Appendiceal tumors with glandular and neuroendocrine features exhibiting peritoneal metastases - Critical evaluation of outcome following cytoreductive surgery with perioperative chemotherapy.

BACKGROUND: A rare appendiceal malignancy is characterized by both glandular and neuroendocrine histology. It often presents with dissemination of the perforated tumor to peritoneal surfaces. Current treatments involve systemic chemotherapy, cytoreductive surgery and perioperative intraperitoneal chemotherapy. METHODS: The impact of clinical, histological and treatment-related characteristics on survival were evaluated and subjected to univariate statistical analyses. All patients had stage IV disease and were treated by a uniform treatment strategy. Survival was determined from onset of disease until death or most recent follow-up. RESULTS: There were 47 patients available for study of whom 17 were male. Median age was 48 with a range of 27-65. None or a single symptom vs. 2 or more symptoms had a significant effect on survival. Median survival of the entire cohort was 45 months and 34.88% and 8.72% of patients survived 5 and 10 years, respectively. The use of neoadjuvant chemotherapy showed no impact on survival. Patients with a peritoneal cancer index (PCI) of 0-20 as compared to PCI > 20 survived longer (p = 0.012). The survival of patients able to have a complete resection as compared to an incomplete resection of disease was significant (p = 0.0087). The type of perioperative chemotherapy did not alter survival. CONCLUSIONS: These data show that patients with a lesser extent of disease with a complete cytoreduction had an improved prognosis. No benefit from systemic or perioperative regional chemotherapy was apparent. With long-term follow-up, patients with the combined glandular and neuroendocrine histology exhibiting peritoneal metastases have a guarded prognosis.

Dysregulated Mucosal Immunity and Associated Pathogeneses in Preterm Neonates.

Many functions of the immune system are impaired in neonates, allowing vulnerability to serious bacterial, viral and fungal infections which would otherwise not be pathogenic to mature individuals. This vulnerability is exacerbated in compromised newborns such as premature neonates and those who have undergone surgery or who require care in an intensive care unit. Higher susceptibility of preterm neonates to infections is associated with delayed immune system maturation, with deficiencies present in both the innate and adaptive immune components. Here, we review recent insights into early life immunity, and highlight features associated with compromised newborns, given the challenges of studying neonatal immunity in compromised neonates due to the transient nature of this period of life, and logistical and ethical obstacles posed by undertaking studies newborns and infants. Finally, we highlight how the unique immunological characteristics of the premature host play key roles in the pathogenesis of diseases that are unique to this population, including necrotizing enterocolitis and the associated sequalae of lung and brain injury.

Port site metastases after minimally invasive resection for colorectal cancer: A retrospective study of 13 patients.

BACKGROUND: Minimally invasive surgeries are increasingly being performed for primary colon cancer resections since laparoscopic and robotic surgeries have less post-operative pain, shorter length of hospitalization, less morbidity, improved patient satisfaction and equivalent R0 resection rates compared to laparotomy. METHODS: To analyze characteristics of patients who developed port site metastases after minimally invasive colectomy, a retrospective case series of a single institution from 2004 to 2017 was performed. The study included patients who had a minimally invasive resection of the primary colon cancer and subsequent cytoreduction and heated intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal metastases. Patient characteristics, histology, pathology, prior treatments, time between surgeries, carcinoembryonic antigen (CEA) levels and survival were reviewed. RESULTS: There were 123 patients who had CRS/HIPEC and 13 of them had a history of laparoscopic or robotic colectomy followed by the development of port site disease. Four were females, nine were males. Median age was 48 years (range, 19-64). Eleven of 13 primary colon cancers were T3 or T4. Ten of 13 patients had no clinical evidence of peritoneal metastases at the time of initial resection. All 13 patients had metastatic deposits at port sites that were confirmed histopathologically at the time of CRS/HIPEC. CONCLUSIONS: Port site metastases were present concomitantly with peritoneal metastases in 13 patients. An advanced T-stage of disease occurred in 85% of patients. Port site metastases do occur after minimally invasive colon resection.

Primary colonic adenocarcinoma diagnosed with cutaneous shave biopsy.

A 67-year-old man presented to the emergency department with chronic weakness, fatigue and failure to thrive. On physical examination, he was found to have multifocal exophytic cutaneous masses in the pubic and scrotal regions. We obtained a shave biopsy, and subsequent histopathology demonstrated non-native tissue consistent with metastasis from a primary adenocarcinoma. We report this novel case of anogenital cutaneous metastases of colorectal adenocarcinoma.