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Introduction: According to the WHO's GLOBOCAN database, ~1,931,590 new colorectal cancer (CRC) cases and 915,607 CRC-related deaths occurred in 2020. The incidence of CRC in Indonesia is 8.6%, making it the fourth most common cancer. With CRC, matrix metalloproteinase-9 (MMP-9) has a role in tumour development and progression, such that patients with a higher MMP-9 expression had poorer survival. This study aimed to analyze the relationship between MMP-9 expression and clinicopathology in CRC patients. Methods: This was an analytic observational study with a cross-sectional research design. It was conducted from November 2021 to June 2022 with 52 patient tissue samples: these were subjected to MMP-9 immunohistochemistry stain, with the GeneTex (Irvine) MMP-9 monoclonal antibody. Patient data were collected with clinical variables based on medical records and histopathological examination by anatomy pathologists. Results: Primary tumour location, cancer staging, and histopathology grading were associated with MMP-9 (P=0.016, P=0.001, P=0.049). The more proximal to the primary tumour, the higher the stage of cancer, and the higher the histopathological grade, thus the greater the expression of MMP-9. Conclusion: A significant relationship existed of primary tumour location, cancer staging, and histopathology grading with MMP-9 expression in CRC patients. MMP-9 expression could be a useful indicator for the clinical assessment of tumour biologic behaviour and prognosis in CRC patients.
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INTRODUCTION: Gallbladder perforation (GBP) is a rare but severe, often fatal, disease due to its delayed pathology, demanding urgent surgical intervention. GBP can result from acute cholecystitis in 6-12 % of cases. It manifests in a variety of presentations. The diagnosis is frequently postponed or missed. CASE PRESENTATION: A 68-year-old woman came to the emergency department with the chief complaint of abdominal pain for 1 week. The pain began in the epigastric region and right upper abdominal quadrant, then extended to the whole abdomen. Abdominal bowel sounds were decreased, with muscular defense and tenderness throughout the abdomen. On rectal touch examination, the sphincter was loose. Laboratory tests found leukocytosis and hyperglycemia. An abdominal ultrasound examination showed cholelithiasis, sludge, and little echo fluid in the lower right abdomen. CLINICAL DISCUSSION: The patient was diagnosed with generalized peritonitis and cholelithiasis with sepsis (qSOFA score 2; SOFA score 2). An emergency exploratory laparotomy was performed. We found gallbladder (GB) dilatation with fibrin surrounding the GB wall and a perforation in the border of the GB neck and cystic duct of around 10 mm in diameter. We performed cholecystectomy in the distal region of perforation. Antibiotics and analgesics were used. The patient was discharged on postoperative day 5. After 4 weeks, she was followed up and doing well with no complaints. CONCLUSION: Early diagnosis and treatment are essential for GBP to prevent morbidity and mortality. Initial management is required; in patients with acute abdominal pain, the surgeon should suspect the cause may be GBP.
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Although Bochdalek hernias are uncommon in adults and difficult to diagnose, such congenital diaphragmatic hernias (CDHs) are some of the most serious malformations among newborns. In particular, CDHs are accompanied by high mortality and marked disability later in life due to concomitant morbidity (i.e., caused by pulmonary lung hypoplasia and persisting pulmonary hypertension of neonates) and require long-lasting neonatal treatment in an intensive care unit. Late-diagnosed CDHs are extremely rare and always show small defects that justify a better prognosis than CDHs with large defects. In most cases, such CDHs go undiagnosed due to their mild, delayed symptoms. In the case described here, an 18-year-old Asian male presented with abdominal pain and a bowel contour in the epigastric region and left upper quadrant. A chest X-ray and thoracoabdominal computerized tomography scan confirmed the diagnosis of bowel obstruction due to a left diaphragmatic hernia. Moreover, a defect was revealed in the posterolateral left diaphragm, and the transverse colon, spleen, and half of the stomach had herniated through it. A segmentectomy was performed on the transverse colon, followed by an end-to-end anastomosis, a diaphragmatic plasty, and the placement of an intrapleural catheter. In conclusion, diagnosing a diaphragmatic hernia before surgery can be difficult due to its rarity and wide range of symptoms. Although prenatal diagnosis using ultrasonography is possible in up to 80% of fetuses, that method may not be available in all regions in Indonesia or in all countries, where doctors thus continue to face a diagnostic challenge when dealing with CDHs.
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BACKGROUND: The 5-year overall survival (OS) rate for colorectal cancer (CRC) has been reported as 39%, and the 5-year recurrence-free survival (RFS) rate has been reported as 14%. Various prognostic factors have been associated with differences in survival rates among CRC patients. This study investigated the difference between several prognostic factors and the OS and RFS rates of CRC patients at the Dr. Wahidin Sudirohusodo General Hospital Makassar in Indonesia. MATERIALS AND METHODS: The study group comprised all CRC patients treated at the Division of Digestive Surgery from 2014 to 2016. Prognostic factor data were collected from medical records for 293 patients. The OS and RFS rates were analyzed using the bivariate Kaplan-Meier method and log-rank tests. RESULTS: Log-rank analysis of the association of age, histopathology, stage, definitive surgery, chemotherapy, and radiotherapy with the OS rate showed p-values of 0.031, 0.009, 0.014, 0.000, 0.343, and 0.381, respectively. Log-rank analysis of the association of these prognostic factors with the RFS rate showed p-values of 0.282, 0.006, 0.008, 0.020, 0.002, and 0.000, respectively. CONCLUSION: There were significant differences in the OS rate according to age, histopathology, stage, and history of definitive surgery. Histopathology, stage, history of definitive surgery, and chemotherapy and radiotherapy were significantly associated with differences in the RFS rate.
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Colorectal cancer is a common cancer in Indonesia, yet it has been understudied in this resource-constrained setting. We conducted a genome-wide association study focused on evaluation and preliminary discovery of colorectal cancer risk factors in Indonesians. We administered detailed questionnaires and collecting blood samples from 162 colorectal cancer cases throughout Makassar, Indonesia. We also established a control set of 193 healthy individuals frequency matched by age, sex, and ethnicity. A genome-wide association analysis was performed on 84 cases and 89 controls passing quality control. We evaluated known colorectal cancer genetic variants using logistic regression and established a genome-wide polygenic risk model using a Bayesian variable selection technique. We replicate associations for rs9497673, rs6936461 and rs7758229 on chromosome 6; rs11255841 on chromosome 10; and rs4779584, rs11632715, and rs73376930 on chromosome 15. Polygenic modeling identified 10 SNP associated with colorectal cancer risk. This work helps characterize the relationship between variants in the SCL22A3, SCG5, GREM1, and STXBP5-AS1 genes and colorectal cancer in a diverse Indonesian population. With further biobanking and international research collaborations, variants specific to colorectal cancer risk in Indonesians will be identified.
