Carcinoma Of Large Bowel Research Articles

CT FINDINGS OF MALIGNANT NEOPLASTIC MASSES OF SMALL AND LARGE INTESTINE WITH HISTOPATHOLOGICAL CORRELATION: A CROSS SECTIONAL STUDY

AIMS AND OBJECTIVES: To formulate an appropriate scanning protocol technique to evaluate malignant neoplasm of small and large intestine. To dene various CT ndings in malignant bowel neoplasm. To stage bowel neoplasm. To accurately characterize the tumour by histologic type as far as possible. Materials And Methods: In our cross-sectional study, 76 cases of small and large bowel carcinoma were referred to radiology department. After taking informed consent, CECT abdomen of the patients was done. All these patients went for surgical excision of the neoplastic mass; and the mass were sent for HPE examination. Epidemiological data, clinical features, CECT abdominal features were correlated with HPE type of the mass were found out. P-Value<0.05 was considered to be statistically signicant. Results: In Small bowel, ileum was the commonest site of involvement (5.26%), whereas sigmoid colon and rectum (18.42%) was commonest site of involvement in large bowel. Adenocarcinoma was the commonest histological subtype seen in 54 patients (71.05%), followed by lymphoma in 14 patients (18.42%), Mucinous Adenocarcinoma seen in 5 patients (57.5%). and gastrointestinal stromal tumor [GIST] seen in 3 patients(3.94%). Conclusion: Common CT imaging features in malignant bowel neoplasm are bowel Wall thickening >2cm,short Segment Involvementand heterogeneous mixed pattern. Although CT has a high specicity for detection of a metastatic lymph nodes, sensitivity is low.Liver is the commonest site of distant metastasis in malignant bowel neoplasm. Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from bowel malignant.

PH-sensitive nanoparticles containing 5-fluorouracil and leucovorin as an improved anti-cancer option for colon cancer.

Background: Parenteral administration of chemotherapeutic drugs, 5-fluorouracil (5-FU) and leucovorin (LV), is commonly used to treat large bowel carcinomas such as colon cancer (CC) and colorectal carcinoma (CRC). Aim: Our study aims to design a novel nanoparticulate drug-delivery vehicle for oral use capable of colon-specific release. Methods: A modified double-emulsion solvent evaporation method was used in the preparation of pH-responsive Eudargit® S100 polymeric nanoparticles, loaded with 5-FU/LV combination (5-FU/LV-loaded Eudargit S100 NPs). Results: Our optimized drug-loaded NP showed a pH-responsive drug release and exhibited significantly more cytotoxic actions in cancer-cell lines than free drugs. Conclusion: These findings open the way for conducting clinical trials for colon malignancies treated with nanoparticles.

English

INTRODUCTION: Right iliac fossa mass may arise from parietal wall or intraperitoneum or retroperitoneum. Mass may arise from right iliac regional structures or extended from adjacent structures. Appendicular pathology is commonest cause for right iliac fossa mass (either appendicular mass or abscess). Other common causes are ileo-caecal tuberculosis and carcinoma caecum. Appendicular mass is formed by inflamed appendix adherent with dilated ileum, greater omentum and caecum. Appendicular abscess due to suppuration in an acute appendicitis or suppuration in an already formed appendicular mass. Abdominal tuberculosis is common in developing countries like India. It is sixth most common type of extra pulmonary tuberculosis. Its incidence is high in HIV infected patients. Ileo-caecal tuberculosis is commonest type of abdominal tuberculosis due to presence of Peyer's patches and stasis of luminal contents favoured by ileo-caecal valve. Commonest type of carcinoma in caecum is adenocarcinoma. Third common site in large bowel carcinoma (12%). Diet with lack of fibres and high fat increases risk. Dietary vitamins A, C, E (antioxidants) and Zinc and high fibre diet reduce the risk. Diagnosis of right iliac fossa mass mainly depends on complete clinical examination, radiological, biochemical, microbiological and pathological investigations. Commonest cause of right iliac fossa mass in our country is appendicular mass or abscess, ileo-caecal tuberculosis and carcinoma caecum. OBJECTIVES: To study the aetiology, pattern of presentation, management and complications in patients with right iliac fossa mass in our institution. MATERIALS AND METHODS: This retrospective study was carried out in our institution over a period of two years from October 2010 to October 2012. All patients who are provisionally diagnosed to have mass in the right iliac fossa by clinical evaluation are included in the study. All data including age, gender, relevant history, investigations (complete blood count, Blood grouping and Rh typing, HIV I & II, Chest radiograph, Ultrasound abdomen and pelvis, CT Scan abdomen and pelvis, IVP and barium follow through and enema, FNAC, BIOPSY) were done to conclude the final diagnosis and appropriate treatment and postoperative complications and final histopathological reports were recorded in the standard forms. Cases are selected by following Inclusion and exclusion criteria; Inclusion criteria: All the cases admitted with Right iliac fossa mass in our institution. Exclusion criteria: Female patients with gynaecological diseases. Paediatric age group (<12 years) patients with right iliac fossa mass. CONCLUSION: Right iliac fossa mass was common in 20 to 50 years of age group. Overall incidence was more common in males as compared to females (1.1:1).Appendicular pathology and Carcinoma caecum was more common in males as compared to females. Ileo-caecal tuberculosis was more common in females. The diseases were more in people from low socio –economic status and the commonest symptom was pain in abdomen. Appendicular pathology (60%) either in the form of appendicular mass (32.5%) or appendicular abscess (27.5%) were the commonest cause of mass in the right iliac fossa. Ileo-caecal tuberculosis (20%), carcinoma caecum (12.5%) was the other common causes of mass in the right iliac fossa. Ultrasound abdomen was the essential investigation and it had a sensitivity of greater than 95%. Normal levels of serum CRP titer essentially ruled out appendicular pathology. Serial titers were helpful in assessing the treatment response of ileo-caecal tuberculosis and in prognosis of carcinoma caecum. In patients with appendicular mass, initial conservative management followed by interval appendicectomy had better results with minimal complications. In patients with appendicular abscess, abscess drainage combined with appendicectomy in the same procedure, had high morbidity compared to patients who underwent interval appendicectomy following abscess drainage. 44% of the patients with ileo-caecal tuberculosis were managed conservatively with anti-tubercular therapy (DOTS-I). Surgery was required in another 56 % of the patients, of which 25 % of the patients presented with acute complications needing immediate surgery. 31 % of the patients presented with sub-acute intestinal obstruction due to adhesions and strictures following the initiation of anti-tubercular therapy, which later required surgical intervention. 80 % of the patients with carcinoma caecum underwent successful surgical resection. 20 % of the patients presented with acute surgical problem requiring immediate surgery. 10 % of the patients presented with advanced disease. Most of the parietal wall and retroperitoneal conditions were treated surgically. Early evaluation and intervention is needed to improve the patients’ outcome and to reduce the morbidity and mortality.

Correlation of number of tumor buds and tumor stage in large bowel carcinomas

Correlation of number of tumor buds and tumor stage in large bowel carcinomas

Abdominal wall reconstruction after resection of an enterocutaneous fistula with an island pedicled anterolateral thigh perforator flap. Case report.

Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.

Heat shock protein 60 levels in tissue and circulating exosomes in human large bowel cancer before and after ablative surgery.

Heat shock protein 60 (Hsp60) is a chaperonin involved in tumorigenesis, but its participation in tumor development and progression is not well understood and its value as a tumor biomarker has not been fully elucidated. In the current study, the authors presented evidence supporting the theory that Hsp60 has potential as a biomarker as well as a therapeutic target in patients with large bowel cancer. The authors studied a population of 97 subjects, including patients and controls. Immunomorphology, Western blot analysis, and quantitative real-time polymerase chain reaction were performed on tissue specimens. Exosomes were isolated from blood and characterized by electron microscopy, biochemical tests, and Western blot analysis. Hsp60 was found to be increased in cancerous tissue, in which it was localized in the tumor cell plasma membrane, and in the interstitium associated with cells of the immune system, in which it was associated with exosomes liberated by tumor cells and, as such, circulated in the blood. An interesting finding was that these parameters returned to normal shortly after tumor removal. The data from the current study suggested that Hsp60 is a good candidate for theranostics applied to patients with large bowel carcinoma and encourage similar research among patients with other tumors in which Hsp60 has been implicated.

COLORECTAL CARCINOMA

Introduction: Prognosis is excellent in colonic carcinoma in case of well differentiated growth. All efforts must be done todiagnose the malignancy at an earlier stage for a better outcome specially if it is well differentiated growth. Objectives: To compare thedifferent modes of presentation of carcinoma of large bowel in a tertiary care hospital and their association with pathological findings.Material &amp; Methods: It is a cross sectional retrospective study. Patients with histological proof of carcinoma were included in the study.Data over the period of two year was collected and analyzed. Results: This study included one hundred patients. Mean age was 49.56years and 56 % of the patients were males. 40 % of the patients present between the ages of 40 to 60 years. Mean time of start ofsymptoms and the time of presentation in the hospital was 6.5 months ranges from 1 to 24 months. 76 % of the patients had history ofaltered bowel habits and 60% had anorexia and weight loss. 41.66% of patients had well differentiated growth while 37.55% of patientshad moderately differentiated adenocarcinoma. Conclusions: Majority of the patients with colonic carcinoma had well or moderatelydifferentiated growth. If they are diagnosed and properly treated at an early stage, outcome is good.

Abstract A87: Correlation between microsatellite instability and clinical characteristics and outcome of colorectal cancer in an Iranian population

Abstract Widespread microsatellite instability (MSI) occurs in nearly 15% of sporadic colorectal cancers. Large bowel carcinomas with high-frequency MSI (MSI-H) (instability at &amp;gt; or = 30% of microsatellite loci) are believed to display distinctive pathologic features and to behave less aggressively than microsatellite-stable (MSS) tumors and carcinomas with low-frequency MSI (MSI-L) (instability at &amp;lt; 30% of microsatellite loci). In this study we would like to show the impression of MSI on clinical condition and outcome of patients with colorectal adenocarcinoma. Methods: MSI status was evaluated in 600 large bowel adenocarcinomas using polymerase chain reaction (PCR) and sequencing. Tumors that showed instability with at least two microsatellite markers were classified as MSI-H, whereas the other tumors were classified as MSI-L (instability at one locus) or MSS (no instability). Results: MSI-H was detected in 51.6% of CRC patients. The prevalence of proximal lesions in the MSI-H group (38.7%) was higher than in the MSS group (27.4%). The percentage of moderately differentiated tumors was slightly lower in the MSI-H group (16.3%) when compared to the MSS group. Eight mutations were detected in five patients with 32 MSI-H. Conclusion: Assessment of MSI status is an essential step in discovering genetic characterizations of large bowel carcinomas and identifies a subset of tumors with distinct clinical, pathologic, and biologic features. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A87.

Interaction between HSP60 and β-catenin promotes metastasis

Heat shock protein 60 (HSP60) plays an essential role in assisting many newly synthesized proteins to reach their native forms. Increased HSP60 expression is observed in different types of human cancers with metastasis (e.g. pancreatic cancer and large bowel carcinoma). However, the role of HSP60 in metastasis remains little known. Aberrant activation of beta-catenin plays a key role in tumorigenesis and metastasis. Here, we show that overexpression of HSP60 induces metastatic phenotypes in vitro and in vivo. HSP60 interacts with beta-catenin, increases beta-catenin protein levels through the apical domain and enhances its transcriptional activity. Short-interference RNA-mediated repression of beta-catenin reverts metastatic activity caused by HSP60 overexpression. Proteosomal activity is not required for the induction of beta-catenin by HSP60. Coexpression of HSP60 and nuclear beta-catenin predicts a worse prognosis of metastatic head and neck cancer patients. These results implicate a novel role of HSP60 in metastasis.

Anal gland adenocarcinoma

Anal malignancies constitute approximately 1 to 3 % of all large-bowel carcinomas 12 and less than 6 % of all anorectal carcinomas 34 . The latter is either squamous or glandular type. The squamous cell carcinoma is much more common than adenocarcinoma. Anal canal adenocarcinoma is subclassified into adenocarcinoma arising in anal mucosa and extamucosal (perianal) adenocarcinoma. The latter includes adenocarcinoma with anorectal fistula, and adenocarcinoma of anal glands 5 . In this article, we present a case of 49-year-old man with anal mass diagnosed as anal gland adenocarcinoma. We also reviewed the literature of this rare entity.

Clinical significance of heat shock protein 10 in large bowel carcinoma

To investigate the expression of heat shock protein 10 (HSP10) during genesis and development of large bowel carcinoma and discuss the clinical significance about its expression. The expression of HSP10 was observed in specimens from normal colonic mucosa (NC), colorectal adenomas (CA) and colorectal adenocarcinomas (CAC) by immunohistochemistry EnVision™. Its correlations to clinicopathologic features, as well as to postoperative survival time of large bowel carcinoma patients were analyzed. The expression of HSP10 was common in normal colonic mucosa, colorectal adenomas and adenocarcinomas and more intensive in colorectal adenomas and adenocarcinomas than that in normal colonic mucosa (P < 0.001). The positive expression of HSP10 had no correlation to clinicopathologic features, including age, gender, primary tumor, infiltrating of regional lymph node, metastasis, clinical stage and histopathology of large bowel carcinoma patients, as well as to their postoperative survival time. HSP10 was overexpressed in the early stage of colorectal adenocarcinoma suggesting that it could serve as an index for early diagnosis of large bowl carcinoma. The positive expression of HSP10 had no correlation to clinicopathologic features or postoperative survival time of large bowel carcinoma patients.

Malignant Mesothelioma of the Pleuraand Other Malignancies in the Same Patient

The co-existence of mesothelioma, mostly asbestos-related, and other primary malignancies has repeatedly been reported. The present study evaluated the frequency of such an occurrence. In the period October 1979-June 2002, 215 cases of malignant pleural mesothelioma were diagnosed at the Hospital of Monfalcone, Italy. All the cases of the above series, examined at necropsy (169), were included in the study. Occupational histories had been obtained from the patients or from their relatives by personal or telephone interviews. In 132 cases, asbestos bodies were isolated after chemical digestion of lung samples. The thoracic cavities were examined for pleural plaques. Additional malignancies were observed in 32 cases (18.9%). Multiple tumors were synchronous in 22 cases, metachronous in 8 cases, and synchronous and metachronous in 2. Four different tumors were found in 2 cases, 3 malignancies were detected in 6 patients, and 2 malignancies in the remaining 24. The most frequent additional malignancies were prostate adenocarcinoma (7 cases), non-Hodgkin lymphoma or chronic lymphocytic leukaemia (5 cases), bladder carcinoma (4 cases), kidney carcinoma (4 cases), large bowel carcinoma (4 cases), and liver cell carcinoma (4 cases). All the patients had histories of exposure to asbestos, mostly in shipbuilding. Lung asbestos body burdens ranged between 60 and 230,000 per gram of dried tissue. Pleural plaques were found in 26 cases. In contrast with other series of the literature, in the present cases the co-existence of mesothelioma and other malignancies appeared as a relatively frequent event. The lack of a control group does not allow definite conclusions about the meaning of the occurrence. However, the co-existence of certain tumors with asbestos-related mesothelioma suggests that mesothelioma and associated malignancies might share some etiologic factors (asbestos and others).

The immunology of large bowel carcinoma in a rat model.

A rat large bowel carcinoma model has been established with close similarities to the immunological features of the corresponding human neoplasms as far as those are presently known: (1) common antigens with tissue-type specificity, (2) expression of immunogenic gut-specific embryonal antigens, (3) cell-mediated immunity present in tumor bearers, whose sera are capable of blocking the lymphocyte effect specifically, and (4) rapid disappearance of the serum blocking activity after tumor excision. It is suggested that this model is therefore particularly suitable for further detailed analysis of the potential function in vivo of tissue-type specific antigens. In addition, this model appears to be applicable to correlating alterations in immune status with tumor course after various modes of intervention such as chemotherapy and immunotherapy alone, or in combination with surgery.

Paget's disease of the anus: A clinicopathological study

Paget's disease of the anus is a rare disorder of controversial origin and is frequently associated with malignancy. We studied eight patients and carried out immunohistochemical studies to determine whether particular functional profiles might be indicators of a malignant association. One patient presented with synchronous carcinoma and two developed carcinomas 3 and 10 years after excision of Paget's disease. Five patients underwent wide local excision and have not developed cancer (median follow-up 6 years, range 5-13 years). However, four patients developed recurrent Paget's disease. Immunohistochemical studies showed that in general Paget cells stained positively with CAM 5.2 (a cytokeratin marker), gross cystic disease fluid protein (a marker for apocrine cells), human milk fat globule glycoprotein (HMFG 1 and 2) and carcinoembryonic antigen but negatively for PR3A5 (a marker for colonic goblet cells). Three cases had a staining profile which was quite different from that usually observed and these were associated with malignancy. One showed an antigenic profile more typical of a large bowel carcinoma. Paget's disease of the anus appears to run one of two clinical courses: to develop malignancy; or to recur locally, often on repeated occasions. Wide local excision is the treatment of choice but long-term follow-up is necessary because of the cancer risk. An immunohistochemical staining pattern which is different from usual may indicate a higher malignant risk and/or identify some cases of Paget's disease as representing a downward 'pagetoid' extension from a anorectal adenocarcinoma rather than a true epidermotropic apocrine neoplasm of the perianal skin.

Incidence of synchronous and metachronous colorectal carcinoma.

Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10.7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis--synchronous carcinoma. In the other six cases a second carcinoma was found at a later time--metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.

Carcinoma of proximal large bowel associated with acute appendicitis

Carcinoma of proximal large bowel associated with acute appendicitis

The value of routine preoperative urological assessment in patients undergoing elective surgery for diverticular disease or carcinoma of the large bowel.

A consecutive series of 176 patients was studied prospectively in order to assess the value of full urological assessment prior to elective colorectal surgery for carcinoma or diverticular disease. Fifty-one patients had urological symptoms and 29 of these had an abnormal intravenous urogram (IVU); when compared with the 125 asymptomatic patients, they were twice as likely to develop acute retention of urine and four times more likely to require prostatectomy. Twenty of the 31 patients with an abdominal mass had an abnormal intravenous urogram, and the presence of this physical sign may be regarded as an absolute indication for IVU. Forty-five patients had a urological abnormality on the preoperative IVU; of these, 1 in 6 required treatment prior to elective large bowel surgery and 1 in 3 developed acute retention of urine postoperatively (half required prostatectomy). Twenty-two patients had a disease-related abnormality on preoperative IVU and in 12 planned urological surgery was undertaken at the time of the colorectal resection. In the 91 patients with no urological symptoms, no abnormal mass and normal blood urea and mid-stream urine sample, the incidence of IVU abnormalities and of postoperative complications was low and surgical management was not altered in these patients.

Villous tumours of the large bowel.

A series of 110 patients with villous tumours of the colon and rectum treated by a single surgeon over an 18-year period is reported. Multiple lesions were present in 15 per cent of patients and 24 per cent of cases contained invasive malignancy, of which 83 per cent were Dukes' A. The major lesion was in the rectum in 84 per cent of patients and in the sigmoid colon in 12 per cent. Rectal bleeding and diarrhoea were the most common presenting symptoms; 6 per cent of patients were asymptomatic. Digital assessment proved a more reliable indicator of the presence of malignancy than either random biopsy or barium enema. In all, 70 of 76 (92 per cent) benign rectal lesions and 15 of 22 (68 per cent) malignant rectal lesions were successfully removed by peranal submucous excision or snaring and none of the malignancies so treated has developed a recurrence to date. Benign recurrence has developed in 13 per cent of all patients; the majority appeared within 4 years and were at the same level as the initial lesion. Of the 79 patients with benign tumours 7.6 per cent have subsequently developed large bowel carcinomas, after 2-16 years; all were symptomatic, half were at the same level as the previous benign lesion, and half were suitable for peranal removal.

The expression of HSP60 and HSP10 in large bowel carcinomas with lymph node metastase

BackgroundThe involvement of Heat Shock Proteins (HSP) in cancer development and progression is a widely debated topic. The objective of the present study was to evaluate the presence and expression of HSP60 and HSP10 in a series of large bowel carcinomas and locoregional lymph nodes with and without metastases.Methods82 Astler and Coller's stage C2 colorectal cancers, of which 48 well-differentiated and 34 poorly-differentiated, were selected along with 661 lymph nodes, including 372 with metastases and 289 with reactive hyperplasia only, from the same tumours. Primitive tumours and both metastatic and reactive lymph nodes were studied; specifically, three different compartments of the lymph nodes, secondary follicle, paracortex and medullary sinus, were also analysed. An immunohistochemical research for HSP60 and HSP10 was performed and the semiquantitative results were analysed by statistical analysis to determine the correlation between HSPs expression and 1) tumour grading; 2) degree of inflammation; 3) number of lymph nodes involved; 4) lymph node compartment hyperplasia. Moreover, western blotting was performed on a smaller group of samples to confirm the immunohistochemical results.ResultsOur data show that the expression of HSP60, in both primary tumour and lymph node metastasis, is correlated with the tumoral grade, while the HSP10 expression is not. Nevertheless, the levels of HSP10 are commonly higher than the levels of HSP60. In addition, statistical analyses do not show any correlation between the degree of inflammation and the immunopositivity for both HSP60 and HSP10. Moreover, we find a significant correlation between the presence of lymph node metastases and the positivity for both HSP60 and HSP10. In particular, metastatic lymph nodes show a higher percentage of cells positive for both HSP60 and HSP10 in the secondary follicles, and for HSP10 in the medullary sinuses, when compared with hyperplastic lymph nodes.ConclusionHSP60 and HSP10 may have diagnostic and prognostic significance in the management of this tumour and their overexpression in tumoral cells may be functionally related to tumoral progression. We hypothesise that their expression in follicular and medullary cells of lymph nodes may be induced by formation of metastases. Further studies based on these observations could lead to a better understanding of the HSPs involvement in colorectal cancer progression, as well as other neoplasms.

Intramucosal bacteria in colon cancer and their elimination by probiotic strainEnterococcus faecium M-74 with organic selenium

Intraepithelial bacteria were isolated by the gentamicin protection assay (GPA) from biopsy samples obtained at colonoscopy (colon cancer, n = 10 patients; colonic adenoma, n = 20; control group, n = 20; cancer patients without gastrointestinal tract GIT malignancy, n = 10). After a three-month administration of E. faecium M-74 to patients with positive GPA biopsies, 172 biopsy specimens from 60 patients were examined with the GPA. The number of biopsies with intracellular bacteria was significantly higher in adenoma and carcinoma group than in control group (26 vs. 10%; p = 0.004); in cancer patients without GIT malignancy the difference was nonsignificant. E. faecium M-74 was also administered to 5 patients with colonic adenoma; according to a control colonoscopy the number of biopsies with intracellular bacteria was significantly lower after probiotic administration (48 vs. 16%; p = 0.03). A striking prevalence of intraepithelial bacteria was also showed in patients with large bowel adenoma and carcinoma. The administration of probiotic strain M-74 can thus be considered to be an effective and promising method for elimination of pathogenic bacteria in the case of inflammatory bowel disease and colon cancer.