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Abstract@#The genitourinary tract is known to be infiltrated in 3–10% of cases of advanced rectal adenocarcinoma. It is usually managed with total pelvic exenteration with urinary diversion. Complications are encountered because of this diversion. This case series aims to present four cases of locally advanced rectal adenocarcinoma involving the prostate who underwent en bloc prostatectomy in Jose Reyes Memorial Medical Center.@*Methods@#This case series consists of review of records of hospital charts, documentation of specimens from the database of the department.@*Results@#The study consists of four (4) male patients in their 50s presenting with primary rectal adenocarcinoma with invasion to the prostate, bladder or seminal vesicle. Two out of 4 patients had shorter hospital days (6 days) while 2 patients spent 14 and 28 days. Two out of 4 patients have anastomotic leakage, 1 had nosocomial pneumonia and no one had urinary tract infection, postoperatively. All 4 patients had a histopathologic diagnosis of rectal adenocarcinoma with a tumor size of 3.5 to 7.0 cm. Two patients are positive for lymphovascular space invasion while 1 patient has a positive line of resection margin. Two patients had neoadjuvant chemotherapy and radiotherapy while 1 patient had 1 adjuvant chemotherapy and radiotherapy. One patient was lost to follow-up.@*Conclusion@#En bloc prostatectomy combined with abdominoperineal resection to treat locally advanced rectal adenocarcinoma provides good local control with the risk of having less postoperative complications. Since there is only one stoma, there is less chance of infection and better quality of life. Complete resection of the tumor can be obtain but can also cause urologic morbidity even after chemotherapy and radiotherapy.
Subject(s)
Proctectomy摘要
Objective To explore the apparent diffusion coefficient(ADC)value of rectal cancer lesions obtained by two measurement methods in predicting the pathological types of moderately and poorly differentiated rectal adenocarcinoma.Methods A total of 41 patients were divided into moderately differentiated group and poorly differentiated group according to degrees of differentiation.Direct measurement method and minimum ADC value method were used to measure the ADC value of the tumor,and the effectiveness of the ADC value in predicting moderately and poorly differentiated rectal adenocarcinoma was analyzed.Results The ADC values of rectal adenocarcinoma tumor obtained by two different measurement methods were different between the moderately and poorly differentiated groups(P＜0.01).The area under the curve(AUC)of the direct measurement method was 0.753,and the sensitivity and specificity were 96.67％and 63.64％,respectively.The AUC of the minimum ADC value method was 0.838,the sensitivity and specificity were 76.67％and 81.82％,respectively.The ADC value obtained by direct measurement method was positively correlated with its pathological characteristics(r=0.519,P＜0.01)and that by the minimum ADC value method was positively correlated with its pathological characteristics(r=0.391,P＜0.05).Conclusion The pathological types of moderately and poorly differentiated rectal adenocarcinoma is determined by ADC value.It is found that the direct measurement method has more greater comprehensive clinical value than the minimum ADC value method.
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RESUMEN Introducción: el cáncer de recto se considera una de las neoplasias más frecuentes del siglo XXI, con elevada mortalidad. Objetivo: caracterizar a los pacientes operados de cáncer rectal en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, entre enero de 2015 y diciembre de 2018. Materiales y métodos: se realizó un estudio observacional descriptivo. El universo fue de 97 pacientes de ambos sexos, operados de cáncer rectal. Se obtuvieron los datos de las historias clínicas individuales. Se analizaron variables como edad, sexo, localización específica del tumor, manifestaciones clínicas, características anatomopatológicas y estadios de la enfermedad, técnica quirúrgica empleada y complicaciones postoperatorias durante los primeros siete días. El método estadístico utilizado fue la distribución de frecuencia, en valores absolutos y porcentajes. Resultados: entre los pacientes operados de cáncer rectal, predominaron las personas de 70 a 79 años y el sexo masculino. El recto superior fue el sitio de mayor localización. El sangrado rectal, la expulsión de flemas y los cambios del hábito intestinal fueron los síntomas más frecuentes. El adenocarcinoma bien diferenciado fue la variedad histológica de mayor incidencia, y los estadios que prevalecieron fueron el II y el III. La técnica quirúrgica más empleada fue la resección anterior, y la complicación más frecuente la infección del sitio quirúrgico. Conclusiones: prevenir los factores de riesgo, sus causas predisponentes y desencadenantes, utilizar los medios diagnósticos convencionales y de avanzada. Detectar y tratar de forma temprana la enfermedad puede lograr mejor calidad de vida en estos pacientes (AU).
ABSTRACT Introduction: rectal cancer is considered one of the most frequent neoplasia of the 21st century, with high mortality. Objective: to characterize patients who underwent rectal cancer surgery at the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, of Matanzas, between January 2015 and December 2018. Materials and methods: a descriptive observational study was carried out. The universe was 97 patients of both sexes, who underwent a rectal cancer surgery. Data were obtained from individual medical records. Variables such as age, sex, specific tumor location, clinical manifestations, anatomopathologic characteristics and stages of the disease, surgical technique used and post-surgery complications during the first seven days were analyzed. The statistical method used was the frequency distribution, in absolute values and percentages. Results: people aged 70-79 years and men predominated among patients with rectal cancer. The upper rectum was the site of most common location. Rectal bleeding, phlegm expulsion, and changes in bowel habit were the most frequent symptoms. Well-differentiated adenocarcinoma was the most prevalent histological variety, and the stages that prevailed were II and III. The most commonly used surgical technique was anterior resection, and the most common complication was surgical site infection. Conclusions: to prevent risk factors, their predisposing causes and triggers; to use conventional and advanced diagnostic means. Early detection and treatment of the disease can achieve better quality of life in these patients (AU).
Subject(s)
Humans , Male , Female , Rectal Neoplasms/surgery , Inpatients/classification , Rectal Neoplasms/diagnosis , Rectal Neoplasms/rehabilitation , Rectal Neoplasms/epidemiology , Surgical Procedures, Operative/classification , Surgical Procedures, Operative/methods , Medical Records , Hospitals摘要
Objective To explore the value of spectral CT imaging in the preoperative evaluation on histodifferentiation of rectal adenocarcinoma.Methods 90 patients with rectal adenocarcinoma underwent dual-phase enhanced spectral CT scan,and were divided into well,moderately and poorly differentiated adenocarcinoma groups according to the pathology.Single-energy images with energy levels from 40 to 140 keV were generated by GSI Viewer software,and the slope K value of the energy curves were calculated.Iodine concentrations were derived from iodine-based material-separation images and normalized to the iodine concentrations in the aorta. ROC curves were derived to evaluate the differentiation diagnosis efficiency of normalized iodine concentration (NIC)and slope K in rectal adenocarcinoma,respectively.Results There were 22,50 and 18 cases in the well,moderately and poorly differentiated group,respectively.The iodine concentration,NIC and slope K value were statistically different both in the arterial and venous phase (P76% and the specificity>74% in the arterial phase,and the sensitivity>77% and the specificity>70% in the venous phase by choo-sing the appropriate threshold.Conclusion The spectral CT can provide a new method for preoperatively evaluating the histodiffer-entiation of rectal adenocarcinoma.
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Objective To investigate the relationship between apparent diffusion coefficient (ADC)value of rectal adenocarcinoma on DWI and its pathological grading.Methods The ADC values of 46 rectal adenocarcinomas were measured and compared with their histopathological grades.Results The 46 rectal adenocarcinomas included well differentiated adenocarcinomas in 14,moderate-ly differentiated ones in 20,and poorly differentiated ones in 12.The ADC values of well,moderately and poorly differentiated ade-nocarcinomas were (1.125±0.103)×10 -3 mm2/s,(1.030±0.098)×10 -3 mm2/s and (0.922±0.091)×10 -3 mm2/s,respective-ly,exhibiting a statistical difference (χ2 =1 7.35 1,P =0.000).Mann-Whitney U test showed that difference in ADC value between different histopathological grades was statistically significant.Conclusion ADC value of rectal adenocarcinoma can be used as a bio-marker for cell grading to guide treatment decision and prognosis assessment.
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Objective To analyze the response rate and prognostic factors for patients with locally recurrent rectal cancer treated with hypofractionated chemoradiotherapy without reresection.Methods Totally 52 patients with locally recurrent rectal cancer received hypofractionated irradiation and concurrent chemotherapy from January 2006 to January 2013 were enrolled.All patients received intensity-modulated radiotherapy (IMRT).The median dose was 63.4 Gy (61.6-64.4 Gy) at 2.2-2.3 Gy/f,5 f/week.Thirteen patients underwent prophylactic irradiation at lymph nodes region,the total dose of 45-50.4 Gy with conventional fraction and a simultaneous integrated boost was used.All patients received concurrent chemotherapy,capecitabine at 1 650 mg·m-2 ·d-1,divided into 2 times,5 d/week.The variables were compared by the chi-square test or Fisher's exact test.Local control (LC) and overall survival (OS) were calculated with using the Kaplan-Meier method.Results For all patients,the clinical complete response (CR),partial response (PR),stable disease (SD) and progressive disease (PD) was 23.1％,38.5％,32.7％ and 5.8％,respectively.The response rate (CR + PR) for patients with previous irradiation to pelvis and without were 37.1％ and 71.1％,respectively (x2 =5.40,P ＜ 0.05);for patients with 1 and 2 or more recurrent subsites were 81.8％ and 46.7％,respectively (x2 =6.63,P ＜ 0.05).Acute grade 3 skin and hematologic toxicities occurred in 19 patients (36.5％) and 1 patient (1.9％),respectively.None occurred grade 4 toxicity and none occurred grade 3 or more gastrointestinal and urologic toxicities.Four patients showed severe late toxicity of anastomotic stricture and performed a stoma at transverse colon.No other severe late toxicities were observed.The LC at 5 years was 49.1％ and the OS was 23.1％.Conclusions For patients with locally recurrent rectal cancer,hypofractionated chemoradiotherapy without resection is an acceptable and effective regimen,the response rate and long-term outcomes are promising.
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Pelvic recurrence after resection of rectal adenocarcinoma is a feared complication and is associated with a worse prognosis and low resectability rates. The differential diagnosis is difficult, as biopsy is seldom performed preoperatively. We report two cases of desmoid pelvic tumor after resection of rectal adenocarcinoma. Therapeutic options and literature review are described.
O aparecimento de tumor pélvico após ressecção de adenocarcinoma de reto é complicação temida e está associado à pior prognóstico e baixos índices de ressecabilidade. O diagnóstico diferencial é difícil, pois o diagnóstico histológico usualmente não é realizado no pré-operatório. São relatados dois casos em que houve o aparecimento de tumor pélvico após a ressecção de adenocarcinoma de reto, com diagnóstico histológico de tumor desmóide. As condutas adotadas e revisão da literatura são descritas.
Subject(s)
Humans , Female , Middle Aged , Aged , Rectal Neoplasms , Adenocarcinoma , Pelvic Neoplasms/diagnostic imaging , Recurrence , Fibromatosis, Aggressive/pathology , Fibromatosis, Aggressive/therapy , Diagnosis, Differential摘要
PURPOSE: The role of local excision in treating rectal cancer patients continues to be controversial. The aim of this study was to evaluate the long-term oncological results of local excision for early rectal adenocarcinomas and review the outcomes of salvage therapy on rectal cancer patients. MATERIALS AND METHODS: Between March 1992 and September 2005, 35 consecutive patients with early-stage primary rectal adenocarcinomas were treated by local excision with curative intent. The mean tumor distance from the anal verge was 5 cm (range, 1-10 cm). RESULTS: The median follow-up was 66 months (range, 17-161 months). Pathological examination revealed 23 cases of T1 and 12 cases of T2. Recurrence had developed in 10 patients (6 local recurrences, 4 systemic recurrences). Purely extrapelvic recurrence was observed in only two (5.7%) patients. Of the eight recurrent patients with surgical salvage, five survived with no evidence of disease at the time of this analysis. The 5-year local recurrence-free and disease-free survival rates were 79.6% and 67.9%, respectively. CONCLUSION: Local excision alone of early-staged rectal adenocarcinomas, even in the ideal candidate, is followed by a relatively higher local recurrence rate than previously reported and may not be a valid modality. Either the use of adjuvant therapy with local excision, even in patients with T1 lesions or the use of preoperative therapy followed by local excision has good promise.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/pathology , Neoplasm Recurrence, Local/epidemiology , Rectal Neoplasms/pathology , Retrospective Studies , Risk Factors , Salvage Therapy , Time Factors , Treatment Outcome摘要
Hepatoid adenocarcinoma (HAC) of the stomach is a rare neoplasm consisting of both adenocarcinomatous and hepatocellular carcinoma (HCC)-like foci; the latter of which showed the full spectrum of morphological and functional features of HCC. Numerous cases of HAC have been reported in a variety of primary organs, the stomach is one of the most common sites. HAC is associated with an increased serum alpha-fetoprotein (AFP) level and a strong tendency for lymphatic and venous invasion. Because of early hepatic metastasis, prognosis seems less favorable than more common types of adenocarcinoma. Here, we report a case of synchronous double primary cancer, consisting of hepatoid adenocarcinoma of the stomach and adenocarcinoma of the rectum.
Subject(s)
Adenocarcinoma , alpha-Fetoproteins , Carcinoma, Hepatocellular , Neoplasm Metastasis , Prognosis , Rectum , Stomach摘要
Peutz-Jeghers syndrome (PJS) is a rare disease of autosomal dominant inheritance, which is characterized by hamartomatous gastrointestinal polyps and mucocutaneous melanin pigmentation. PJS often presents as surgical emergen cies with complications of the polyps, such as intussusception, small bowel obstruction, bleeding and volvulus. Intussusception caused by PJS polyps is often observed in the small bowel, but intussusception which involving small and large bowel concommittantly is not so much. The association between PJS and an increased risk for cancer has been controversial. Recent studies have shown PJS have a increased risk for both gastrointestinal and extraintestinal cancer. We report a case of PJS with rectal adenocarcinoma and multiple intussusceptions involving small and large bowel concommittantly.
Subject(s)
Adenocarcinoma , Hemorrhage , Intestinal Volvulus , Intussusception , Melanins , Peutz-Jeghers Syndrome , Pigmentation , Polyps , Rare Diseases , Wills摘要
Metastatic urethral tumor is extremely rare. We report a case of anterior urethral and hepatic metastasis from a rectal adenocarcinoma developed 17 months after radical resection of rectal cancer. The patient was performed suprapubic cystostomy for management of voiding difficulty, thereafter, died 4 months after presentation.
Subject(s)
Humans , Adenocarcinoma , Cystostomy , Neoplasm Metastasis , Rectal Neoplasms摘要
Cutaneous metastatic tumors on the scalp from the rectum are very A 66-year-old male presented a nodule and papule an his scalp three months after surgical removal of a rectal adenocarcinorna. Biopsy specien from the scalp showed adenocarcinoma which is similar to the primary rectal carcinoma.
Subject(s)
Aged , Humans , Male , Adenocarcinoma , Biopsy , Rectum , Scalp摘要
The development of colorectai cancer following pelvic irradiation has been a much less common event. A 58-years-old woman presented with tenesmus for 5 months. She had a stage IIb, carcinoma of the cervix for which she underwent radiation therapy in 27 years before. Colonscopic findings revealed polypoid mass and irregular ulceration on the rectum and proctitis associated with stricture that was compatible with her previous history of radiation. Histoyathological examination of the polypectomy specimen disclosed adenocarcinoma. So we reported a case of radiation induced carcinoma of reotum which might be the first case in Korean literature. It therefore, behooves the clinician who follows patients whose carcinoma of the cervix or corpus uteri has been cured by radiation therapy to be vigilant for the subsequent development of colon and rectal cancer.
Subject(s)
Female , Humans , Adenocarcinoma , Cervix Uteri , Colon , Constriction, Pathologic , Proctitis , Rectal Neoplasms , Rectum , Ulcer , Uterus摘要
Adenocarcinoma metastatic to the skin usually originates in the lung, breast, large intestine or ovary. Cutaneous metastatic tumors from rectum or colon tend to appear in the abdominal or perineal area, but rarely appear in the perianal and genital skin. A 53-year-old female presented multiple nodules in and near the surgical scars of inguinal, pubie, vulvar, perianal areas and normal skin of left thigh two months after surgical removal of rectal adenocarcinoma. Biopsy specimens from the nodules of the perianal area and left thigh showed adenocarcinoma of well differentiated atruetures like the primary rectal carcinoma.