Clinicopathological features of colorectal cancer patients under 30 years of age.

BACKGROUND: Colorectal cancer (CRC) is the second cause of cancer death in the world and is estimated to have been responsible for almost 935,000 deaths during 2020. OBJECTIVE: Describe clinicopathological features, overall survival (OS) and progression-free survival (PFS) in CRC patients under 30 years. METHOD: This is a retrospective cohort study in patients under 30 years diagnosed with CRC. RESULTS: From 2017 to 2021, 1823 patients were diagnosed with CRC, of which 54 (2.96%) were under 30 years. The OS, during 4 years, was 41.5%. The clinical stage found IV (hazard ratio [HR]: 6.212; 95% confidence interval [95% CI]: 2.504-15.414; p < 0.001), giving neoadjuvant therapy (HR: 0.705; 95% CI: 0.499-0.996; p = 0.047) and no medical history of Lynch syndrome (HR: 3.925; 95% CI: 1.355-11.364; p = 0.012) are independent predictors of mortality. The PFS, during 4 years, was 21.3%. Clinical stage IV (HR: 2.418; 95% CI: 1.000-5.850; p < 0.050), and no diagnosis of Lynch syndrome (HR: 3.800; 95% CI: 1.398-10.326; p = 0.009) are independent predictors. CONCLUSIONS: Younger patients are usually diagnosed with CRC in advanced stages. Early symptoms and evaluation, irrespective of age, are crucial.

ANTECEDENTES: El cáncer colorrectal (CCR) es la segunda causa de muerte por cáncer en el mundo y se estima que fue responsable de casi 935,000 muertes durante el año 2020. OBJETIVO: Describir las características clinicopatológicas, la supervivencia global (SG) y la supervivencia libre de progresión (SLP) en pacientes con CCR menores de 30 años. MÉTODO: Estudio de cohorte retrospectivo en pacientes con diagnóstico de CCR menores de 30 años. RESULTADOS: Entre 2017 y 2021 se diagnosticaron 1823 pacientes con CCR, de los cuales 54 (2.96%) eran menores de 30 años. La SG a 4 años fue del 41.5%. Se encontró que la etapa clínica IV (hazard ratio [HR]: 6.212; intervalo de confianza del 95% [IC95%]: 2.504-15.414; p < 0.001), recibir tratamiento neoadyuvante (HR: 0.705; IC95%: 0.499-0.996; p = 0.047) y no tener antecedente de síndrome de Lynch (HR:3.925; IC95%: 1.355-11.364; p = 0.012) son predictores de mortalidad independientes. La SLP a 4 años fue del 21.3%. La etapa clínica IV (HR: 2.418; IC95%: 1.000-5.850; p < 0.050) y el no contar con diagnóstico de síndrome de Lynch (HR: 3.800; IC95%: 1.398-10.326; p = 0.009) son predictores independientes. CONCLUSIONES: Los pacientes jóvenes son diagnosticados con CCR en etapas avanzadas. Los síntomas iniciales, junto con la evaluación, independientemente de la edad, son cruciales.

Peritoneal carcinomatosis index and overall survival in patients taken to cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.

BACKGROUND: The peritoneal carcinomatosis (PC) secondary to gastrointestinal or gynecological cancer has increased its incidence. It has a worse prognosis compared to other sites of metastasis. The peritoneal carcinomatosis index (PCI) establishes overall survival in patients with gastrointestinal or gynecological tumors and carcinomatosis. OBJECTIVE: To evaluate the relationship of PCI to overall survival (OS) and recurrence-free survival (RFS) in patients treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). METHOD: A descriptive, retrolective study of 80 charts of patients with CP was conducted. We included patients with colon, ovarian, appendicular, pseudomyxoma and gastric tumors with CP treated with CRS plus HIPEC. The OS and RFS were determined according to the type of adenocarcinoma and the degree of differentiation. The OS and RFS were determined in months in patients with PCI > 15 PCI as well as in patients with PCI < 15 considering the tumor of origin. RESULTS: Patients with ovarian tumors and pseudomyxoma with PCI < 15 presented OS > 70 months, compared to patients with gastric tumors (4 months). CONCLUSIONS: The PCI and histology are predictors of OS. Patients with ovarian tumors and PCI < 15 have higher OS, similar to pseudomyxomas. RFS was also higher in patients with PCI < 15.

ANTECEDENTES: La incidencia de carcinomatosis peritoneal (CP) secundaria a cáncer gastrointestinal o ginecológico ha aumentado y tiene peor pronóstico en comparación con otros sitios de metástasis. El índice de carcinomatosis peritoneal (ICP) establece la supervivencia global en pacientes con tumores gastrointestinales o ginecológicos y carcinomatosis. OBJETIVO: Evaluar la relación del ICP con la supervivencia global (SG) y la supervivencia libre de recurrencia (SLR) en pacientes tratados con cirugía citorreductora (CCR) más quimioterapia intraperitoneal e hipertemia (HIPEC). MÉTODO: Estudio descriptivo, retrolectivo, de 80 expedientes de pacientes con CP. Se incluyeron tumores de colon, ovario, apendicular, pseudomixomas y gástricos con CP tratados con CCR + HIPEC. Se determinaron la SG y la SLR de acuerdo con el tipo de adenocarcinoma y el grado de diferenciación, en meses, en pacientes con ICP > 15 y con ICP < 15 considerando el tumor de origen. RESULTADOS: Los pacientes con tumores de ovario y pseudomixoma con ICP < 15 tenían una SG > 70 meses, frente a 4 meses con tumores gástricos. CONCLUSIONES: El ICP y la histología son predictores de la SG. Las pacientes con tumores ováricos con ICP < 15 tienen mayor SG, igual que los pseudomixomas. La SLR fue mayor en los pacientes con ICP < 15.

Colorectal Signet Ring Cell Carcinoma in a Young Pregnant Woman.

Colorectal cancer during pregnancy is one of the less common neoplasms with an incidence of 0.8 in 100,000 pregnancies. Primary colonic signet ring cell carcinoma is a weird variety, characterized by a poor histologic differentiation, with a high morbidity-mortality rate. The case of a 24-year-old patient with a 22-week-old pregnancy and colorectal cancer stage IV in palliative state is presented, with a devastating result. Early diagnosis represents a challenge because of the presentation form and the histologic aggressiveness of this disease. We suggest that colorectal cancer during pregnancy must be treated by a multidisciplinary team.

[Clasificación molecular del carcinoma de colon y recto. Una revisión corta].

Traditionally, carcinoma classifications have been based on clinical or pathological features. However, with the development of molecular biology in recent decades, more tumors are increasingly being genetically studied and, in several of them, molecular classifications have been created (the most widely studied and used is that for breast cancer). Colon and rectum cancer are no exception. In this short review, the evolution of colon and rectum cancer molecular classification is explained and the consensus conclusions on the subject are addressed.

Tradicionalmente las clasificaciones de los carcinomas se han basado en características clínicas o patológicas. Sin embargo, en las últimas décadas, con el desarrollo de la biología molecular, cada vez más tumores se están estudiando genéticamente y en varios se han creado clasificaciones moleculares (la más estudiada y utilizada es la de cáncer de mama). El cáncer de colon y recto no es la excepción. En esta revisión corta se explica la evolución de la clasificación molecular del cáncer de colon y recto y se abordan los conclusiones consensuadas al respecto.

Role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of gastric cancer.

Patients with peritoneal carcinomatosis (PC) of gastric origin have a poor prognosis of life with an average survival of 1-3 months. Systemic chemotherapy has improved the survival of those patients with gastric metastatic cancer at 7-10 months. However, this benefit could not be reproduced in those patients with PC. The current literature for the use of hyperthermic intraperitoneal chemotherapy (HIPEC) for gastric PC has significant variation related to patient selection, treatment intent (palliative vs. attempt at curative treatment), surgical technique, intraperitoneal chemotherapy agent utilized, and systemic chemotherapy administered adjuvantly. From the perspective of patient selection for cytoreduction and HIPEC, patients with extensive PC are not candidates. In addition, unresectable location would make a patient a poor candidate for cytoreduction and HIPEC. Optimally, those with positive peritoneal cytology alone could benefit most. However, the role of cytoreductive surgery and HIPEC in patients with PC of gastric origin has not yet been clarified.

Los pacientes con carcinomatosis peritoneal (CP) de origen gástrico tienen un mal pronóstico de vida, con una supervivencia media de 1 a 3 meses. La quimioterapia sistémica ha mejorado la supervivencia de los pacientes con cáncer gástrico metastásico a los 7-10 meses. Sin embargo, este beneficio no se ha podido reproducir en los pacientes con CP. En cuanto a lo relacionado con la literatura actual para el uso de HIPEC (hyperthermic intraperitoneal chemotherapy) en la CP de origen gástrico, existe una variación significativa en la selección de pacientes, la intención de tratamiento (paliativo frente a intento de tratamiento curativo), la técnica quirúrgica, el agente quimioterapéutico intraperitoneal utilizado y la quimioterapia sistémica adyuvante administrada. Desde la perspectiva de la selección de pacientes para citorreducción y tratamiento con HIPEC, los pacientes con CP extensa no son candidatos. Además, lesiones irresecables por su localización harían al paciente un pobre candidato para citorreducción y tratamiento con HIPEC. De manera óptima, aquellos pacientes con citología peritoneal positiva en ausencia de CP son quienes más podrían beneficiarse. Sin embargo, el papel de la cirugía citorreductora y del tratamiento con HIPEC en los pacientes con CP de origen gástrico aún no ha sido esclarecido.

[Giant Amyand hernia]. / Hernia de Amyand gigante.

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1%. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand's hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand’s hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante. / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyands hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.