RESUMO
BACKGROUND: Secondary metastasis to regional lymph nodes for adjacent bowel invaded by colorectal cancers (CRCs) has not been extensively reviewed. We herein present three such cases. CASE PRESENTATION: The first case is a cancer involving the cecum and sigmoid colon, and its primary site could not be determined even by pathological evaluation. Nodal involvement was revealed both in the mesocolon of the cecum and sigmoid. The second and third cases are a sigmoid colon cancer invading the jejunum and an ascending colon cancer invading the jejunum, respectively. These patients harbored secondary metastases to lymph nodes draining from the invaded small bowel segments. In spite of complete resection, all three patients metachronously developed liver metastases or recurrent disseminated nodules in the pelvis and subsequently died. CONCLUSIONS: In cases of CRC invading another bowel segment, bowel resection with regional lymphadenectomy for both involved segments should be considered to achieve complete resection. However, the radical surgery did not necessarily provide a long-term survival.
Assuntos
Adenocarcinoma/secundário , Colo Sigmoide/patologia , Neoplasias do Colo/patologia , Mesocolo/patologia , Adenocarcinoma/terapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/terapia , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Masculino , PrognósticoRESUMO
A 47-year-old male patient without a documented past medical history was referred to Sanno Hospital because of constipation and abdominal pain, which he had had for more than 5 years. Abdominal X-ray and CT scan showed an enlarged ascending colon from the cecum to the transverse colon, without apparent mechanical obstruction. The patient was diagnosed with chronic idiopathic colonic pseudo-obstruction, and because his symptoms were resistant to medication, surgical treatment was required. Laparoscopic subtotal colectomy was performed without any complications. Constipation was relieved, and the patient began defecating 2-3 times a day without medication. Pathological specimens showed that Meissner's plexus and Auerbach's plexus had decreased and that there were fewer ganglion cells-findings consistent with chronic idiopathic intestinal pseudo-obstruction.
Assuntos
Colectomia/métodos , Pseudo-Obstrução do Colo/cirurgia , Laparoscopia/métodos , Pseudo-Obstrução do Colo/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The expression of doublecortin-like kinase 1 (DCLK1) has been investigated in cancer; however not in precancerous adenomatous polyps. MATERIALS AND METHODS: Immunohistological expression of DCLK1 was evaluated in various grades of adenomas, cancerous polyps, and hyperplastic polyps in resected human tissue specimens. RESULTS: Ninety-two specimens were positive for DCLK1 and 134 were negative. Cancerous polyps showed a high DCLK1 positivity rate compared to adenomas (68.4% vs. 36.8%; p<0.01). The rate of DCLK1 positivity was not significantly different among the three grades of adenomas (mild, moderate, and severe). DCLK1 was highly positive in advanced adenomas than low risk adenomas (49.6% vs. 29.3%; p<0.01). CONCLUSION: The expression of DCLK1 was found in low-grade adenomas and increased with worsening severity of dysplasia. DCLK1 expression was highly observed in advanced adenomas, which had a clinically higher malignant potential.
Assuntos
Pólipos do Colo/genética , Pólipos do Colo/patologia , Expressão Gênica , Peptídeos e Proteínas de Sinalização Intracelular/genética , Proteínas Serina-Treonina Quinases/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Biópsia , Pólipos do Colo/diagnóstico , Pólipos do Colo/mortalidade , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Quinases Semelhantes a Duplacortina , Feminino , Humanos , Hiperplasia , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Proteínas Serina-Treonina Quinases/metabolismo , Índice de Gravidade de Doença , Carga TumoralRESUMO
BACKGROUND/AIM: Few studies have evaluated the risk of postoperative colorectal neoplasms stratified by the nature of primary colorectal cancer (CRC). In this study, we revealed it on the basis of the microsatellite (MS) status of primary CRC. MATERIALS AND METHODS: We retrospectively reviewed 338 patients with CRC and calculated the risk of neoplasms during postoperative surveillance colonoscopy in association with the MS status of primary CRC. A propensity score method was applied. RESULTS: We identified a higher incidence of metachronous rectal neoplasms after the resection of MS stable CRC than MS instable CRC (adjusted HR 5.74, p=0.04). We also observed a higher incidence of colorectal tubular adenoma in patients with MSS CRC (adjusted hazard ratio 7.09, p<0.01) and a higher incidence of postoperative tubulovillous/villous adenoma in patients with MS instable CRC (adjusted HR=8.50, p=0.03). CONCLUSION: The MS status of primary colorectal cancer influenced the risk of postoperative colorectal neoplasms.