Diffuse large B-cell lymphoma originating from the rectum and diagnosed after rectal perforation during the treatment of ulcerative colitis: a case report.

BACKGROUND: Gastrointestinal lymphomas like diffuse large B-cell lymphoma (DLBCL) are rare complications of ulcerative colitis (UC), and only a few studies have reported intestinal ulcers caused by DLBCL, which got perforated during the treatment of UC. CASE PRESENTATION: A 43-year-old man with severe lower abdominal pain and an 8-year history of UC was admitted in our hospital. He was diagnosed UC since 8 years and received a maintenance oral dose of 5-aminosalicylic acid, and no other immunosuppressive drugs. A deep rectal ulcer was endoscopically diagnosed 10 months before admission, no malignancy or cytomegalovirus infection was detected on biopsy. After 7 months a further endoscopy with biopsies confirmed the finding and the absence of malignancy. Three months later the patient developed sudden abdominal pain and was admitted in our hospital. Rectal perforation was suspected on X-ray and computed tomography imaging, and an emergency surgery was performed. Surgical exploration revealed a perforation on the anterior wall of the rectum. A subtotal colectomy with temporary ileostomy was performed. Pathology examinations showed lymphocyte infiltration of all of the layers of the perforated site and an immunohistochemical evaluation revealed DLBCL. Clinical staging was stage IV, and the patient received a 6-months regimen of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Positron emission tomography restaging revealed disappearance of distant uptake and a slight uptake in the residual rectum, and completion proctectomy with ileal pouch-anal anastomosis was performed. No residual tumor in the specimen was found, and the patient was disease-free at 2 years follow-up. CONCLUSIONS: DLBCL may increase the frequency of perforation and is a poor prognostic risk factor for patients with UC. This case study emphasizes the importance of careful medical surveillance and repeated endoscopic biopsies during the treatment of UC.

Correction to: Long-term results of intersphincteric resection for low rectal cancer in Japan.

In the original publication Fig. 2 and Table 4 were incorrectly published. The corrected figure and table are given in this Correction.

Long-term results of intersphincteric resection for low rectal cancer in Japan.

Intersphincteric resection (ISR) is the ultimate sphincter-preserving procedure for low rectal cancer. A questionnaire about the standardization of ISR was given to 2125 patients who underwent curative ISR for low rectal cancer between 2005 and 2012 at 127 affiliated institutions of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), and the results were compared with the results of a systematic review. The findings revealed that although mortality and morbidity were relatively low and the survival rate after ISR was good, the rates of local recurrence and postoperative fecal incontinence were relatively high. The radicality of ISR was compared with that of abdominoperineal resection and low anterior resection using the propensity score matching prognosis analysis of patients in the JSCCR nationwide registry. The local recurrence rate was significantly higher after ISR, and especially high in patients with T3 (invasion into the external anal sphincter) and T4 disease. These results provide evidence about the factors related to fecal incontinence after ISR. As measures for the standardization of ISR, it is important to reconfirm that ISR is not indicated for patients with cT3 and cT4 disease and those with poor preoperative defecatory function, based on the ISR indication criteria.

Predominant expression of mutated allele of the succunate dehydrogenase D (SDHD) gene in the SDHD-related paragangliomas.

Recent studies indicate that succinate dehydrogenase (SDH) genes B, C, or D are, at least partly, involved in the pathogenesis of pheochromocytoma or paraganglioma. Of these three genes, the SDHD gene mutation is most closely related with paragangliomas of the neck. Here we describe a case of an SDHD-related paraganglioma, in which we studied the molecular characteristics of an SDHD mutation to evaluate the involvement of SDHD in neck paragangliomas. Genetic testing revealed a heterozygous G106D mutation in the SDHD gene. In the tumor tissue, loss of heterozygosity was demonstrated by real time polymerase chain reaction (PCR). In the present case of SDHD mutated paragangliomas, wild type SDHD gene expression was markedly reduced possibly due to loss of heterozygosity not due to imprinting of SDHD gene in the tumors.

Pyogenic liver abscesses secondary to carcinoma of the sigmoid colon: a case report and clinical features of 20 cases in Japan.

We report a case of liver abscesses associated with sigmoid colon cancer in an 81-year-old woman. The patient was referred to our hospital because of a tumorous lesion of the sigmoid colon. Five days before the scheduled operation, she presented abdominal pain, fever and chill. Imaging scans revealed multiple liver abscesses in both lobes, which were successfully treated with intravenously administered antibiotics. Two weeks later, the patient underwent laparoscopic-assisted sigmoidectomy. Nineteen cases of liver abscess associated with colonic cancer have been reported during the past ten years in Japan, and we report the clinical features of these cases in this paper. An aggressive search for the underlying cause of pyogenic liver abscess should be an integral part of the definitive treatment of this disease.

Is tumor size a prognostic indicator for gastric carcinoma?

BACKGROUND: Retrospective studies using multivariate analysis of clinical and pathological features in gastric cancer have identified a number of high-risk, independent prognostic factors. In these clinical features, tumor size can be measured easily before or during the operation without the requirement of any special equipment, but its prognostic value in patients with gastric cancer is unclear. The aim of this study was to review the experience at our institution of gastric adenocarcinoma to determine the influence of tumor size on outcome. PATIENTS AND METHODS: Between January 1985 and December 1995, 697 patients with gastric adenocarcinoma underwent resection of the stomach at the Department of Surgery, Sendai National Hospital, Japan. Data on age, gender, tumor location, structure and size, evidence of local invasion, and type of operation performed for each patient were obtained. The sizes of tumors were derived from measurements made in fresh resected specimens. The patients were divided into three groups: 102 patients with tumors of less than 2 cm in diameter, 392 patients with tumors of 2-7 cm in diameter, and 203 patients with tumors of more than 7 cm in diameter. RESULTS: In these three groups, there were statistical differences in tumor location, macroscopic type, depth of invasion, lymph node metastasis, histological type, lymphatic invasion, vascular invasion and cancer-stromal relationship. Patients with larger tumors had more invasion into the gastric wall in terms of depth of invasion and more frequent lymph node metastasis than did patients with smaller tumors. Histologically, diffuse, scirrhous-type was more common in the larger tumor group. The frequency of lymphatic and vascular permeation in the larger tumor group was higher than that in the other groups. The 5-year survival rates according to tumor size were 94.3% in cases of tumors of less than 2 cm, 75.1% in cases of tumors of 2-7 cm, and 26.3% in cases of tumors of more than 7 cm. Multivariate analysis revealed that the prognosis of gastric cancer patients was affected most by depth of invasion, followed by lymph node metastasis and tumor location. Tumor size is not an independent prognostic factor. CONCLUSION: In conclusion, according to the results of univariate analysis, tumor size is clinically a predictor of survival of patients with gastric cancer. In multivariate analysis, however, it is not an independent factor, and the presence of lymph node metastasis, depth of invasion and tumor location are more important than tumor size.

Early and late recurrences after gastrectomy for gastric cancer: a multiple logistic regression analysis.

PURPOSE: Although many studies have focused on clinical risk factors for prognosis of patients with surgically treated gastric cancer, little information is available regarding the timing of recurrent malignant disease. The purpose of this study was to determine the factors that are predictive of early and late recurrences after gastrectomy. PATIENTS AND METHODS: We reviewed the hospital records of patients with hisotological proof of gastric cancer who were admitted to Sendai National Hospital during the period from 1985 to 1995. A total of 923 records were examined, and 251 patients with recurrent disease were identified. The patients were divided into an "early recurrence group" consisting of 195 patients (died within one year after surgery) and a "late recurrence group" of 56 patients (died two years or more after surgery). Clinicopathological characteristics were examined, and independent risk factors influencing the timing of recurrence were determined by a multiple logistic regression analysis. RESULTS: The mean tumor size of early recurrence cases was larger than that of late recurrence cases (p=0.0294). Tumors penetrating the serosa with direct invasion to continuous structures were found more frequently in the early recurrence group than in the late recurrence group. The patients with early recurrence showed a higher tendency to have nodal involvement, lymphatic invasion and vascular invasion. The relative risks of early and late recurrences associated with different variables were estimated by a multiple logistic regression method. The following variables were found to be significant risk factors for early recurrence: male gender (p=0.0382), lymph node metastasis (p=0.0016), and vascular invasion (p=0.0006). CONCLUSION: Male patients who have node-positive gastric cancer with vascular invasion have a high risk of early recurrence.