Synchronous Colon Cancer Research Articles

A case of synchronous thyroid papillary carcinoma and colon cancer of the neck node

A case of synchronous thyroid papillary carcinoma and colon cancer of the neck node

上行結腸癌と右腎癌の同時性重複癌に対して一期的に腹腔鏡下手術を施行した１例

上行結腸癌と右腎癌の同時性重複癌に対して一期的に腹腔鏡下手術を施行した１例

Unusual imaging profile of a solitary splenic lymphangioma

Splenic lymphangioma is a rare, benign lesion of the spleen that is characterized microscopically by a proliferation of thin-walled vascular channels filled by proteinacious material. Based on microscopic features, three types of lymphangiomas are described as simple capillary, cavernous, and cystic; however, the distinction between these types is not uniformly accepted. The cystic type is the most common type and has well described imaging characteristics. However, little is known about the less common cavernous and capillary forms of lymphangioma. Herein, we present a case of a patient with two synchronous colon cancers that presented with a concomitant splenic mass that was initially suspected to be metastatic disease. Despite the use of multiple imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), nuclear imaging, and contrast-enhanced ultrasound, the final diagnosis of cavernous lymphangioma was made following core needle biopsy of the lesion. A thorough review of literature and this case now demonstrate the difficulty in differentiating atypical forms of splenic lymphangiomas from other benign lesions such as hemangioma.

Synchronous colon and advanced gastric cancer

Aim The development of synchronous cancers of the colon and the stomach is particularly rare. An unusual case of advanced synchronous colon and gastric carcinoma is described and the literature reviewed.

Short-Term Outcomes after Combined Colon and Liver Resection for Synchronous Colon Cancer Liver Metastases: A Population Study

The timing of surgical resection for stage IV colon cancer with liver metastasis and the safety of simultaneous colon and liver resection remains controversial. The purpose of our study was to evaluate short-term outcomes after combined colon and liver resection (CCLR) versus colon resection (CR) or liver resection alone (LR) using a population database. The National Inpatient Sample was used to select patients who had surgery for colon cancer from 2002 to 2006. We evaluated for in-hospital morbidity, mortality, and prolonged length of stay (PLOS). Our analysis was done using design-weighted unadjusted analysis and logistic regression. We identified 361,096 patients during our study period (CCLR 3,625; CR 322,286; LR 35,185). CCLR was not associated with an increased risk of complications (odds ratio (OR) 1.12; 95% confidence interval (CI) 0.94-1.33; P=0.21) or PLOS (OR 1.19; 95% CI 0.99-1.4; P=0.06) compared with CR. In-hospital mortality occurred in 3.5% of patients who underwent CCLR and was not significantly associated with mortality compared with CR alone (OR 1.17; 95% CI 0.79-1.74; P=0.43). Liver lobectomy with CR was associated with a PLOS and a trend toward increased morbidity and mortality. Significant predictors of complications, mortality, and PLOS included: age>70 years, male gender, nonprivate health insurance, and Elixhauser score>1. CCLR with limited liver resection can be performed with similar morbidity and mortality to colectomy alone. For patients who require hepatic lobectomy, however, strong consideration should be given to a staged approach.

The Transverse Colon Cancer with the Reversed Rotation of the Midgut Treated with Single Incision Laparoscopic Colectomy

Reversed rotation of the midgut is a rare type of intestinal malrotation. Moreover, synchronous colon cancer has rarely been reported. Preliminary experience with single-incision laparoscopic colectomy (SILC) for colon cancer with reversed rotation of the midgut is reported. An 82-year-old woman was admitted because of a fecal occult blood. A colonoscopy revealed transverse colon cancer. An air-barium contrast enema showed the right-sided sigmoid colon and the left-sided cecum. A computed tomography revealed that the duodenum and the transverse colon were situated at the ventral side of the superior mesenteric artery, and a preoperative diagnosis of suspicion of reversed rotation of the midgut was made. First, a lap protector was inserted through a 4.0cm transumbilical incision. Four 5mm ports were placed in the lap protector. On the observation of laparoscopy, the cecum and the ascending colon were not fixed with the retroperitoneum and situated on the left, and the sigmoid colon was situated on the right. We successfully mobilized the transverse colon using a single-incision laparoscopic approach. Resection was achieved following extracorporealization, and the anastomosis was performed extracorporeally using staplers. The patient was discharged on the thirteenth postoperative day. Postoperative follow-up did not reveal any umbilical wound complications. SILC for colon cancer associated with malrotation of the midgut is feasible and a promising alternative method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

Right Colon to Rectal Anastomosis (Deloyers Procedure) as a Salvage Technique for Low Colorectal or Coloanal Anastomosis

After extended left colectomy, it may be difficult to take down a well-vascularized colon into the pelvis and perform a tension-free colorectal or coloanal anastomosis. The Deloyers procedure comprising complete mobilization and rotation of the right colon while maintaining the ileocolic artery may be used in this circumstance. The aim of this study is to report postoperative and long-term outcomes after the Deloyers procedure as a salvage technique for colorectal anastomosis or coloanal anastomosis. From a prospective database, we retrospectively reviewed all patients who underwent a Deloyers procedure. This study was conducted at the Colorectal Unit in a tertiary referral teaching hospital. Between 1998 and 2011, 48 consecutive patients underwent a Deloyers procedure. Indications were as following: Hartmann reversal (n = 17), previous colorectal anastomosis-related complications (n = 11), diverticular disease (n = 6), left colon cancer (n = 6), ischemic colitis (n = 3), iterative colectomy for cancer (n = 3), rectal cancer local recurrence (n = 1), and synchronous colon cancer (n = 1). There were 38 men and 10 women (median age at surgery, 67 years). Colorectal anastomosis and coloanal anastomosis were performed in 38 and 10 patients. Thirty-one patients had defunctioning stoma. Mortality and early morbidity rate was 2% and 23%. Three patients (6%) had severe complications (Dindo ≥ 3). There was no anastomotic leakage. Reoperation was required in 2 patients for intra-abdominal hemorrhage. The median hospital stay was 12 days. The median follow-up was 26 months. All patients had their ileostomy closed. Twenty-three percent of patients developed late complications. The median number of bowel movements per day was 3 (range, 1-7), but 67% of patients had fewer than 3. One patient required an ileostomy refashioning because of poor functional results, and 23% of patients routinely take loperamide-based medication. The retrospective nature of the study was a limitation. The Deloyers procedure is safe, associated with low morbidity and good long-term functional results. It represents a safe alternative to total colectomy and ileorectal anastomosis.

Synchronous T-cell lymphoma in patient with colon cancer: a case report

Colorectal cancer is the third most common malignancy in Korea. In contrast, pericolic or mesenteric lymphoma is relatively rare. We experienced an extremely rare case of synchronous primary colon cancer in the ascending colon with T-cell lymphoma in the pericolic lymph node. A 79-year-old woman presented with complaints of epigastric and right lower abdominal pain combined with anorexia and nausea. Colonoscopic evaluation and biopsy were performed, and the diagnosis was cecal adenocarcinoma. She underwent right hemicolectomy with lymph node dissection. The pathology report revealed adenocarcinoma in cecum with metastasis to 1 regional lymph node out of 37 lymph nodes. In addition, there was malignant angioimmunoblastic T-cell lymphoma in 1 pericolic lymph node. There was no evidence of lymphoma in ileum, cecum and ascending colon, so the possibility of early phase of lymphoma was suggested.

S状結腸閉塞にて発症し経肛門的ステント留置後切除した大腸同時8多発癌の1例

家族歴，既往歴のない54歳男性が便秘，腹部膨満感を主訴とし初診した．腹部単純CT検査にてS状結腸腫瘍に伴う腸閉塞と診断した．同日緊急下部消化管内視鏡にて経肛門的に金属ステントを留置した．留置後，ただちに排便がみられ腸管内容減圧が得られた．十分な前処置の後，注腸造影を施行したところ回盲部，横行結腸に径約4cmの腫瘍が造影された．内視鏡下にステントの口側観察を試みたが，挿入不可能であった．結腸多発腫瘍と術前診断し大腸亜全摘術を施行した．病理組織では，S状結腸狭窄部はpSSで，狭窄部口側結腸に6病変，術前EMRした直腸1病変を含め，合計8病変の同時多発癌が認められた．左側結腸閉塞に対する内視鏡下経肛門的ステント留置術は経肛門的イレウスチューブと比較し，挿入後の患者のQOL維持に有効で，また口側腸管の精査に非常に有用である．大腸癌イレウス症例では，多発性を考慮し術前検査として可能なかぎり口側腸管を精査する必要がある．

日本住血吸虫卵を認めた同時性多発大腸癌の1例

大腸癌発癌の一因として，日本住血吸虫感染症が指摘されている．今回，癌部に日本住血吸虫卵を認めた同時性多発大腸癌の1例を経験したので報告する．症例は79歳男性，18歳まで日本住血吸虫の流行地であった山梨県甲府盆地に居住していた．健診での便潜血の精査で進行S状結腸癌および早期下行結腸癌と診断した．内視鏡的切除を行った下行結腸M癌の病理組織において，茎部・粘膜筋板直下に日本住血吸虫卵を認めた．同時に切除した大腸腺腫4カ所には虫卵はなかった．S状結腸癌に対しては，腹腔鏡下S状結腸切除術を行った．病理所見は，中分化管状腺癌，type2，45×35mm，SS，N1（1/13）であり，H0，P0，M0，fStage IIIaであった．S状結腸癌病巣の一部および周囲粘膜筋板直下にも日本住血吸虫卵を認めた．虫卵の存在と発癌の関与が示唆された．

Laparoscopic Surgery for the Ascending Colon Cancer Associated with Malrotation of the Midgut

Malrotation of the midgut is a congenital anomaly of the gastrointestinal tract that usually presents in neonates. Moreover, synchronous colon cancer has rarely been reported. In the present article, we report a preliminary experience with laparoscopic approach for intestinal malrotation with early colon cancer in a 68-year-old woman who presented with bloody stools. Colonoscopy revealed a lateral spreading tumor of the ascending colon. An air-barium contrast enema showed that the entire colon lay within the left hemiabdomen. A computed tomography revealed the superior mesenteric vein rotation sign. At surgery, a condition of malrotation of the midgut was observed: the third and the fourth part of the duodenum descended vertically without Treitz's ligament, and the small bowel and colon were located in the right and left side of the abdominal cavity, respectively. We mobilized the terminal ileum and the right colon with laparoscopic approach. A 3-cm abdominal incision was made via the umbilicus. Right colectomy with lymph node dissection was achieved following extracorporealization. Pathological examination revealed well-differentiated tubular adenocarcinoma without nodal involvement. The patient had an uneventful postoperative course. Laparoscopic surgery for colon cancer associated with malrotation of the midgut is feasible and a promising method because of its less invasiveness and its adaptability to the malrotation without extending the skin incision.

Rate of Missed Polyps on Colonoscopy When Compared to Surgically Resected Specimens

Purpose: To compare the rate of polyps and lesions found at colonoscopy in comparison to surgically resected specimens. Methods: This retrospective analysis used the Saskatchewan Cancer Registry to identify patients who underwent resectional surgery for primary colorectal cancer and had colonoscopy within 3 months prior to the date of surgery. Synchronous colonic polyps and cancers were identified from the pathology report. Colonoscopy reports were then compared to the pathologic specimen to determine the missed polyp rate. Results: Analysis of pathologic specimens identified 97 synchronous lesions, 47 of which were missed at colonoscopy. Of the 47 missed polyps three were larger than 1cm including one colorectal cancer. Female gender was significantly associated with an increased rate of missed polyps (p<0.001). Location of cancer was weakly associated with missed polyps with more polyps being missed when the malignancy was located in the right colon (P=0.036). Presence of diverticulosis and endoscopist specialty did not affect the rate of missed polyps (p=0.48 & p=0.31 respectively). Because of inadequate reporting regarding quality of bowel preparation & patient tolerance for procedure we were unable to determine the effect these factors may have had on missed polyp rate. Conclusion: Colonoscopy is an effective tool to identify and obtain tissue diagnosis of polyps and colonic lesions; however, there is a considerable miss rate of lesions identified at colonoscopy when compared to pathologic specimens including clinically significant lesions. A prospective study is needed to address the risk factors that might significantly contribute to and affect the rate of missed polyps at colonoscopy and to determine why gender has a significantly different miss rate.

Use of antiperistaltic cecoproctostomy in colorectal reconstruction

To explore the feasibility and functional outcome of antiperistaltic cecoproctostomy in colorectal reconstruction. Fifty-six patients who underwent antiperistaltic cecoproctostomy were retrospectively studied. Indications for antiperistaltic cecoproctostomy included slow transit constipation(n=44), synchronous colon cancer or colonic polyps(n=5), acute obstructing left colon carcinoma(n=4), and adult megacolon(n=3). Short-term postoperative complications included wound infections(n=5), 3 lymphatic leakages(n=3), and inflammatory small bowel obstruction(n=1). One month after antiperistaltic cecoproctostomy, the median frequency of daily bowel movement was 4.0(range, 2-6). After a median follow-up of 4 years(range, 1 month to 7 years), the median daily bowel frequency was 2.5(range, 0.5-4.0). Five patients suffered from long-term postoperative complications including small bowel obstruction(n=3), incision hernia(n=1), and mild cecal dilatation(n=1). The mean Wexner incontinence score was 4.2±1.1. Antiperistaltic cecoproctostomy is safe and effective for colorectal reconstruction.

Gynecologic cancer screening in women at high risk of Lynch syndrome.

1559 Background: Endometrial cancer is the most frequent extracolonic tumor in women with Lynch syndrome (LS). The aim of this study was to assess adherence to screening of gynecological tumors by women with LS and determine the impact of monitoring and prophylactic surgery in these women. Methods: Between 2005-2008, 91 women with LS were subjected to gynecological examination (GE), transvaginal ultrasound (TVS) and endometrial aspirate (EA). The implementation of screening, its results and prophylactic surgery information were evaluated annually and verified with documentation. We analyzed factors associated with adherence: socioeconomic, clinical, genetic and family history, and the results of screening. Results: Of the 91 women with gynecological follow-up, 78 (85.71%) were performed at least once (GE and ETV). EA was zero, except in 3 women (3.3%) with abnormal TVS. 48 underwent a gynecological screening only once. The average gynecological screening examinations (EG + ETV) performed was 1.4 ± 1.07 (range 0-4). Women at risk without cancer adhered better (58.3% vs 52.5% vs 30.8%, p = 0.028). In addition, there was greater compliance if ≥ 2 first degree relatives were affected with endometrial cancer (80% vs 56.3 and 35.4%, p = 0.009). Socioeconomic status, educational, employment and mutational status had no effect on compliance. 3 (3%) women were diagnosed with endometrial cancer. 2 patients suspected diagnosis of endometrial cancer with the first GE including ETV, and confirmed with EA. The third case was detected by a prophylactic hysterectomy in a woman newly diagnosed with two synchronous colon cancers by screening colonoscopy. This was in the one case who underwent prophylactic surgery, and her endometrial cancer was at an early stage (stage IA). Conclusions: Compliance with the recommendations of gynecological screening was 44%. EA is not performed for screening of endometrial cancer. The number of relatives with endometrial cancer increases the likelihood of adhering to gynecological screening. The identification of a mutation has no effect. The first gynecological screening examination detects a significant number of endometrial cancers; and, in addition, prophylactic hysterectomy detects early stage tumors in women with LS.

Coexistence of a colon carcinoma with two distinct renal cell carcinomas: a case report

IntroductionWe present the case of a patient with two tumors in his left kidney and a synchronous colon cancer. While coexisting tumors have been previously described in the same kidney or the kidney and other organs, or the colon and other organs, to the best of our knowledge no such concurrency of three primary tumors has been reported in the literature to date.Case presentationA 72-year-old man of Greek nationality presenting with pain in the right hypochondrium underwent a series of examinations that revealed gallstones, a tumor in the hepatic flexure of the colon and an additional tumor in the upper pole of the left kidney. He was subjected to a right hemicolectomy, left nephrectomy and cholecystectomy, and his postoperative course was uneventful. Histopathology examinations showed a mucinous colon adenocarcinoma, plus two tumors in the left kidney, a papillary renal cell carcinoma and a chromophobe renal cell carcinoma.ConclusionThis case underlines the need to routinely scan patients pre-operatively in order to exclude coexisting tumors, especially asymptomatic renal tumors in patients with colorectal cancer, and additionally to screen concurrent tumors genetically in order to detect putative common genetic alterations.

A Case of Synchronous Transverse Colon Cancer and Low Rectal Cancer Treated by Chemoradiotherapy and Divided Planning Operation to Preserve the Anal Function

症例は73歳，男性．下血を主訴に来院．横行結腸脾彎曲部に全周性2型腫瘍，下部直腸に3/4周性2型腫瘍を認め，生検にて両者とも中分化管状腺癌と診断した．画像診断にてリンパ節腫大や遠隔転移は認めなかった．第1期手術として結腸左半切除術，横行結腸人工肛門造設術（ハルトマン手術）を施行し横行結腸癌に対する根治手術，および下部直腸癌治療に対するfecal diversion stomaを造設した．引き続き下部直腸癌に対し化学放射線療法（chemoradiation therapy：以下CRT）を施行．第2期手術として残存結腸亜全摘，超低位前方切除，内肛門括約筋切除（intrasphincteric resection：以下ISR），盲腸肛門吻合，回腸人工肛門造設術を施行した．自験例では計画的二期分割切除に術前CRTを組み合わせることで根治性および術後機能の向上が得られると考えられた．また左側結腸が口側吻合腸管として使用できない症例でも盲腸肛門吻合術を施行することにより肛門温存可能であり有用な術式と考えられた．

First evidence for digenic inheritance in hereditary colorectal cancer by mutations in the base excision repair genes

Biallelic mutations in the base excision repair gene Mut Y homologue ( MUTYH) are responsible for variable recessively inherited phenotypes of polyposis. Beside MUTYH, the proteins 8-oxo-guanine DNA glycosylase ( OGG1) and MTH1 (or NUDT1) are also involved in the repair of 7,8-dihydro-8-oxoguanine (8-oxo-G), previous studies, however, only found missense mutations of unclear pathogenicity in either MTH1 or OGG1. To investigate the role of a defective 8-oxo-G repair we performed a germline mutation screening in the genes OGG1, MTH1 and MUTYH, in 81 patients with a clinical phenotype ranging from attenuated or atypical adenomatous polyposis coli including hyperplastic polyps to hereditary non-polyposis colorectal cancer (HNPCC) type X syndrome without mono- or biallelic mutations in either APC, MUTYH or the DNA mismatch repair genes. We describe here the first pathogenic germline mutation in OGG1, a splice site mutation affecting exon 1, which was inherited from the father, in combination with a maternal MUTYH missense mutation p.Ile223Val in a female patient with advanced synchronous colon cancer and adenomas at the age of 36 years pointing towards digenic inheritance for colorectal cancer (CRC) predisposition. Monoallelic missense mutations in MTH1 (3x), OGG1 (2x), or MUTYH (3x) were identified in 10 patients (12%), three of them were novel. Our findings indicate that mutations in other genes of the 8-oxo-G repair beside MUTYH are involved in CRC predisposition. Oligogenic inheritance affecting genes of a certain repair pathway might therefore be the missing link between monogenic and polygenic traits.

Simultaneous Laparoscopy-assisted Distal Gastrectomy and Right Hemicolectomy for Synchronous Advanced Gastric and Colon Cancer

Concurrent laparoscopic surgery for the synchronous gastric and colon cancer in one patient is not only a rare procedure, but also has some demerits such as longer operation time, more blood loss, and the use of additional laparoscopic ports. Moreover, laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection is still controversial in the case of advanced gastric cancer. We report the successful laparoscopic surgery of a 78-year-old patient with synchronous advanced gastric and right colon cancers. The laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection followed by right hemicolectomy through 7 ports was carried out. All procedures were successfully performed without complications and the patient has had no evidence of recurrence for 33 months after the operation. Synchronous neoplasms that are distantly located from one another could be treated using minimally invasive technique, which may sufficiently relieve patients' postoperative distress in selected cases.

Hand-assisted laparoscopic colon and rectal cancer surgery: Feasibility, short-term, and oncological outcomes

Hand-assisted laparoscopic surgery (HALS) is an established alternative to laparoscopic-assisted surgery, but limited data exist regarding its applicability for colorectal cancer (CRC). We report short-term outcomes in a large series of CRC patients who underwent HALS between 2004 and 2009. A prospectively maintained database was used to identify all CRC patients. Patients with colon cancer (CC) and rectal cancer (RC) were considered separately. Three patients with synchronous CC and RC were excluded. Data are frequency (%) or median (interquartile range). Between 2004 and 2009, 323 CRC patients underwent a HALS procedure. Median age was 65 (53-73) years, 39% were women, and the median BMI was 27 (24-31) kg/m(2). Diagnoses included 194 colon cancers (CC, 56.7% stage I/II), 129 rectal cancers (RC, 62.7% stage I/II). Operative time was less for CC than RC (157 vs 204 min; P < .0001). Conversion to laparotomy occurred in similar proportions of CC and RC cases (14% vs 10%; P = .38); lymph nodes retrieval was also similar (18 vs 18; P = .45). Overall duration of stay was 5 (4-7) days. At 30 days, postoperative complications occurred in similar proportions of CC and RC patients (28% vs 30%; P = .72). There was 1 mortality (0.5%). For the subgroup with 3 year follow-up, (73 CC and 45 RC patients), the overall survival was 80% and 88% (CC and RC, respectively), and disease free survival 79% and 85%, respectively. Colon and rectal cancer can be resected safely using HALS techniques. Conversion rates are low, complication rates expected, durations of hospital stay shorter, and the number of lymph nodes retrieved is high.

Colorectal cancer during pregnancy in a Sudanese female

We report a new case of uncommon but not rare condition of colorectal cancer during pregnancy in 33 years old Sudanese female at her 16th weeks of gestation presented with bloody diarrhea and intermittent left side abdominal pain. Initially she was diagnosed as a case of dysentery which was treated by antibiotics. Condition was diagnosed by colonoscopy and histopathology as colonic cancer, located in the sigmoid colon 50 cm from anal verge. A review of literature found that 276 cases of colon cancer associated with pregnancy have been reported. Pregnancy affects the clinical presentation, evaluation, therapy, and prognosis of colon cancer. Patients usually present with misdiagnosed symptoms. Diagnostic delays often lead to the tragic demise of a young woman from a potentially curable disease and of an otherwise viable fetus. This delay in diagnosis is a major contributing factor to the poor prognosis associated with this disease. Synchronous colon cancer during pregnancy presents a diagnostic and therapeutic challenge for clinicians because there are no generally accepted guidelines regarding diagnosis or treatment. This article reviews this uncommon condition with a focus on the features of colon cancer inpregnancy to facilitate earlier diagnosis, to modify investigations, to optimize the therapy, and to improve the maternal and fetal outcomes.Keywords: Colorectal cancer; Pregnancy; CEA, FOLFOX