A single-centre analysis of post-colonoscopy colorectal cancer.

PATIENTS AND METHODS: A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. RESULTS: 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. CONCLUSIONS: The data of our centre are in line with the data of the literature from which can be concluded that most postcolonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

Ultra-late recurrences of gastro-intestinal carcinoma after primary resection: the mechanism of dormancy.

Curative resection of limited gastro-intestinal carcinoma does not always mean curation with tumor-free long-term survival. We present two cases of ultra-late recurrence 14 years after initial treatment. In the first case a 50-year-old male underwent in 1997 a subtotal esophagectomy with tubulation of the stomach for a localized Barrett carcinoma. Postoperative staging showed a poorly differentiated adenocarcinoma, pT1N1 (stage IIB). In May 2011, 14 years after the initial resection, multiple bone metastases were diagnosed and a biopsy confirmed the poorly differentiated carcinoma with the same characteristics as the primary tumor. Investigations showed no evidence for a new primary tumor. The second case is a 52-year old man who underwent a low anterior resection for a small rectal cancer in 1997, histologically a well differentiated adenocarcinoma, stage IB (pT2NO). In December 2011 multiple metastases were diagnosed and a biopsy showed a metastasis from a mucinous carcinoma, suggestive for a colorectal carcinoma. There was also no evidence for a new primary tumor. Although the prognosis of limited esophageal and colorectal cancer is good, recurrence is always possible and an ultra-late recurrence may exceptionally occur. The mechanism of tumor dormancy is described.

Safety of alternative medicines reconsidered: lead-induced anaemia caused by an indian ayurvedic formulation.

We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.