R.L., et al, Bailey, C.E., et al., Dozois, E.J., et al., Deen, K.I., et al.], and the expectation that by the year 2030, the incidence rate will increase by 90% in this patient population. Data from the Surveillance and Cancer registry at Cancer Care Ontario shows a similar trend with increased rates in younger adults (ages 30 to 49) by 5.2 per cent per year between 2005 and 2012 [Ontario, C.C., Cancer Fact.]. Moreover, these younger patient groups are often diagnosed with aggressive forms and advanced stages of the disease [Ontario, C.C., Cancer Fact.]. Methods: In this study, using a total of 30 colorectal cancer patient samples from Windsor Regional Hospital Cancer Program, we performed comprehensive targeted gene sequencing to identify single nucleotide variants, small insertions/deletions, copy number variants in over 500 genes that are implicated in cancer. Mean age of the patients in this study was 44 years and only patients without any personal or family history of colon cancer /other malignancies or IBD were enrolled in the study. Results: While identifying previously known colorectal cancer associated genetic variants, our preliminary data shows distinct missense mutations in several genes potentially contributing to the development and progression of cancer in these patients. In addition to showing pathogenic mutations in colorectal cancers associated genes, such as PIK3CA (H1047R, E545K, E545G, R93W, V344A), KRAS (G12V, G12D, A146T) and APC, our study showed recurring missense mutations in several genes including AXIN2, ALK, CDKN1A, MAP3K1, ROS1, EPCAM, KDM5A and AURKA in over 50% of our samples. Conclusions: The genomic profiling performed using biopsies from young colorectal cancer patients through this study provides a unique ability to identify the potential “genomic triggers” for the development and progression of cancer in young sporadic colorectal cancer patients. This information can not only be used to develop targeted treatment options for these patients but also to design new screening protocols as well as optimal surveillance strategies.

Sonographic, Demographic, and Clinical Characteristics of Pre- and Postmenopausal Women with Endometrial Cancer; Results from a Post Hoc Analysis of the IETA4 (International Endometrial Tumor Analysis) Multicenter Cohort.

In this study, we conducted a comparative analysis of demographic, histopathological, and sonographic characteristics between pre- and postmenopausal women diagnosed with endometrial cancer, while also examining sonographic and anthropometric features in 'low' and 'intermediate/high-risk' cases, stratified by menopausal status. Our analysis, based on data from the International Endometrial Tumor Analysis (IETA) 4 cohort comprising 1538 women (161 premenopausal, 1377 postmenopausal) with biopsy-confirmed endometrial cancer, revealed that premenopausal women, compared to their postmenopausal counterparts, exhibited lower parity (median 1, IQR 0-2 vs. 1, IQR 1-2, p = 0.001), a higher family history of colon cancer (16% vs. 7%, p = 0.001), and smaller waist circumferences (median 92 cm, IQR 82-108 cm vs. 98 cm, IQR 87-112 cm, p = 0.002). Premenopausal women more often had a regular endometrial-myometrial border (39% vs. 23%, p < 0.001), a visible endometrial midline (23% vs. 11%, p < 0.001), and undefined tumor (73% vs. 84%, p = 0.001). Notably, despite experiencing a longer duration of abnormal uterine bleeding (median 5 months, IQR 3-12 vs. 3 months, 2-6, p < 0.001), premenopausal women more often had 'low' risk disease (78% vs. 46%, p < 0.001). Among sonographic and anthropometric features, only an irregular endometrial-myometrial border was associated with 'intermediate/high' risk in premenopausal women. Conversely, in postmenopausal women, multiple features correlated with 'intermediate/high' risk disease. Our findings emphasize the importance of considering menopausal status when evaluating sonographic features in women with endometrial cancer.

Adrenocortical carcinoma: A tumor with poor answer to classic chemotherapy

Abstract Introduction: Adrenocortical carcinoma (ACC) represents a rare endocrine malignancy being the second most aggressive endocrine cancer after anaplastic thyroid cancer. [1]. While most of them arise sporadically, up to 15% of adult ACC patients are related to germline mutations associated with familial cancer syndromes.[1,2]. Current treatment strategies include surgery as well as systemic therapy with mitotane and chemotherapy. Case report: A 60-year-old female patient with a family history of colon cancer, multinodular goiter, hypothyroidism treated with substitutive therapy, uterine fibroids, and hypertension, was diagnosed with adrenocortical carcinoma. No distant metastasis were present at the moment of diagnosis so an adrenalectomy was performed. Due to postoperative complications, a total nephrectomy was also needed. Adjuvant Mitotane treatment was given. A CT exam performed 5 months after the resection showed multiple pulmonary metastasis, a liver nodule and peritoneal carcinomatosis. The standard first-line chemotherapy of choice was Carboplatin and Etoposide. After completing 3 cycles of chemotherapy the imaging reassessment show the progression of liver and peritoneal lesions and the quasi-complete regression of lung lesions. Currently, the Mitotate treatment was stopped due to severe adverse reactions. Conclusions: Adrenocortical carcinoma is a rare endocrine malignancy with a poor prognosis. The recruitment of ACC patients for new clinical trials to investigate new treatment strategies is needed because currently, no significant therapeutic breakthrough is emerging.

Correlations of high molecular weight adiponectin, tumor necrosis factor-alpha and vascular endothelial growth factors with occurrence of colonic polyps in the prediabetic population.

We aimed to explore the correlations of high molecular weight adiponectin (HMW-ADP), tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factors (VEGFs) with the occurrence of colonic polyps in the prediabetic population. Two hundred patients with prediabetes were enrolled, and their clinical data were retrospectively analyzed. They were divided into group A (75 patients with colonic polyps) and group B (125 patients without colonic polyps). Eighty patients with normal glucose tolerance in the same period were divided into group C (32 patients with normal glucose tolerance and colonic polyps) and group D (48 patients with normal glucose tolerance but no colonic polyps). The correlations of serum HMW-ADP, TNF-α and VEGF levels with plasma glucose and insulin levels were explored by Pearson's analysis. The factors influencing the occurrence of colonic polyps were determined by logistic regression analysis. Serum HMW-ADP was negatively correlated with TNF-α, VEGFs, FPG, 2hPG, FI and HOMA-IR (r<0, P<0.05), whereas serum TNF-α and VEGFs were positively correlated with FPG, 2hPG, FI and HOMA-IR (r>0, P<0.05). Age, body mass index, waist-to-hip ratio, history of smoking, history of drinking, family history of colon cancer, TNF-α and VEGF were independent risk factors [odds ratio (OR)>1, P<0.05], and HMW-ADP was a protective factor (OR<1, P<0.05). The areas under the curves of serum HMW-ADP, TNF-α, VEGFs and their combination for predicting the occurrence of colonic polyps were 0.899, 0.787, 0.908 and 0.922, respectively. The combination of HMW-ADP, TNF-α and VEGFs can effectively predict the occurrence of colonic polyps in prediabetic patients.

BG13 A rare case of Muir–Torre syndrome

Abstract Muir–Torre syndrome is a rare variant of hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome. It is caused by a defect in mismatch repair genes, which are most commonly inherited in an autosomal dominant fashion. It is characterized clinically by sebaceous neoplasms of the skin associated with at least one visceral malignancy, with colon cancer being the most frequent. The most common genetic defects responsible are in MLH1, MSH2 and MSH6, which results in an increased frequency of unrepaired base mismatching during DNA replication and subsequent microsatellite instability, predisposing to cancer. We present a case of a 59-year-old man with a history of colon cancer who was referred with a rapidly growing irregular nodule on his lower back for the past 2 months, concerning for an amelanocytic melanoma. An excision biopsy was arranged, and subsequent histology demonstrated a sebaceoma. Immunohistochemistry for mismatch repair genes showed loss of expression for MSH2 and MSH6. Upon further questioning, it was found that he had a strong family history of colon cancer (father, brother and two sisters), and he developed colon cancer at 36 years of age, which was treated with a pancolectomy. Genetic testing revealed a mutation in MSH2. Given this history, annual follow-up was arranged for skin surveillance.

Colorectal cancer screening barriers and facilitators among Jordanians: A cross-sectional study

The factors affecting the adherence of Jordanians to colorectal cancer (CRC) screening remain underexplored. We examined the inhibitory and facilitating factors that influence the uptake of CRC screening among Jordanians. We conducted questionnaire interviews between April 2020 and June 2021 with 861 Jordanians aged 50–75. We analyzed the differences between proportions using the chi-square test. Binary logistic regression was conducted to determine factors associated with awareness of CRC and its screening. Of all participants, 41.7 % were aware of the necessity of screening for CRC, and 27.2 % were aware of at least one of the tests for CRC screening. However, only 17.2 % of participants underwent screening. In the multivariate analysis, participants with higher income (p-value < 0.001, odds ratio[OR] = 1.9, 95 % confidence interval [CI]: 1.4–2.7), higher level of education (p-value < 0.001, OR = 2.6, 95 % CI: 1.8–3.7), family history of colon cancer (p-value < 0.001, OR = 2.8, 95 % CI = 1.7–4.5), and those who had been screened for other cancers (p-value = 0.003, OR = 1.7, 95 % CI: 1.2–2.5) were more aware of the necessity of screening. Concerning barriers to screening, 'feeling well,' lack of physician endorsement, and difficult access to health care were the most commonly reported inhibitory factors (53.9 %, 52.3 %, and 31.9 %, respectively). The most commonly stated incentivizing factor was physician endorsement (82.3 %). Screening rates for CRC in eligible Jordanians remain low, albeit more than one-third of participants are aware of the necessity of screening. Enhanced awareness of barriers and incentivizing factors should help to prioritize national strategies to improve screening rates.

At What Age Should We Stop Colorectal Cancer Screening? When Is Enough, Enough?

There is strong evidence that colorectal cancer screening can reduce both colorectal cancer incidence and mortality. Guidelines recommend screening for individuals age 45 to 75 years, but are less certain about the benefits after age 75 years. Dalmat and colleagues provide evidence that individuals with a prior negative colonoscopy 10 years or more prior to reaching age 76 to 85 years, had a low risk of colorectal cancer, and would be less likely to benefit from further screening. It is important to note that this study population did not include individuals with a family history of colon cancer or a personal history of having high-risk adenomas. These data suggest that a negative colonoscopy can be an effective risk-stratification tool when discussing further screening with elderly patients. See related article by Dalmat et al., p. 37.

S2000 Colonoscopy-Induced Transient Mobitz Type 1 Block

Introduction: Propofol is a commonly used anesthetic in endoscopic procedures. It can prolong the atrioventricular (AV) conduction through vagal stimulation leading to AV block. We report a unique case of a previously healthy patient undergoing a routine screening colonoscopy who developed a Mobitz type 1 block during the procedure, in which propofol was the sole agent used for sedation. Case Description/Methods: A 74-year-old female with a medical history of diverticulosis and a family history of colon cancer in her first-degree relative presented for a routine colonoscopy performed under monitored supervised propofol sedation. During the final phase of the colonoscopy which was performed with minimal air insufflation, she was observed to have a transient 2:1 heart block mixed with periods of 3:2 heart block on the monitor. After the procedure was completed, she reported no cardiac or neurological symptoms. Review of an electrocardiogram strip showed lengthening of the PR interval consistent with Wenckebach (Mobitz type 1 block; Figure. This resolved post procedure. All labs were within normal limits. Prior to this procedure, she had no cardiac history nor was she on any medications. She was referred for a formal cardiology evaluation which included a 14-day Holter monitor showing 22 asymptomatic episodes of supraventricular tachycardia with longest being 26. No treatment was initiated. She also underwent an echocardiogram showing an ejection fraction of 75%, with a normal left ventricle. The incident was deemed to be a vagal affect due to the probe being in the colon/rectum and the effects of propofol. She has not had any recurrences of the Wenckebach phenomenon on subsequent electrocardiograms and continues to remain asymptomatic. Discussion: Propofol can prolong the AV conduction system leading to a heart block even in patients without any cardiac history. The suggested mechanism is hypervagal stimulation causing slow sinus rate, prolongation of stimulus to the bundle of His interval, lengthening of the Wenckebach cycle and the effective refractory period. While air distention in the stomach or colon can also result in a vasovagal reaction and bradycardia, cases of nodal block in this situation are extremely rare. This case demonstrates that in addition to expected vasovagal bradycardia, nodal block is a rare possibility and hence the need for close continuous cardiac monitoring during endoscopy.Figure 1.: Lengthening of the PR interval consistent with Wenckebach (Mobitz type 1 block).

S2200 A Rare Case of Extraluminal Rectal Fecaloma

Introduction: Fecaloma is usually an intraluminal stony mass of inspissated feces covered with layers of calcified shell. It can cause obstructive or compressive symptoms and sometimes even luminal rupture. It is usually managed conservatively and surgical removal is rarely needed. Most common sites for fecaloma are sigmoid colon and rectum. It is commonly associated with inflammatory bowel disease, Hirschsprung’s disease, Chagas disease, psychiatric and bedridden patients, neoplasm or idiopathic chronic constipation. We present a unique case of extraluminal fecalith presenting as subepithelial rectal mass. Case Description/Methods: A 60-year-old male with history of colon polyps underwent surveillance colonoscopy which showed a 3-4 cm firm rectal subepithelial mass that resembled a large lipoma or GIST (Figure A) Patient denied any symptoms including constipation or abdominal pain and had no family history of colon cancer. On endoscopic ultrasound (EUS) with radial and linear probe a subepithelial mass like lesion with calcified wall (Figure B) was noted. Multiple cold snare polypectomies were performed to de-roof the lesion as well as a deep "bite on bite/well biopsy technique" in order to get through the wall when feculent material and purulent debris was noted within the cavity (Figure C). Mucosal and muscular layer biopsies showed only vegetable fiber and fecal debris focally calcified consistent with fecalith. A CD 117 immunostain was negative excluding a GIST tumor. Historically this patient had an episode of complicated diverticulitis with phlegmon and microperforation in his 40s that was treated conservatively. Few months after that episode he had sigmoid colon resection with anastomosis in order to prevent future episodes. Discussion: Although there are rare reported cases of extraluminal cecal fecalomas, to our knowledge this is the first reported case of extraluminal rectal fecaloma. We suspect that our patient developed fecal leakage through the suture line after sigmoid resection with anastomosis nearly 20 years ago. Over time, the leakage likely became a well-organized fecaloma with calcification. In summary, fecaloma is a differential diagnosis to consider when encountering a large subepithelial mass in the rectum.Figure 1.: Extraluminal Rectal Fecaloma. A. Colonoscopic imaging showing large subepithelial mass. B. Endoscopic ultrasound image showing subepithelial mass with calcified wall. C. Colonoscopic image showing feco-purulent material inside the mass.

S2036 Granular Cell Tumor of the Cecum: An Uncommon Tumor in an Unusual Location

Introduction: Granular cell tumors are rare soft tissue neoplasms derived from Schwann cells and are commonly found in the skin, oral cavity, and gastrointestinal tract. While most follow a benign course, malignant cases have been reported in 1-2% of cases. In the gastrointestinal tract, the majority of cases involve the esophagus but rarely these tumors will involve the colon. We present a case of a granular cell tumor of the cecum found incidentally in a middle aged woman during a screening colonoscopy. Case Description/Methods: A 52-year-old female presented for colon cancer screening. She used tobacco but had no past medical history. She denied a family history of colon cancer or colon polyps. Physical examination was normal. Colonoscopy revealed a 1 cm subepithelial, polypoid lesion in the cecum in close proximity to the appendiceal orifice. Biopsies revealed a proliferation of plump cells with bland nuclei and granular, eosinophilic cytoplasm in the lamina propria and submucosa. The cells were S100 and CD68 positive, consistent with a granular cell tumor. Due to subepithelial involvement she underwent laparoscopic appendectomy with en bloc wedge resection of cecum with negative margins (Figure). Discussion: Gastrointestinal involvement of granular cell tumors account for 5-11% of all cases reported. In the gastrointestinal tract, the esophagus is the most frequently encountered location followed by the duodenum, anus, stomach, and colon. Less than 130 cases of colonic involvement have been reported. Most lesions are found incidentally on screening colonoscopy. While most tend to follow a benign course, malignant lesions have been reported. Management typically involves surgical resection due to subepithelial involvement or endoscopic submucosal dissection. This case highlights the importance of recognizing colonic involvement of a tumor that is typically considered to be a tumor of the esophagus. Endoscopists should consider granular cell colonic tumors when encountering subepithelial lesions of the colon.Figure 1.: Endoscopic and microscopic images of Granular Cell Tumor.

S3703 A Case of Hereditary Diffuse Gastric Cancer

Introduction: Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant disorder associated with pathogenic germline variants in the cadherin 1 (CDH1) or alpha-1 catenin (CTNNA1) genes. Carriers have an 80% risk of developing stomach cancer, at an average age of 38, and 60% lifetime risk of developing lobular breast cancer. This is a case of a middle-aged female diagnosed with CDH1+ HDGC. Case Description/Methods: An asymptomatic 50-year-old Bangladeshi female presented for surveillance colonoscopy given a strong family history of colon cancer in three siblings, mother and uncle and stomach cancer in her mother. She had a normal upper endoscopy three years earlier for indication of heartburn. She proceeded with colonoscopy which showed two tubular adenomas measuring 7-8 mm. Due to concern of a hereditary syndrome, she was referred to a genetics counselor and an Ambry Colonext Panel with RNA Analysis was conducted. Results were positive for pathogenic heterozygous c.1137G >A mutation in the CDH1 gene raising concern for HDGC. At the time, she opted for surveillance instead of prophylactic gastrectomy. A follow up upper endoscopy showed a few, minute pale regions on close inspection, but no masses, ulcerations or other features suggestive of malignancy. Per Cambridge protocol, 34 biopsies were collected and one gastric body biopsy returned positive for gastric adenocarcinoma with signet ring cell features and weak E-Cadherin expression. Cross sectional imaging was negative for metastatic disease. She met with oncology and surgery teams and underwent laparotomy with total gastrectomy and Roux-en-Y esophagojejunostomy. Gastrectomy biopsy confirmed a single microscopic focus of diffuse adenocarcinoma. Discussion: Diagnosis of HDGC-associated signet ring cancers is especially difficult because they are only visible on direct mucosal evaluation late in the disease process. Genetic testing is recommended for those meeting family or individual criteria. Prophylactic gastrectomy, as early as age 20, is recommended for pathogenic mutation carriers with an appropriate pedigree. Those denying surgery can be offered annual endoscopy with the understanding that frequent surveillance has not been proven to be effective in early gastric cancer detection in HDGC. During endoscopy, any visible lesion should be biopsied and a minimum of 30 biopsies are recommended to include all five anatomic gastric zones. H. pylori should be screened for and treated. Referral to a breast surgeon is also recommended.

S2024 Elderly Patient, Youthful Pathology: Solitary Colonic Juvenile Polyp Found in a 75-Year-Old Male

Introduction: Colonic juvenile polyps are generally found in the pediatric population. Classically, juvenile polyps (JP) are the most common polyp subtype seen in pediatric gastroenterology, accounting for approximately 80-90% of polyps in children. Generally, JP are diagnosed within the first decade of life and most common presentation is painless rectal bleeding. Other terminology used are juvenile hamartomatous polyp or retention polyps. There is no malignant potential for solitary JP and they tend to not recur. Case Description/Methods: We present a 75-year-old male with past medical history of hypertension, diabetes and hyperlipidemia referred to gastroenterology for surveillance colonoscopy due to a history of tubular adenomas. At the pre-procedure visit, the patient was well without GI complaints such as overt bleeding, change in bowel habits or unintentional weight loss. No family history of colon cancer or polyps was reported. Physical exam and vitals were normal at the time of procedure. Colonoscopy revealed a 40mm pedunculated sigmoid colon polyp which was excised using an endoloop at the stalk base followed by hot snare polypectomy ((Figure A). Three other sub-centimeter sessile polyps in the rectosigmoid area were removed by cold snare polypectomy. Histopathological examination of the large pedunculated polyp was consistent with a JP(Figure B). Other polyps were tubular adenomas. Discussion: Our current patient is the oldest reported case of isolated colonic JP. These polyps tend to have a common phenotypical appearance measuring around 10-30mm and roughly 90% of them are considered pedunculated. JP are ultimately defined by their distinctive histopathological features such as edematous lamina propria with inflammatory cells, cystically dilated glands that are bordered by cuboidal or columnar epithelium with reactive changes, and mucus filled glands. Fortunately for our patient, the presence of only a solitary colonic JP generally carries no known malignant potential. Juvenile polyposis syndrome (JPS) on the other hand is a hereditary condition characterized by the presence of hamartomatous polyps in the digestive tract and is known to have an increased risk of digestive tract malignancies. JPS is suspected when a patient has 5 or more juvenile polyps in the gastrointestinal tract or a juvenile polyp and a family history of juvenile polyps. A DNA test to check SMAD4 or BMPR1A gene is helpful.Figure 1.: (a) A 40mm polyp (Paris 0-Ip) located in the in the sigmoid colon. (b) Hamartomatous polyp has ulcerated surface with benign dilated glands.

The latest recommendations for the pharmacological treatment of irritable bowel syndrome with diarrhea. Review

Irritable bowel syndrome (IBS) is a common disorder resulting from disturbances in gut‑brain interactions, with a worldwide prevalence of 4.1 % to 10.1 % in adults. Although IBS is not life‑threatening, it is associated with a significant disease burden, including reduced quality of life, increased rates of comorbid psychological disorders, and high economic costs. One of the main subtypes of IBS is IBS with diarrhea (IBS‑D). Recently published guidelines of the American Gastroenterological Association (AGA) for pharmacologic treatment of patients with IBS‑D have just been released, based on evidence from a systematic and comprehensive review of the literature, while considering only randomized controlled trials conducted in adults with IBS. A positive diagnosis of IBS‑D can be made on the basis of medical history and physical examination, evaluation of gastrointestinal symptoms (especially presence or absence of worrisome features), limited diagnostic testing, and use of symptom‑based Rome IV criteria. The presence of alarming signs, such as the onset of new symptoms after age 50 years, rectal bleeding not associated with hemorrhoids or anal fissures, unintentional weight loss, iron deficiency anemia, nocturnal diarrhea, a family history of colon cancer, inflammatory bowel disease, or celiac disease, requires a thorough evaluation. In the treatment of IBS‑D, drugs with different mechanisms of action and different effectiveness are used. According to the latest AGA recommendations, most of the drugs, widely used in the treatment of IBS‑D (in particular, antispasmodics, loperamide, antidepressants), have a low reliability of efficacy evidence. Drugs with significant evidence of effectiveness include rifaximin‑a, eluxadoline, and alosetron, but the last two are not registered and are not used in Ukraine. Thus, until now, the only drug available in Ukraine for the treatment of IBS‑D and its relapses with well‑proven efficacy, is rifaximin‑a (Alfa Normix, Xifaxan). Selective serotonin reuptake inhibitors are not recommended for patients with IBS‑D.&#x0D;

De Novo Diagnosis of Lymphocytic Colitis After SARS-CoV-2 Vaccination

ABSTRACTSARS-CoV-2 mRNA vaccines are safe and effective for most patients. Gastrointestinal complications reported after vaccination have included gastroparesis and inflammatory bowel disease flares. In this study, we present a unique case of lymphocytic colitis that occurred in a healthy middle-aged man after Moderna SARS-CoV-2 mRNA vaccination. This reveals an unexpected complication of a mRNA vaccine that presented as worsening diarrhea after vaccination in a dose-dependent pattern. Caregivers should be aware of lymphocytic colitis as a possible complication of the Moderna vaccine and monitor those patients closely for symptom resolution.

Does Finding Cecal Adenoma Increase the Risk of Discovering More and Advanced Adenomas in the Remainder of the Colon?

Adenomatous polyps are common, occurring in up to 25% of the population older than 50 years of age in the United States. Conflicting data are present in the literature about the impact of specific adenoma locations and the prediction on the number and advanced histology of adenomas elsewhere. With this study we aimed to review the association between cecal adenoma and the risk of discovering more and advanced adenomas in the remainder of the colon. We performed a retrospective study of 1880 patients who received outpatient colonoscopies between June 2012 and December 2014 at the Veterans Affairs Medical Center in Oklahoma City. The data collected included patient demographics, indications for colonoscopy, smoking history, alcohol use, family history of colon cancer, quality of bowel preparation, number of adenomas, location, size of adenomas, and the histology of adenomas and colon cancer. The mean age of the study population was 61.6 ± 9.4 year, with 95% of the population being men. Cecal adenomas were found in 243 (12.9%) of patients. Patients with cecal adenoma tended to be older (65 ± 7 vs 61 ± 10, P < 0.0001), more likely to be men (97% vs 94%, P = 0.06) and less likely to have a colonoscopy done for screening indication (11% vs. 13%., P = 0.03). After adjusting for age, sex, indication, and quality of bowel preparation, patients with cecal adenoma were found to have a sixfold increase in finding ≥10 other adenomas elsewhere (4.5% vs 0.8% P = 0.0009) and a threefold increase in finding advanced adenomas (17.7% vs 9.9% P = 0.002) in the remainder of the colon. Stratifying by location, the increased risk was more pronounced in the right side (24.7% vs 8.9% P ≤ 0.0001) compared with the left side. Cecal adenoma is associated with an increased risk of finding more and advanced adenomas in the remainder of the colon, especially on the right side; therefore, the discovery of a cecal adenoma should prompt a more thorough evaluation of the entire colon, particularly the right colon.

Isolated Colonic Lymphangiectasia Secondary to Submucosal Injection.

CASE REPORT An 81-year-old woman with a medical history of tobacco use and family history of colon cancer was referred for colonoscopy because of a reported weight loss of 25 pounds over 10 months. Colonoscopy revealed a 15 mm flat polyp in the ascending colon with a mucus cap (Figure 1). A submucosal injection of ORISE gel revealed a large whitish discoloration of the mucosa encompassing the polyp and surrounding mucosa (Figure 2). The polyp was removed with a cold snare in a piecemeal manner. Biopsy specimens of the surrounding mucosa revealed dilated lymphatics (4× magnification, hematoxylin and eosin stain) (Figure 3), which were interpreted as isolated colonic lymphangiectasia secondary to submucosal injection.Figure 1.: Flat polyp in the ascending colon with a mucus cap.Figure 2.: Large whitish discoloration of the mucosa encompassing the polyp and surrounding mucosa after submucosal injection with ORISE gel.Figure 3.: Colonic specimen (4× magnification, hematoxylin and eosin stain) showing dilated lymphatics.Primary intestinal lymphangiectasia is a rare disease of an unknown worldwide incidence that primarily affects the small intestine in children younger than 3 years, usually with other congenital abnormalities.1 However, it is increasingly being recognized in adults because of direct visualization of the small bowel with imaging modalities, such as capsule endoscopy and double-balloon enteroscopy.2,3 Isolated colonic lymphangiectasias are even more rare, and their clinical significance in an asymptomatic patient is unclear. DISCLOSURES Author contributions: S. Tomar wrote and edited the article, reviewed the literature, and is the article guarantor. E. Alqassim provided the images and revised the article for intellectual content. S. Mahmood provided the images and critically reviewed the article. All authors approved the final version of the manuscript. Financial disclosures: None to report. Informed consent was obtained for this case report.

P-229 Comparison of clinicopathological and survival features of right and left colon cancers: Experience of the medical oncology department of Fez

Right-sided colon cancers (RCC) and left-sided colon cancers (LCC) have different epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. The objective of our study is to compare right-sided colon cancers and left-sided colon cancers regarding clinicopathological and survival characteristics. This is a retrospective study of 664 patients with colon cancer treated at the medical oncology department of Fez over a period from December 2009 to September 2020. Rectosigmoid, descending colon, and splenic flexure tumors were considered left-sided colon cancers, whereas ascending colon tumors were considered right-sided colon cancers. The Kaplan Meier method was used to estimate median survival. The study included 664 patients (female, 47 %) having colon cancer with a median age of 60years [23-83]. Of the patients, 78.5% (n=519) had LCC and 19.36 % (n=128) had RCC. The rate of patients aged ≥65 years and the rate of patients with a family history of colon cancer were higher in the LCC patients. The proportion of poorly differentiated adenocarcinomas represented 3%, of which 63% had cancer of the right colon. There was a significantly higher proportion of higher T stage (T3-4 :62%vs 38 %) in right sided tumors as compared to left sided tumors. The rate of metastatic patients was 64.1% in the RCC group and 43% in the LCC group. The median follow-up period was 14 months in the RCC group and 19 months in the LCC group with a higher median overall survival in the LCC group (32 vs 21 months). We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage associated with a median overall survival better in left colon cancer.

Improving sessile serrated adenoma detection rates with high definition colonoscopy: A retrospective study

BACKGROUNDSessile serrated adenomas (SSAs) are important premalignant lesions that are difficult to detect during colonoscopy due to poor definition, concealment by mucous caps, and flat appearance. High definition (HD) colonoscopy may uniquely aid in the detection of these inconspicuous lesions compared to standard definition (SD) colonoscopes. In the absence of existing clinical guidelines to obligate the use of HD colonoscopy for colorectal cancer screening in average-risk patients, demonstrating the benefit of HD colonoscopy on SSA detection rate (SSADR) may help strengthen the evidence to recommend its use in all settings.AIMTo evaluate the benefit of HD colonoscopy compared to SD colonoscopy on SSADR in average-risk patients undergoing screening colonoscopy.METHODSData from screening colonoscopies for patients aged 50-76 years two years before and two years after the transition from SD colonoscopy to HD colonoscopy at our large, academic teaching center were collected. Patients with symptoms of colorectal disease, positive occult blood test, history of colon polyps, cancer, polyposis syndrome, inflammatory bowel disease or family history of colon cancer or polyps were excluded. Patients whose endoscopists did not perform colonoscopies both before and after scope definition change were also excluded. Differences in individual endoscopist SSADR, average SSADR, and overall SSADR with SD colonoscopy vs HD colonoscopy were also evaluated for significance.RESULTSA total of 3657 colonoscopies met eligibility criteria with 2012 colonoscopies from the SD colonoscopy period and 1645 colonoscopies from the HD colonoscopy period from a pool of 11 endoscopists. Statistically significant improvements of 2.30% in mean SSADR and 2.53% in overall SSADR were noted with HD colonoscopy (P = 0.00028 and P = 0.00849, respectively). On the individual level, three endoscopists experienced statistically significant benefit with HD colonoscopy (+5.74%, P = 0.0056; +4.50%, P = 0.0278; +4.84%, P = 0.03486).CONCLUSIONOur study suggests that HD colonoscopy statistically significantly improves sessile serrated adenoma detection rate in the screening of average risk patients during screening colonoscopy. By improving the detection and removal of these lesions, adoption of HD colonoscopy may reduce the significant premalignant burden of sessile serrated adenomas.