Adenocarcinoma Of Sigmoid Colon Research Articles

Multiple primary tumors in children: a clinicopathological analysis of four cases

Objective: To investigate the clinicopathological features of children with metachronous or synchronous primary tumors and to identify related genetic tumor syndromes. Methods: The clinicopathological data of 4 children with multiple primary tumors diagnosed in the Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China from 2011 to 2023 were collected. The histological, immunophenotypic and molecular characteristics were examined using H&E staining, immunohistochemical staining, PCR, Sanger sequencing and next-generation sequencing (NGS). The patients were followed up. Results: Case 1 was an 8-year-old boy with the adrenal cortical carcinoma, and 5 years later a poorly differentiated gastric adenocarcinoma was detected. Case 2 was a 2-year-old boy, presented with a left ventricular choroid plexus carcinoma, and a hepatoblastoma was detected 8 months later. Case 3 was a 9-month-old girl, diagnosed with renal rhabdoid tumor first and intracranial atypical teratoid/rhabdoid tumor (AT/RT) 3 months later. Case 4 was a 7-year-old boy and had a sigmoid colon adenocarcinoma 3 years after the diagnosis of a glioblastoma. The morphology and immunohistochemical features of the metachronous or synchronous primary tumors in the 4 cases were similar to the corresponding symptom-presenting/first-diagnosed tumors. No characteristic germ line mutations were detected in cases 1 and 2 by relevant molecular detection, and the rhabdoid tumor predisposition syndrome was confirmed in case 3 using NGS. Case 4 was clearly related to constitutional mismatch repair deficiency as shown by the molecular testing and clinical features. Conclusions: Childhood multiple primary tumors are a rare disease with histological morphology and immunophenotype similar to the symptom-presenting tumors. They are either sporadic or associated with a genetic (tumor) syndrome. The development of both tumors can occur simultaneously (synchronously) or at different times (metachronously). Early identification of the children associated with genetic tumor syndromes can facilitate routine tumor screening and early treatment.

A novel oral microtubule inhibitor utidelone capsule (UTD2): A phase 1 clinical study to assess the tolerability, safety, and efficacy in advanced solid tumors.

e15014 Background: Utidelone is a potential best-in-class novel microtubule stabilizing agent that offers several advantages including improved efficacy and safety, broader anti-cancer spectrum, blood-brain barrier penetrance, and response against multidrug-resistant tumors. Utidelone injection (UTD1) has been approved for advanced breast cancer in China since 2021 (30 mg/m2/d-5day in combination with capecitabine; 35mg/m2/d-5day for monotherapy’s recommended dose). Utidelone is not susceptible to P-glycoprotein, leading to better oral bioavailability and successful development of an oral capsule. This is the first-in-human study of Utidelone Capsule (UTD2) in the United States. Methods: This is an ongoing phase I, open-label, dose escalation study (NCT05681000). Eligible patients are aged ≥18, and have an ECOG PS of 0-1, life expectancy ≥12weeks, adequate organ functions, pathologic confirmed advanced solid tumor refractory to prior standard therapies. Patients are treated with UTD2 monotherapy. The starting dose is 25 mg/m2/d-5day, with planned escalation to 50, 75, 100 mg/m2/d-5day, 70 mg/m2/d-7day and 85 mg/m2/d-7day in a 21-day cycle. The primary objective is to determine DLT and MTD. Secondary objectives include efficacy, pharmacokinetic profile and phase II dose recommendation. Results: As of 22nd January 2024, 10 advanced solid tumor patients were enrolled with median age of 62.5 years (range 52.0-81.0), 5 females and 5 males. All patients had received prior treatment in advanced settings. Dose escalation is ongoing, and 100mg/m2/d-5day cohort is under evaluation. The first 8 patients were evaluated for efficacy with an outcome of 1 CR (ovarian cancer), 5 SD (prostate adenocarcinoma, testicular Sertoli cell tumor, non-small cell lung cancer, pancreatic adenocarcinoma and appendiceal adenocarcinoma) and 2 PD (carcinoma of fallopian tube and adenocarcinoma of sigmoid colon), among whom 5 patients are still on the treatment with durations of 2 to 11 cycles. The ovarian patient with CR was enrolled to the lowest dose cohort, and is still on treatment. She is heavily pre-treated with multiple prior lines including chemotherapies. Regarding safety, most treatment-emergent adverse events (TEAEs) were Grade 1/2, manageable, and included diarrhoea, nausea, alopecia. There were two cases of Grade 3 diarrhea that recovered to Grade 1 through dose reduction or medical support. No grade 4 or 5 adverse events and no treatment discontinuations due to AE were reported. There have been no DLTs and the MTD is not yet reached. Conclusions: This study has demonstrated encouraging anti-tumor activity with good tolerance and manageable safety profile of UTD2 in patients with heavily pre-treated advanced solid tumors. This study is still actively ongoing, and further data will be provided at time of presentation. Clinical trial information: NCT05681000 .

Polymer clip granuloma mimicking lymph node recurrence: a case report

BackgroundForeign body granulomas are postoperative inflammatory reactions to surgical materials within the body. Traditionally, sutures have been the leading cause of foreign body granulomas in the abdomen, commonly referred to as “suture granuloma”. However, the use of polymer clips in modern surgeries has introduced new challenges, and reports of intra-abdominal foreign body granulomas caused by surgical clips are limited. Herein, we present a case of an intra-abdominal foreign body granuloma formed due to polymer clips.Case presentationA 45-year-old woman who underwent laparoscopic resection for sigmoid colon adenocarcinoma subsequently developed a suspected lymph node recurrence during follow-up. Imaging showed an enlarging mass adjacent to the inferior mesenteric artery with increased fluorodeoxyglucose uptake. Laparoscopic surgical resection revealed the formation of a foreign body granuloma in response to the polymer clips.ConclusionsThis case suggests that nonabsorbable polymer clips can induce granulomatous reactions postoperatively, and the appearance of lymph node recurrence may be foreign body granulomas.

Stage IV perihilar cholangiocarcinoma with loss of expression of MSH2 and MSH6: hereditary cancer syndrome?

We present the case of a 69-year-old male diagnosed with stage IV perihilar cholangiocarcinoma with loss of expression of MSH2 and MSH6 proteins, but somatic wild type MSH2 and MSH6 genes with Oncomine Comprehensive Assay (OCA) genomic sequencing panel. In his cancer family history, there was a maternal aunt with sigmoid colon adenocarcinoma also missing MSH2 and MSH6 protein expression. Subsequently, we will discuss whether or not we are facing a hereditary cancer syndrome.

BARD1 deletion in a patient with suspected hereditary colorectal cancer

Deleterious germline variants in the BRCA1-associated ring domain (BARD1) gene moderately elevate breast cancer risk; however, their potential association with other neoplasms remains unclear. Here, we present the case of a 43-year-old female patient diagnosed with sigmoid colon adenocarcinoma whose maternal family members met the Amsterdam Criteria II for Lynch syndrome. Comprehensive multigene panel testing revealed a heterozygous BARD1 exon 3 deletion.

Goblet cell adenocarcinoma of the appendix with ovarian metastasis and synchronous adenocarcinoma of the sigmoid colon: A case report

Appendiceal goblet cell adenocarcinoma (GCA) is an amphicrine tumor composed of goblet-like, and variable numbers of endocrine and Paneth-like cells, typically arranged as tubules resembling intestinal crypts. As a rare cancer, the characteristics of and appropriate treatment strategy for GCA have not been fully elucidated. Here, we describe a case of an appendiceal GCA detected during sigmoidectomy for synchronous sigmoid colon adenocarcinoma and discuss whether appendiceal GCA coexisted incidentally. A 78-year-old woman was referred to our institution due to severe anemia. Colonoscopy and computed tomography revealed circumferential sigmoid colon cancer and a primary or metastasized ovarian tumor. We performed a laparoscopic sigmoidectomy and bilateral adnexectomy. The appendix appeared infiltrative and indurated, and appendectomy was performed. Immunohistochemistry revealed sigmoid colon adenocarcinoma and appendiceal GCA with ovarian metastasis. GCAs should be considered when ovarian tumors are detected with other abdominal malignancies.

Paraneoplastic seropositive AQP4-IgG neuromyelitis optica spectrum disorder associated with sigmoid adenocarcinoma

Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing demyelinating and inflammatory disease of the central nervous system, mediated by aquaporin-4 (AQP4)-immunoglobulin G (IgG) autoimmunity. Although NMOSD is most commonly an idiopathic autoimmune condition, it may also occur as a paraneoplastic syndrome in rare instances. Hereby, we report a rare case of a 61-year-old lady with paraneoplastic AQP4-IgG NMOSD associated with adenocarcinoma of sigmoid colon.

A unique case report of sigmoid colon cancer metastasising to the breasts, ovaries and stomach in pregnancy

Colorectal cancer in pregnancy is an infrequent phenomenon. It is estimated to occur in 1 in 13,000 pregnancies, with 80% representing rectal cancer. We report a rare case of a young pregnant female presenting with primary sigmoid colon adenocarcinoma metastasizing to the breast, ovaries, and stomach. Diagnosing colorectal malignancy in pregnancy is challenging, given the similarities in symptoms. Cancer in pregnancy may take on a more malignant course with rapid progression. Physicians must recognise the potential of this deadly disease lurking undetected in patients of this vulnerable population.

Circulating tumor DNA analysis detects micrometastatic disease and predicts recurrence in a patient with colon cancer: A case report.

Colorectal cancer (CRC) is one of the most prevalent and deadly cancers worldwide, and approximately 50% of patients with early-stage disease develop metastases. A critical limitation for successful management of CRC is early disease detection and identification of progression. Next-generation sequencing-based circulating tumor DNA (ctDNA) profiling has emerged as a promising biomarker for the assessment of minimal or molecular residual disease in CRC. The patient was initially diagnosed with resectable CRC with uncertain small lung nodules. The patient was diagnosed with sigmoid colon adenocarcinoma placed at 15 to 20 cm above the anal verge (ypT4N1R0). Lung nodules were found in the apical part of the upper lobe of the right lung and the dorsal segment of the lower lobe of the left lung. The patient received systemic therapy and local treatment and plasma ctDNA-MRD detection was performed for monitoring the molecular disease status after surgery. The patient achieved a complete response after treatment. However, he presented with disease recurrence in liver lesions. The postoperative ctDNA detection suggested the possibility of micrometastatic pulmonary disease, and that was confirmed by follow-up examination. Serial ctDNA detection revealed disease relapse ahead of radiologic imaging by a lead time of 9 months. This case demonstrated the potential of ctDNA analysis to be a sensitive and specific tool for the detection of micrometastatic disease and prediction of recurrence.

Perforated sigmoid colon adenocarcinoma within an irreducible inguinal hernia: A case report

Inguinal hernia is a potentially occult common surgical condition. Its association with asymptomatic adenocarcinoma is uncommon. However, malignancy-associated perforation of the large bowel within an irreducible hernia is rare. We report a case of 78-year-old male presenting with a long-standing inguinal hernia with a 2-day history of irreducibility. Examination revealed a large left-sided irreducible inguinal hernia. Patient underwent urgent inguinal herniotomy, during which multiple perforations were noted in the sigmoid colon. Patient underwent Hartmann's procedure following bowel resection. Histology revealed a mucinous adenocarcinoma with extensive metastasis involving the resection margins. Elderly patients with long-standing inguinal hernia presenting with acute symptoms should be evaluated further for this rare but sinister diagnosis.

Black pigmentation in duodenum

Here, we present the case of an 87-year-old woman with heart failure, hypertension, and iron deficiency anemia with a treatment history of amlodipine, olmesartan, carvedilol, and hydralazine for 4 years, and ferrous sodium citrate for 2 years. The patient was referred to the Department of Gastroenterology for occult blood in stool, and endoscopic examination was arranged. Colonoscopy showed sigmoid colon adenocarcinoma, and esophagogastroduodenoscopy revealed speckled black pigmentation distributed from the duodenal bulb to the duodenal second portion (Figure 1). Histopathology revealed macrophages in the lamina propria containing pigmented granules negative for Prussian blue stain (Figure 2). The final diagnosis was pseudomelanosis duodeni. Pseudomelanosis duodeni, characterized by brown to black spotty pigmentation in the duodenal bulb and the second portion on esophagogastroduodenoscopy,1-3 was first described in 1976 by Bisordi and Kleinman.4 It occurs more commonly in older women.3 The pathogenesis is distinct from melanosis coli and remains poorly understood.1 Previous studies have shown association with diabetes mellitus, hypertension, renal disease, folate deficiency, gastrointestinal bleeding, and ingestion of food or oral agents containing iron and sulfur.1-3 Thus, one hypothesis implicates the accumulation of iron and sulfur in the duodenal mucosa caused by drugs (eg, hydralazine, furosemide, and hydrochlorothiazide) and food absorption, microhemorrhages, or reduced sulfur clearance due to decreased renal function.1 Usually, this is an incidental finding without obvious clinical symptoms. Microscopically, the pigmented granules are found in the macrophages located in the lamina propria.1, 3 Although all pseudomelanosis duodeni contains an iron component, Prussian blue stain can still sometimes be negative, possibly because the iron pigments are in a sulfide form, and do not react with Prussian blue staining reagents.5 Pseudomelanosis duodeni should be distinguished from metastatic malignant melanoma as it is a benign condition with no evidence of malignant transformation in the future.1-3 Further investigation or management are not required. All authors contribute to all stages of article composition: data acquisition and editing, manuscript drafting, and manuscript revision. The authors declare no conflict of interest. The patient authorized the publication of the data and the patient's anonymity is preserved in the article.

Lymphadenectomy with venation is preferred compared to skeletonization for patients with rectal and sigmoid colon cancer: a retrospective cohort study.

BackgroundFor patients with rectal and sigmoid colon cancer, dissecting No. 253 lymph nodes and preserving the left colic artery are the essentials of radical surgery. In clinical work, some surgeons prefer to dissect lymph nodes with skeletonization, believing that lymph nodes can be dissected completely by this method, while other surgeons prefer to dissect lymph nodes with venation. They believe that their method can not only dissect lymph nodes completely but also ensure the safety of patients. This study aimed to investigate whether lymphadenectomy with skeletonization is superior to lymphadenectomy with venation for patients with rectal and sigmoid colon cancer.MethodsWe performed a retrospective cohort study between August, 2017 and October, 2019 at the Department of General Surgery, the Affiliated Hospital of Nanjing University Medical School. The inclusion criteria were as follows: diagnosed as rectum or sigmoid colon adenocarcinoma by electronic colonoscopy and histopathology; 18–80 years of age; underwent radical resection. The exclusion criteria were as follows: received neoadjuvant therapy before surgery; combined with distant metastasis. According to the method of lymph node dissection, patients were divided into the skeletonization group and venation group. We then compared the curative effect and safety between the 2 groups.ResultsA total of 211 patients were recruited in this retrospective study and assigned as follows: 62 cases to the skeletonization group and 149 patients to the venation group. There were no statistical differences in the total number of lymph nodes (P=0.082), number of positive lymph nodes (P=0.097), total number of No. 253 lymph nodes (P=0.096), number of positive No. 253 lymph nodes (P=0.813), and nodal staging (P=0.254) between the 2 groups. However, the amount of bleeding in the skeletonization group was significantly higher than that in the venation group (P≤0.001), and the operation time in the skeletonization group was also significantly longer than that in the venation group (P≤0.001).ConclusionsLymphadenectomy with venation is preferred in the radical resection of patients with rectal and sigmoid colon cancer.

Peutz–Jeghers Syndrome which Develops into Descending Sigmoid Colon Adenocarcinoma

Introduction: Peutz–Jeghers Syndrome (PJS) is an autosomal dominant hereditary condition mainly characterized by hamartomatous gastrointestinal (GI) polyps. Medical treatment is often sought due to complications that arise from the polyps. PJS polyps tend to be accompanied by freckling or hyperpigmentation on the lips, buccal mucosa, vulva, fingers, and toes. PJS is also associated with an increased risk for colorectal or extraintestinal tumors. Case Presentation: A 24-year-old female complained about a lump in her abdomen and constipation. The physical examination found hyperpigmentation on the lips and a hard and mobile mass on the left quadrant abdomen. We found a descending-sigmoid colon tumor with multiple polyps on all colon mucous and performed total colectomy and ileorectal anastomosis on the laparotomy operation. Two months later, Esophagogastroduodenoscopy revealed multiple polyps on Duodenum 1, II, and gaster. The colon tumor pathology result showed welldifferentiated adenocarcinoma. Conclusions: Peutz–Jeghers Syndrome (PJS) can develop into malignant intestinal tumors that require surgery for resection of the tumor.

Unusual presentation of primary ovarian diffuse large B-cell lymphoma: a case report

BackgroundPrimary ovarian lymphoma has been difficult to diagnose clinically and pathologically due to its rare incidence and non-specific clinical symptoms.Case presentationA 75-year-old female patient was reported in this study. The patient had a six-month history of changes in bowel habits, with occasional black feces and paroxysmal pain in the abdomen. The computed tomography scan of the pelvic cavity illustrated that rectal cancer and sigmoid colon adenocarcinoma invaded the lower part of the right-side ureter. The patient was once treated with excision of part of small intestine, fallopian tube and ovary, and uterus. The pathological examination of these excised tissues, combined with the immunohistochemistry, confirmed that the female patient suffered from primary ovarian diffuse large B-cell lymphoma (DLBCL), and the lymphoma had invaded the entire right-side ovary tissues, serous membranes on the posterior surface of the uterus, and the wall of small intestine.ConclusionFew reports were available regarding the primary ovarian DLBCL. The initial symptom of the patient was the changes in bowel habits, which had not been reported beforehand. Hopefully, this case could helpfully render the early diagnosis possible, and increase clinical understanding of primary ovarian DLBCL, which would thereby reduce the chance of misdiagnosis.

Plane of mesocolic dissection as predictor of recurrence after complete mesocolic excision for sigmoid colon cancer: A cohort study.

AimTo investigate whether intramesocolic plane dissection assessed on fresh specimens by the pathologist is a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection.MethodSingle‐centre study based on prospectively registered data on patients undergoing resection for UICC stage I–III sigmoid colon adenocarcinoma during the period 2010–2017. The patients were stratified into either an intramesocolic plane group or a mesocolic plane group. Primary outcome was risk of recurrence after 4.2 years using inverse probability treatment weighting and competing risk analyses.ResultsOf a total of 332 patients, two were excluded as the specimen was assessed as muscularis propria plane, 237 (72%) specimens were deemed as mesocolic and 93 (28%) as intramesocolic. The 4.2‐year cumulative incidence of recurrence after inverse probability treatment weighting was 14.9% (10.4–19.3) in the mesocolic group compared with 9.4% (3.7–15.0) in the intramesocolic group, thus the absolute risk difference between the mesocolic plane and intramesocolic plane was 5.5% (−12.5–1.6; p = 0.13) in favour of the intramesocolic group.ConclusionIntramesocolic plane dissection was not a risk factor for recurrence after complete mesocolic excision for sigmoid cancer when compared with mesocolic plane dissection. No difference in risk of local recurrence, death before recurrence, and in overall survival after 4.2 years was observed between the two groups. With less than 1% of the specimens deemed as muscularis propria plane dissection, the classification appears unusable for the risk prediction of sigmoid colon cancer.

Yolk Sac Tumor in a Recurrence of Colonic Adenocarcinoma With Shared Mutations inAPCandTP53Genes: A Case Report

Only four cases of colorectal adenocarcinoma with a yolk sac tumor (YST) component have been reported in the English literature. No genetic investigation has been performed in these cases. We report a case of colorectal adenocarcinoma in which the recurrent tumor had a YST component. A 49-year-old woman presented with a pelvic tumor three years after endoscopic mucosal resection of sigmoid colon adenocarcinoma. The pelvic tumor consisted of an undifferentiated carcinoma component and a YST component. The serum alpha-fetoprotein level was elevated to 42 ng/mL. Treatment as conventional colorectal carcinoma produced some anticancer effects, but the patient died 14 months after the recurrence and 49 months after the EMR. With the help of the next-generation sequencing results of the recurrent tumor, APC c.835 - 8A > G and TP53 c.524G > A (p.R175H) mutations were identified by direct sequencing in both the primary and the recurrent tumors, confirming the relationship between the two metachronous tumors.

Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis

To determine the optimal surgical approach for acute appendicitis and concomitant cystic lesions of small pelvis. The authors report the results of emergency combined surgery on abdominal and pelvic organs in 995 patients for the period from 1990 to 2020 (30 years). Acute appendicitis was diagnosed in 698 (70.15%) patients. Cystic lesions of small pelvis were observed in 286 (28.7%) patients: follicular cyst - 133 (46.5%), serous cyst - 91 (31.8%), corpus luteum cyst - 42 (46.4%), dermoid cyst - 20 (7.0%), endometrioid cyst - 3 (1.0%) cases. Catarrhal appendicitis was diagnosed in 10 (1.4%) patients, phlegmonous appendicitis - 685 (98.1%), gangrenous appendicitis - 3 (0.4%) patients. All patients with pyoinflammatory diseases of small pelvis had long-term history of gynecological diseases. Cystic lesions of small pelvis can undergo malignant transformation. Therefore, surgical intervention is determined by surgeon together with gynecologist. Tree large endometrioid cysts (20-25 cm) were malignant. These patients also had adenocarcinoma of sigmoid colon. Malignant neoplasm resulted acute ileus, and the cysts were incorporated into pyogenic membrane. Extensive adhesive process was also observed. These aspects caused significant technical difficulties during resection of these cysts. Postoperative complications occurred in 2.31% of patients. Prolonged therapy and follow-up of patients with urgent concomitant inflammatory diseases of abdominal cavity and small pelvis (chronic nonspecific salpingitis, diffuse pelvic endometriosis, ovarian cysts, etc.) can lead to development and growth of cystic lesions of small pelvis. These cysts may be complicated by subsequent malignant transformation.

Colon Cancer with Complete Pathological Response to Only 1 Cycle of Capecitabine: Treatment Modification in the Perspective of COVID-19 Pandemic

Incidence of colorectal cancer has surged in the past few decades, currently it accounts for approximately 10% cancer related mortality. Upfront curative surgery is the main stay of treatment for localized disease followed by adjuvant chemotherapy for high-risk disease; however, neo adjuvant chemoradiation followed by surgery and chemotherapy is a standard treatment for rectal cancer. Here, we present a case of a young male aged 33 years with eight months’ history of per rectal bleeding, associated with fever and weight loss who was later diagnosed as sigmoid colon adenocarcinoma. The patient managed to have only one cycle of neoadjuvant capecitabine, as his definitive surgery was delayed due to the rife in pandemic situation of Covid-19. Notably, follow up laparoscopic LAR specimen showed no residual disease, nevertheless, there was an eosinophilic abscess with a giant cell reaction and Ova of Ascaris lumbricoides, which seemingly contributed in achieving pathological complete response with minimal therapy.

Asymptomatic chronic suppurative cholecystitis and peritonitis mimicking metastasis by 18F-FDG PET/CT scan during sigmoid colon cancer surveillance

The study describes an unusual case that a patient with previous history of adenocarcinoma of sigmoid colon who has developed chronic suppurative cholecystitis and peritonitis was misdiagnosed as metastasis. This case is presented to illustrate the importance of considering benign etiologies that may mimic metastatic disease when interpreting positron emmision tomography (PET)/CT scans.

Sigmoid colon adenocarcinoma incarcerated in an inguinoscrotal hernia: diagnostic and management challenges.

Sigmoid colon adenocarcinoma incarcerated in an inguinoscrotal hernia: diagnostic and management challenges.