Recto Sigmoid Research Articles

514P - Does Exact Primary Site Impact on Outcome for Metastatic Colorectal Cancer (Mcrc)?

ABSTRACT Aim: Previous reports have described differences in biology and outcome based on whether the primary bowel cancer is right (R) or left (L) sided. Some authors have, however, argued that separating into right and left is too limited and that different patterns still exist within each sub group. Here we aimed to look at each individual primary site and outcomes from the SA mCRC registry to test this hypothesis. Methods: We assessed for differences in patient characteristics and outcomes based on the standard divisions of primary sites; caecum, ascending (AC), hepatic flexure (HF), transverse (TC), splenic flexure (SF), descending (DC), sigmoid (SC), rectosigmoid (RS) or rectal. Kaplan Meier was used for survival outcomes and a descriptive analysis was undertaken for prognostic markers. Results: 2877 patients were analysed. Primary site frequency was as follows; Caecum 14.6%, AC 9.2%, HF 3.1%, TC 6.2%, SF 2.8%, DC 3.9%, SC 21.9%, RS 6.8% and 26.7% rectum (4% unknown). Differences between sites were age, female sex, rates of poorly differentiated pathology, and rate of lung metastasis. There were no subgroups within the R & L division that stood out as behaving differently. Median age was 76.3 yrs for caecum compared with 69.3 yrs for rectum. Female sex was highest in caecum 52.5% vs. 34.9% rectum. Poorly diff pathology, caecum to SF 30-40.7% vs. DC to rectum 18.3-20.9%. Lung metastasis, caecum to SF 3-6% vs. DC to rectum 9.6-12.8%. There was variation in KRAS mutation; highest 59% in caecum, 48% for DC and Conclusions: Cancer of the caecum had the highest proportion of females, poorly differentiated pathology and KRAS exon 2 mutation. Lung metastases were observed more commonly in cancers that originate from the distal colon to rectum as compared to more proximal cancers. R sided primary sites have a poorer outcome consistently than those designated L. Overall, the SA mCRC data supports a distinction between metastatic tumors of right versus left sides origin, with the transition point being at the splenic flexure. Disclosure: All authors have declared no conflicts of interest.

Recto sigmoid bladder reservoir for patients with exstrophy: Three dimensional evaluation for outcome analysis

ObjectiveTo report the results of recto sigmoid bladder reservoir (RSBR), a variant of ureterosigmoidostomy (US) in patients with bladder exstrophy (BE) using a three dimensional evaluation system. Patients and methodsThis was a predominantly retrospective evaluation for all patients of BE undergoing RSBR who had completed minimum of 1 year follow-up. The patients were evaluated using a three dimensional system which included evaluation of urinary continence per rectally, status of upper tracts and health related quality of life (HRQOL). ResultsA total of 19 patients (four females) were evaluated. Mean age was 8.4 years, and mean duration of follow-up was 3.4 years. Mean age at RSBR was 5.1 years. Ten patients had good rectal continence. There was occasional minimal urine leak while passing flatus or on straining in nine. All patients had preserved renal function except one. The mean HRQOL score was 129.7 out of maximum of 150.. ConclusionsRSBR gives marked improvement in quality of life in patients of BE. In the literature there is a non-uniformity in the results reporting outcome of US. The presented three dimensional assessment provides a comprehensive way to report the results in the short/long term. If used by other surgeons it would make comparison across centers feasible.

Case Report: Long-Term Survival in Patient with Cirrhosis of the Liver and Colon Cancer K-ras Wild-Type

K-ras wild-type carcinoma is a tumour that is sensitive to treatment with anti-cancer and anti-EGFR drugs: the combination of Cetuximab and Panitumumab with chemotherapy (Cetuximab) or as a single therapy (Panitumumab). Case Report: The clinical case presented here refers to a 68-year-old patient who had been diagnosed with adenocarcinoma of the recto sigmoid with pelvic recurrence three years after surgery. The patient had a severe co-morbidity: correlated B-type liver cirrhosis. First-line chemotherapy was begun with Oxaliplatin plus Capecitabine (CAPOXI) following a relapse, and this continued for six months (six cycles), when the treatment was interrupted because of the disease’s progression and hematological and gastrointestinal toxicity. Following an assessment of the K-ras, diagnosed as wild type, the patient was excluded from second-line chemotherapy treatment because of decompensated cirrhosis and the persistence of thrombocytopenia and leukopenia. The patient was put forward for biological treatment with an anti-EGFR monoclonal antibody (Panitumumab). Panitumumab was administered at a dosage of 6 mg/kg every 2 weeks for 17 months; the treatment was well tolerated, despite the cirrhosis, and the main toxicity was the skin rash. Conclusion: In patients with severe comorbidities such as cirrhosis of the liver and K-ras wild-type carcinomas, therapy with a monoclonal antibody such as Panitumumab is a treatment that is well tolerated, with few serious toxic side-effects; it also offers advantages in terms of survival and clinical benefits.

COLORECTAL CARCINOMA;

Introduction: Large bowel obstruction due to colorectal carcinoma occurs in up to 20% of the patients and usually2-4 accompanied by morbidity and mortality . Almost 25 % deaths occur post-operatively following surgery for colorectal cancers occur in1 those who initially present with obstruction . Usually elderly patients with associated co-morbidities presents with bowel obstruction.Objective: Find out the frequency of colorectal cancers in patients presenting with large bowel obstruction. Design: Prospective crosssectional study. Setting: Shaikh Zayed Hospital Lahore. Period: from 31st December 2010 to 31st December 2012. Materials &Methods: A total 20 patients were presented with large bowel obstruction with the age ranges between 40 to 70 years. All the 20 patientsunderwent routine haematological and biochemical tests. In these patients an abdominal x-ray in a supine or standing position was takenand dilated loops of bowel, air-fluid interfaces, or both was observed then Contrast radiography(Barium/gastrograffin) was done todefine the site and extent of the obstruction. An abdominal computed tomography scan was done to evaluate the extent of the disease.Colonoscopy was also carried out in the patients with colorectal cancers to find out the size and location of the tumor and biopsy taken bycolonoscope. Results: 12 patients out of 20 presented with large bowel obstruction were diagnosed to have a colorectal cancers and theage ranges from 60 to 70 years. The 8 patients were diagnosed to have a sigmoid colonic tumour and 4 patients were suffering from atumour of recto sigmoid junction. Whereas in rest of the 8 patients the large bowel obstruction was due to other benign causes likevolvulus and intussusception and age range was 50 – 60 years. 6 patients were suffering from sigmoid volvulus and remaining 2 hadcolo-colic intussusception. Conclusions: It is concluded that the major cause of the large bowel obstruction is the left sided colorectalcancers the tumours of recto sigmoid junction.

Six months versus twelve months of capecitabine as adjuvant chemotherapy for stage III (Dukes' C) colon cancer: Initial safety report for the open-label randomized phase III study (JFMC37-0801).

3607 Background: The standard treatment duration of adjuvant chemotherapy (CT) in patients (pts) with stage III colon cancer is 6 months. On the other hand, no clinical trial showed the optimal treatment duration of oral chemotherapeutic agents in adjuvant setting for colon cancer. Sargent et al have reported that 83% of recurrences in stage II and III pts have occurred within the first 3 years after surgery and peak was observed around one year after surgery. Therefore, to clarify the benefit of 12 months administration of Capecitabine, we designed randomized phase III trial for a comparison of 6 months treatment and 12 months treatment of capecitabine as adjuvant CT for stage III colon cancer. Methods: JFMC37 is a multicenter, randomized Phase III trial. Patients with fully resected Stage III colon or recto sigmoid cancer were eligible. Capecitabine was administered orally as tablets, 2,500 mg/m²/day for 14 days followed by a 7-days rest. Treatment is continued to 8 cycles (6 months) in arm A (A) or 16 cycles (12 months) in arm B (B). Patients were randomized 1:1 to A or B. Data size was estimated by disease free survival as primary endpoint. The statistical design is based on superiority hypothesis; 5-yrs DFS is 60% in arm A, 67% in arm B ;unilateral α=0.05, 1-β=0.8;and planed accrual is 1200 pts. Results: Between September 2008 to December 2009, 1304 patients were enrolled and then randomized. Both arms were well balanced for mean age: (A) 64.1, (B) 63.8; ECOG PS (%0/1): (A) 95.0/5.0, (B) 97.1/2.9; involvement of lymph nodes (%N0/N1/N2): (A) 77.1/19.9/3.1, (B) 76.6/19.7/3.7. Treatment completion rate for A and B were 68.2% and 43.4%. Incidences of serious adverse events (SAEs) over 1% were neutropenia: (A) 2.6%, (B) 3.8%, diarrhea: (A) 2.9%, (B) 2.1%, loss of appetite: (A) 1.3%, (B) 1.0%, fatigue: (A) 1.8%, (B) 1.2%, hand-hoot syndrome: (A) 16.4%, (B) 22.1%. Conclusions: There were no obvious differences in SAEs between arm A and arm B. Although twelve months of capecitabine showed a tendency to increase G3/4 hand-foot syndrome, we concluded that incidence of SAEs were acceptable and comparable to previously report.

Changing Epidemiology of Colorectal Cancer Makes Screening Sigmoidoscopy Less Useful for Identifying Carriers of Colorectal Neoplasms

There is renewed interest in flexible sigmoidoscopy (FS) colorectal cancer (CRC) screening following trials showing significantly reduced CRC incidence and mortality. To evaluate the potential usefulness of FS screening in our population. We examined rectosigmoid (RS) cancer epidemiology in our Jewish population using Israel National Cancer Registry data, computed by CRC site, age groups, and gender. We also reviewed endoscopy-screening publications for prevalence of RS and proximal advanced adenomas (AAP) and having both or either. During 1980-2008, there were 64,559 CRCs registered; 31.6 % were RS cancer which has now decreased to 29 % of men's and 26 % of women's CRC (both P < 0.01). In <50 year olds, RS cancer occurred in 42 % of males' and 35 % of females' CRC, and in the last 2 decades this ratio is unchanged. In 50-74 year olds, RS cancer decreased to stable levels of 32 % of males' and 29 % females' CRC (both P < 0.01). In ≥75 year olds, RS cancer progressively decreased to 24 % of males' and 22 % females' CRC (both P < 0.001). From endoscopy screening reports in 40-79 year olds, RS AAPs occurred in 2.0-5.8 %, being least in women, most in men, and not increased with aging. Some 50-57 % of screenees had both RS and proximal AAPs, least when aged 40-49 years at 25 %, women were 35 %, and with aging 40 %, but most in men at 70 %. With the changing CRC epidemiology, having fewer RS neoplasms but more proximal cancer, the effectiveness of FS screening for identifying significant neoplasms decreases with screenees' age and especially in females. These make FS screening less suitable for our aging and increasingly female population.

Su1327 Pathology Costs and Adenoma Detection Rate (ADR): Another Measure of Quality Colonoscopy?

Adenoma detection rate (ADR) is a validated measure of quality in colonoscopy and polyp detection rate (PDR), is its proposed surrogate marker. In prior study, we demonstrated that ADR and PDR correlated well in segments proximal to the splenic flexure. ADRs declined in the rectosigmoid (R-S) despite increased polypectomy rates. Higher polypectomy rates are associated with higher pathology costs as charges are calculated by specimen bottle. The pathology cost difference may be blunted by the practice of sending multiple polyps in one specimen bottle when they are closely located.

The Application of Current Diagnostic Protocols of patients with colon cancer in Preparation for Therapy

Introduction:Colorectal cancer is the third most common tumor which causes high percentage of mortality in the general population. Etiologic factors which cause this disease are various, while diagnostic methods involve very complex protocols from detection of tumor markers to a combination of endoscopic and imaging methods.Goal:To determine the number of patients suffering from colon cancer for a period of two years and with endoscopic methods to verify and localize the tumor and its spread. Histopathological determination of the tumor type. Determine the concentration of CEA and CA 19-9 in the serum. Depending on the tumor location asses its progression, severity and extent by radiological imaging methods.Material and Methods:The study was prospective and retrospective, performed at the Gastroenterohepatology Clinic of the Clinical Center of Sarajevo University. During the two-year follow-up, 91 patients were hospitalized underwent endoscopy, targeted biopsy and histologically proven adenocarcinoma of the colon in which a pathologist determined grade of the cancers. Samples were eosin stained and underwent pathological histological analyzes. All patients according to tumor localization underwent CT scan and MRI of the rectum and pelvis.Results:The most common location of the cancer regardless of sex was in the recto sigmoid colon. Prevalence of colorectal cancer spread to other organs was not related to location. No significant dependence of the localization of the tumor by gender was found (p-value = 0.313). Ca 19-9 had the highest value in localization of tumors in the rectum. There was no statistically significant difference in age between men and women. The largest number of patients has adenocarcinoma grade 2 and the localization at the rectum.Conclusion:The combination of laboratory parameters (CEA and CA 19-9) with endoscopic and radiological imaging methods is essential in diagnosis of colorectal cancer and assessment of the process progression. There is a need to impose additional diagnostic parameters to detect the disease at an earlier stage.

Unusual Presentation: Endometrial Stromal Sarcoma Arising in the Colonic Endometriosis

Purpose: Endometriosis is a common gynecologic disorder but endometrial malignant transformation is a rare clinical complication. Most common extra-uterine site is ovary. We would like to explore two cases of colonic endometrial carcinomas presenting as colorectal cancer and IBD. Case: Review of two cases of endometrial stromal sarcoma arising in the colonic endometrial implants. First Case: 42 year old female was seen in the clinic due to abdominal pain. Her CT scan showed possible recto sigmoid mass. Colonoscopy confirmed the mass and extensive biopsies were done. Pathology report revealed a well differentiated endometrial stromal sarcoma. There was no evidence of colorectal glandular neoplasia. Markers of GIST, vascular, neural, melanocytic and ovarian stromal tumors are negative. Patient underwent rectosigmoid resection and total abdominal hysterectomy with bilateral salpingo oophorectomy. Results confirmed low grade endometrioid stromal sarcomas from sigmoid colon and multiple extra uterine sites including left ovary. Evidence of sarcoma was not identified in the uterus. Second Case: 64 year old female was seen in the clinic due to rectal bleed. She has a history of hysterectomy with bilateral salpingo oophorectomy 10 years ago for extensive endometriosis. She was diagnosed with ulcerative colitis involving her left colon based on colonoscopy and biopsy results. CT scan showed a thickened sigmoid colon with an adjacent soft tissue mass. She underwent colonoscopy but the scope could not be passed due to a sigmoid colon stricture. She then went to surgery for resection of this portion of the sigmoid colon and adjacent soft tissue mass. Pathology of the surgical specimen showed endometrial carcinoma. Conclusion: Malignant transformation of endometriosis was first reported by Sampson in 1925 (Bullard KM, Am Surg, 2005 Aug; 71(8):694-7). Most common site is ovary with a range from 76 to 79%. Endometrial implants associated intestinal cancers are extremely uncommon clinical condition. Diagnosing these tumors can be some times very challenging. Pathology criteria to support the diagnosis is stromal cell proliferation, positive CD 10 immunohistochemical stains and positive estrogen and progesterone receptors. Abdominal pain and rectal bleeding are common clinical symptoms. We recommend including malignant transformation of endometrial implants as one of the differential diagnosis in women presenting atypically for colorectal cancer or inflammatory bowel disease.Figure: Case 1.

Multidisciplinary Discussion and Management of Rectal Cancer: A Population‐based Study

BackgroundThe purpose of the present study was to evaluate the value of discussing rectal cancer patients in a multidisciplinary team (MDT).MethodsAll treated rectal cancer patients (>T1M0) diagnosed in 2006–2008 were included. According to the national guidelines, neoadjuvant (chemo)radiotherapy should be given to all rectal cancer patients. Patients were scored as “discussed” (MDT+) only if documented proof was available. The primary endpoint was the number of positive circumferential resection margins (CRM ≤1 mm).ResultsOf the 275 patients included, 210 were analyzed (exclusions: (recto)sigmoid tumor, acute laparotomy, and inoperability). Neoadjuvant treatment was applied in 174 (83%) patients and followed by total mesorectal excision in 171 (81%) patients. Patients considered not to require downstaging, received short-course radiotherapy (SCRT) (n = 116) or no radiotherapy (no RT) (n = 36), whereas 58 more advanced patients received chemoradiotherapy (CRT). The MDT discussion took place in 116 cases (55%). In the MDT+ group an MRI was used more often (p = 0.001) and TNM staging was more complete (p < 0.001). The proportion of patients with advanced disease was higher in the MDT+ group (88% ≥T3/N+ versus 68%; p = 0.001). The overall CRM+ rate was 13% and did not differ between the MDT+ and the MDT− group (p = 0.392). In patients receiving SCRT or no RT, the CRM+ rate was 10%, whereas the rate was 20% for patients receiving CRT.ConclusionsAlthough no difference in CRM+ rate was found for those patients who were discussed and those who were not, our results demonstrate room for improvement, especially in the selection of patients for SCRT or no RT. We advocate standardized documentation of treatment decisions and pathology reports.

Six months compared with 12 months of capecitabine as adjuvant chemotherapy for stage III (Dukes' C) colon cancer: Rationale for the open-label randomized phase III study, JFMC37-0801.

517 Background: The standard duration of adjuvant chemotherapy (CT) in patient with stage III colorectal cancer is 6 months. On the other hand, no clinical trial which investigate an optimal duration of oral chemotherapeutic agents has yet been implemented for adjuvant treatments. According to the ACCENT database (Sargent, et al. J Clin Oncol 27: 872- 877, 2009), 83% of recurrences in stage II and III pts have occurred within the first 3 years after surgery and peak was observed around one year after surgery. Also, single-agent FU-based adjuvant CT reduced the hazard rate of OS, DFS, and TTR, although the peak of events around one year was still remained especially for stage III pts. We analyzed the data of recurrent risk of curatively resected colon cancer pts provided by JFMC7-1-7-2-15, X-ACT. Surgery alone group and 6 months CT (5FU/LV or capecitabine [Cape]) showed highest peak between 12 months to 18 months after surgery, but 12 months oral 5-FUs group did not show recurrence peak between 12 months to 18 months after surgery. Therefore, to clarify the benefit of 12 month administration of Cape, we planned a phase III randomized trial for a comparison of 6 months treatment and 12 months treatment. Methods: JFMC37 is a multicenter, randomized phase III trial. Patients with fully resected stage III colon or recto sigmoid cancer were eligible. Patients were randomized 1:1 to receive Cape of 6 months (arm A) or Cape of 12 months (arm B). Primary endpoint is disease-free survival. The statistical design is based on superiority hypothesis; 5-yrs DFS is 60% in arm A, 67% in arm B; unilateral α=0.05, 1-β=0.8; and planed accrual is 1200 pts. Results: Between September 2008 to December 2009, 1,304 pts were randomized. Patients characteristics are (armA/armB); number 653/651, gender M352-F301/M343-F308, median age 65 years/65 years, ECOG PS=0-1 620-33/632-19, involvement of lymph nodes=N0-N1-N2 503-130-20/499-128-24. There were no differences in baseline characteristics between arm A and arm B. Conclusions: This trial is expected to show if 1 year adjutant chemotherapy with capecitabine can reduce the peak of recurrence in 1 year and provide long-term OS benefit. [Table: see text]

An Unusual Cause of Rectal Bleeding - Report of Three Cases and Literature Review

Haemangioma of the rectum and colon is very rare malformation with only around 100 cases have been reported so far. Most commonly young adult is affected. Common site is recto sigmoid junction. Here we present three cases of rectal haemangioma affecting two males and one female patient. All were having cavernous type of haemangioma at rectum and recto sigmoid junction with one involving additional caecum and ascending colon. All the cases were misdiagnosed previously. Colonoscopy is the cornerstone for evaluation of these patients showing bluish discoloration with engorged mucosa. Rectum and sigmoid colon are commonly affected. Abdominoperineal resection was the favored procedure in the past. At present, definitive treatment of diffuse cavernous haemangioma (DCH) of rectum and sigmoid colon is excision of the involved bowel with sphincter saving procedure with either stapling or hand sewn anastomosis of colon and anal canal. Key words : Rectal haemangioma; sphincter saving surgery. DOI: 10.3329/bsmmuj.v2i2.4767 BSMMU J 2009; 2(2): 92-94

Seatbelt syndrome associated with an isolated rectal injury: case report

Seatbelt syndrome is defined as a seatbelt sign associated with a lumbar spine fracture and a bowel perforation. An isolated rectal perforation due to seatbelt syndrome is extremely rare. There is only one case reported in the Danish literature and non in the English literature. A 48-year old front seat restrained passenger was involved in a head-on collision. He had lower abdominal pain and back pain. Seatbelt mark was seen across the lower abdomen. Initial trauma CT scan was normal except for a burst fracture of L5 vertebra which was operated on by internal fixation on the same day. The patient continued to have abdominal pain. A repeated abdominal CT scan on the third day has shown free intraperitoneal air. Laparotomy has revealed a perforation of the proximal part of the rectum below the recto sigmoid junction. Hartmann's procedure was performed. The abdomen was left open. Gradual closure of the abdominal fascia over a period of two weeks was performed. Postoperatively, the patient had temporary urinary retention due to quada equina injury which resolved 10 months after surgery. The presence of a seatbelt sign and a lumbar fracture should raise the possibility of a bowel injury.

Mapping of liver-enriched transcription factors in the human intestine

To investigate the gene expression pattern of hepatocyte nuclear factor 6 (HNF6) and other liver-enriched transcription factors in various segments of the human intestine to better understand the differentiation of the gut epithelium. Samples of healthy duodenum and jejunum were obtained from patients with pancreatic cancer whereas ileum and colon was obtained from patients undergoing right or left hemicolectomy or (recto)sigmoid or rectal resection. All surgical specimens were subjected to histopathology. Excised tissue was shock-frozen and analyzed for gene expression of liver-enriched transcription factors by semiquantitative reverse transcription polymerase chain and compared to the human colon carcinoma cell line Caco-2. Protein expression of major liver-enriched transcription factors was determined by Western blotting while the DNA binding of HNF6 was investigated by electromobility shift assays. The gene expression patterning of liver-enriched transcription factors differed in the various segments of the human intestine with HNF6 gene expression being most abundant in the duodenum (P < 0.05) whereas expression of the zinc finger protein GATA4 and of the HNF6 target gene ALDH3A1 was most abundant in the jejunum (P < 0.05). Likewise, expression of FOXA2 and the splice variants 2 and 4 of HNF4alpha were most abundantly expressed in the jejunum (P < 0.05). Essentially, expression of transcription factors declined from the duodenum towards the colon with the most abundant expression in the jejunum and less in the ileum. The expression of HNF6 and of genes targeted by this factor, i.e. neurogenin 3 (NGN3) was most abundant in the jejunum followed by the ileum and the colon while DNA binding activity of HNF4alpha and of NGN3 was confirmed by electromobility shift assays to an optimized probe. Furthermore, Western blotting provided evidence of the expression of several liver-enriched transcription factors in cultures of colon epithelial cells, albeit at different levels. We describe significant local and segmental differences in the expression of liver-enriched transcription factors in the human intestine which impact epithelial cell biology of the gut.

A Rare Presentation of Rectal Adenocarcinoma with a Paraneoplastic Syndrome

Purpose: Background: Approximately 150,000 new cases of colorectal carcinoma are reported every year in the United states. The most common presenting symptoms are abdominal pain, change in bowel habits and melena. Here we present a case of rectal cancer, which initially presented with skin manifestation. Case Report A 64 year old Hispanic female presented to hospital with a complaint of wide spread skin rash which started on the torso and progressed to involve the arms and legs for the past one year. She tried several over the counter medications including the steroid ointment without any relief. For the past three months she was having abdominal pain, watery diarrhea with an eightypound weight loss. Her past medical history was significant for diverticulitis and gastro esophageal reflux disease. Physical examination revealed crusts on the elbows along with erythematous and hyper-pigmented thin plaques with patches over lower back, buttocks, right neck base, arms, thighs and index fingers. Metacarpophalyngeal joints showed red necrotic lesions. Laboratory values revealed White Blood Cell count of 5.34 × 1000/micL, Hemoglobin of 10.lg/L and a platelet count of 359000/micL. Stool examination for Clostridium difficile, ova and parasites was negative. She was evaluated for connective tissue disorders but all the tests came negative for the Erythrocyte sedimentation rate, C-reactive protein and Anti Nuclear Antibodies. Serum zinc level was 48 mg/dl. Skin Biopsy of the elbow lesion yielded interphase dermatitis. CT scan of the abdomen showed the thickening of recto sigmoid junction. Then patient underwent a colonoscopy, which showed a massive rectal obstructing mass. Biopsy revealed moderately differentiated adenocarcinoma. Patient was stabilized post operatively and was discharged home. Conclusion Paraneoplastic syndrome are believed to be caused by immunological responses to the tumor cells, commonly seen in cancers of lung, breast, ovaries and lymphatic systems. Paraneoplastic syndrome in rectal carcinoma is very rare. In our patient diagnosis was delayed due to her unusual presentation of skin manifestation. In patients with skin lesions, diarrhea, abdominal pain and weight loss, extensive investigations are needed to rule out a colorectal malignancy.

Tratamiento quirúrgico de duplicidad peneana completa

Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities.The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4 years old child, without any other malformation.

Kaposi's sarcoma of the recto sigmoid colon in a patient with HIV infection and a high CD4 count

Kaposi's sarcoma (KS) is a well-recognized, HIV-associated opportunistic tumour, which was first described in 1872 by a Hungarian dermatologist, Moritz Kaposi. It predominantly affects homosexual men and heterosexual patients from Africa infected with HIV. The lesions can arise anywhere in the body but occur more frequently on the skin. Despite a trend towards lower CD4 counts at the time of KS presentation, the use of antiretroviral therapy has been associated with a reduction in mortality compared with the pre-ART era. Prior to the introduction of highly active antiretroviral therapy, 40% of people with KS skin lesions were reported to have lesions in the intestine. Conversely, KS can also develop systemically in the absence of skin lesions. We present a case of KS affecting the distal sigmoid colon and rectum in a patient with a relatively preserved CD4 T-cell count, demonstrating that a less common presentation of KS may occur at any CD4 count.

The impact of varying rectal contours on rectal dose in prostate cancer patients treated with hypofractionated radiation

15598 Background: In curative radiation treatment of prostate cancer,the advent of 3DCRT has made a reduction in the incidence of normal tissue toxicities while optimizing tumor control. To optimize 3DCRT, the ICRU has published standard definitions of target volumes and organs at risk such that the tumor can receive the optimal dose with as little as possible dose to the organs at risk. However, the definition of the rectum as an organ at risk in radiation treatment of the prostate varies widely among institutions and so does the report of toxicities. We studied the effect of varying rectal contouring on rectal dose obtained from DVHs in a homogenous group of prostate cancer patients treated with hypo fractionationed radiation. Methods: 71 patients with favorable risk prostate cancer treated with a total of 66Gy in 3Gy/day fractionation.18 MV photons in a 5-field technique was used. None of the patients received hormonal therapy. Their treatment plans were archived and the rectum was re-contoured by a single investigator. 4 different contours were drawn to compare the rectal dose: i) the whole rectum from the anal verge to the recto sigmoid junction (WR); ii) the rectum from 1cm below the PTV to 1cm above (RPTV); iii) the rectal wall (i.e. the inner and outer rectal wall) from the anal verge to the recto sigmoid junction (RW); iv) the rectal wall from 1cm below the PTV to 1cm above (RWPTV) Results: There were significant differences in the median volume, minimum, mean rectal doses and dose to 50% of the volume, (p=0.0001). The whole rectum (WR) is having the lowest and the rectal wall with 1cm above and below the PTV (RWPTV) having the highest in all the parameters. The only parameter not significantly different among the 4 contours is the maximum rectal dose. Conclusion: the varied rectal contouring across different institutions is a possible reason for the broadly different reports of rectal toxicity after prostate irradiation. Our results suggest significant differences in rectal doses with varied contouring. Contouring the rectal wall only and limiting the volume to 1cm above and below the PTV confers the highest mean rectal dose. Comparison of rectal toxicity between institutions can only be meaningful if a consensual volume definition of the organ at risk is agreed upon. No significant financial relationships to disclose.

Cricket Ball, Rectum Foreign Body: Case Report And Review Of The Literatures

Cricket Ball, Rectum Foreign Body: Case Report And Review Of The Literatures

2107: A Dose Escalation Phase II Study Using Intensity Modulated Radiation Therapy (IMRT) to Deliver Preoperatively 60 Gy in 25 Fractions With 5- Fluorouracil Chemotherapy to Patients With T4 Recto Sigmoid Cancer

2107: A Dose Escalation Phase II Study Using Intensity Modulated Radiation Therapy (IMRT) to Deliver Preoperatively 60 Gy in 25 Fractions With 5- Fluorouracil Chemotherapy to Patients With T4 Recto Sigmoid Cancer