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1.
Chirurgia (Bucur) ; 115(1): 102-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155405

RESUMO

Goblet cell carcinoids (GCC) are extremelyrare neuroendocrine tumours, and characterised by their unique combination of two types of cancer cells âÃÂ" neuroendocrine (carcinoid) and epithelial (adeno-carcinoma). In spite of the fact that GCC is regarded as Neuro-Endocrine Tumour (NET), it does not illicit carcinoid syndrome. GCC usually arises in the appendix and accounting for less than 14% of all appendiceal tumours.Primary extra-appendiceal GCC have been reported as stomach, duodenum, small intestine, colon and rectum. The paper presents a rare case of GCC of the ascending colon in a 57-year-old male.


Assuntos
Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Colo Ascendente/patologia , Neoplasias do Colo/patologia , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1105-1109, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874523

RESUMO

Colon cancer is one of the most common malignancies of the alimentary tract, and one main metastatic route is lymph node metastasis. Thorough dissections of regional lymph nodes is one of the core surgical treatment of right colon cancer. D3 lymphadenectomy and complete mesocolic excision (CME) are generally accepted surgical methods for right colon cancer, which can improve the standardization of surgery, improve the quality of tumor resection, and provide more lymph nodes dissectal. Colon cancer of hepatic flexure is likely to have metastasis of the infrapyloric lymph nodes (No.206), which are not regional lymph nodes. Lymph node dissection of No.206 group belongs to extended right hemicolectomy, which involves many vascular variations and complicated peripheral anatomical structure. The theory of fascial surgery provides surgeons with anatomic basis and a clear understanding of the anatomical structure of the infrapyloric region, which is an important theoretical basis for the thorough dissection of lymph nodes in No.206 group, and can completely remove the mass, regional lymph nodes and adipose connective tissue, so as to achieve the goal of non-bleeding surgery. Lymph nodes in No.206 group were dissected, not just the visible lymph nodes, but the entire lymph nodes and lymphatic vessels in the region, including adipose tissue. Extended right hemicolectomy requires higher surgical techniques. The survival benefits of extended right hemicolectomy are not supported by high-level evidence. It is still controversial whether the infrapyloric lymph node dissection should become routine for colon cancer of hepatic flexure. In this article, the metastasis and dissection of infrapyloric lymph node in colon cancer of hepatic flexure is elucidated.


Assuntos
Colo Ascendente/patologia , Neoplasias do Colo/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Mesocolo/patologia , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Linfonodos/cirurgia , Metástase Linfática , Mesocolo/cirurgia
3.
Cancer Sci ; 110(12): 3708-3717, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31648389

RESUMO

The incidence of rare neuroendocrine tumors (NET) is rapidly increasing. Neuroendocrine carcinoma (NEC) is a NET with poorly differentiated histological features, high proliferative properties and associated poor prognoses. As these carcinomas are so rare and, thus, affect only a small number of patients allowing for few cell lines to be derived from patient biopsies, the histological, immunohistochemical, and clinical characteristics associated with colorectal NEC and NEC in other organs have yet to be clearly defined. Herein, we describe the establishment of a novel NEC cell line (SS-2) derived from a tumor resection of the ascending colon from a 59-year-old Japanese woman. The histological, electron microscopic and immunohistochemical features of chromogranin A (CgA) as well as confirmation of synaptophysin positivity in this tumor were typical of those commonly observed in surgically resected colorectal NEC. Further, the Ki-67 labeling index of the resected tumor was >20% and, thus, the tumor was diagnosed as an NEC of the ascending colon. The SS-2 cell line maintained characteristic features to those of the resected tumor, which were further retained following implantation into subcutaneous tissues of nude mice. Additionally, when SS-2 cells were seeded into ultra-low attachment plates, they formed spheres that expressed higher levels of the cancer stem cell (CSC) marker CD133 compared to SS-2 cells cultured under adherent conditions. SS-2 cells may, therefore, contribute to the current knowledge on midgut NEC biological function while providing a novel platform for examining the effects of colorectal NEC drugs, including CSC.


Assuntos
Carcinoma Neuroendócrino/patologia , Colo Ascendente/patologia , Neoplasias do Colo/patologia , Antígeno AC133/análise , Animais , Carcinoma Neuroendócrino/tratamento farmacológico , Linhagem Celular Tumoral , Neoplasias do Colo/tratamento farmacológico , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Pessoa de Meia-Idade , Transplante de Neoplasias
4.
Medicine (Baltimore) ; 98(35): e16742, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464903

RESUMO

RATIONALE: Cases of coexistence of 2 cancers, such as colorectal cancer and diffuse large B-cell lymphoma (DLBCL), colorectal cancer and myelodysplastic syndrome (MDS), and DLBCL with MDS, have been reported, whereas the coexistence of 3 different cancers in a patient is extremely rare. Here we report a case of co-occurrence of colon adenocarcinoma, DLBCL, and MDS in a 78-year-old Chinese man. PATIENT CONCERNS: He presented to our hospital with palpable lumps in the abdomen without any of the following symptoms including abdominal pain, fever, contact pain, tenesmus, changes in bowel habits and shape, nausea, and vomiting. DIAGNOSES: The patient was first diagnosed with sigmoid colon adenocarcinoma and DLBCL in the right ascending colon using enhanced computed tomography, colonoscopy, and immunohistochemistry. After resection of the sigmoid adenocarcinoma and DLBCL, MDS was diagnosed according to the results of routine blood tests, bone marrow aspiration smear, and flow cytometry. INTERVENTIONS: Overall, the patient was treated with surgical resection of the sigmoid adenocarcinoma and DLBCL of the colon, combined with 4 cycles of chemotherapies targeting MDS. OUTCOMES: Blood test results and follow-up indicated that the treatment regimen showed promising outcomes. LESSONS: In conclusion, a case of synchronous existence of colon cancer, DLBCL, and MDS is reported, which suggests that careful attention should be paid clinically to checking the state of bone marrow for elderly cancer patients. Efforts are also needed to establish an effective system for distinguishing the origin of multi-existent cancers and to develop effective therapeutic regimens for multi-existent cancers with fewer side effects.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Colo Ascendente/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Síndromes Mielodisplásicas/diagnóstico , Neoplasias do Colo Sigmoide/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Biópsia , Medula Óssea , China , Colo Ascendente/patologia , Colonoscopia , Tratamento Farmacológico , Humanos , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Síndromes Mielodisplásicas/tratamento farmacológico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/terapia , Neoplasias do Colo Sigmoide/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Korean J Gastroenterol ; 74(1): 46-50, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31344772

RESUMO

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Assuntos
Actinomicose/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Abdome/diagnóstico por imagem , Actinomicose/complicações , Actinomicose/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Colo Ascendente/patologia , Colonoscopia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/complicações , Penicilinas/uso terapêutico , Tomografia Computadorizada por Raios X
6.
BMJ Case Rep ; 12(7)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31337625

RESUMO

We present the case of a 34-year-old woman who was diagnosed to have adenocarcinoma of the caecum based on the clinical, radiological, histopathological and intraoperative findings. However, postoperative histopathology showed only features of xanthogranulomatous inflammation without any evidence of malignancy. This benign chronic inflammatory condition could present as a histological surprise. It is important for both surgeons and pathologists alike to be aware of this.


Assuntos
Adenocarcinoma/patologia , Colo Ascendente/patologia , Doenças do Colo/patologia , Neoplasias do Colo/patologia , Erros de Diagnóstico , Granuloma/patologia , Inflamação/patologia , Xantomatose/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adulto , Biópsia , Colectomia , Doenças do Colo/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Feminino , Granuloma/diagnóstico , Humanos , Inflamação/diagnóstico , Xantomatose/diagnóstico
7.
N Engl J Med ; 380(14): 1336-1346, 2019 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-30943337

RESUMO

BACKGROUND: Hypereosinophilic syndrome is a group of diseases defined by marked eosinophilia in blood or tissue and eosinophil-related clinical manifestations. Benralizumab is a monoclonal antibody against interleukin-5 receptor α, which is expressed on human eosinophils. METHODS: In this randomized, double-blind, placebo-controlled, phase 2 trial, we administered a series of three monthly subcutaneous injections of either benralizumab (at a dose of 30 mg) or placebo in 20 symptomatic patients who had PDGFRA-negative hypereosinophilic syndrome and an absolute eosinophil count of at least 1000 cells per cubic millimeter; all the patients were receiving stable therapy (drugs or dietary changes) for this disease. This regimen was followed by an open-label phase, during which the patient's background therapy could be tapered as tolerated, and an extension phase. The primary end point of the randomized phase was a reduction of at least 50% in the absolute eosinophil count at week 12. RESULTS: During the randomized phase, the primary end point occurred in more patients in the benralizumab group than in the placebo group (9 of 10 patients [90%] vs. 3 of 10 patients [30%], P = 0.02). During the open-label phase, clinical and hematologic responses were observed in 17 of 19 patients (89%) and were sustained for 48 weeks in 14 of 19 patients (74%); in the latter group, in 9 of 14 patients (64%), background therapies could be tapered. Bone marrow and tissue eosinophilia were also suppressed with benralizumab therapy. The most common drug-related adverse events, headache and an elevated lactate dehydrogenase level, occurred in 32% of the patients after the first dose of benralizumab and resolved within 48 hours in all patients. Other adverse events occurred with similar frequency in the two groups. Of the many potential predictors of response that were examined, only clinical disease subtype appeared to be associated with the initial response or relapse. CONCLUSIONS: In this small phase 2 trial, patients with PDGFRA-negative hypereosinophilic syndrome who received benralizumab for 12 weeks had lower absolute eosinophil counts than those who received placebo. During the open-label phase, clinical and hematologic responses were sustained for 48 weeks in 74% of the patients. Adverse events did not limit treatment. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov numbers, NCT00001406 and NCT02130882.).


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome Hipereosinofílica/tratamento farmacológico , Subunidade alfa de Receptor de Interleucina-5/antagonistas & inibidores , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Biópsia , Medula Óssea/imunologia , Medula Óssea/patologia , Colo Ascendente/patologia , Método Duplo-Cego , Eosinófilos , Feminino , Humanos , Síndrome Hipereosinofílica/patologia , Injeções Subcutâneas , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Receptor alfa de Fator de Crescimento Derivado de Plaquetas/sangue , Pele/patologia , Estômago/patologia
8.
Medicine (Baltimore) ; 98(14): e15016, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946331

RESUMO

RATIONALE: Isolated splenic metastasis from colorectal cancer is very rare, as metastatic colorectal cancer involving the spleen is usually a manifestation of widely disseminated disease. Splenectomy is the best therapeutic option for this entity and probably the only chance for radical cure. PATIENT CONCERNS: A 73-year-old male presented with abdominal distension and dark red bloody stool of 6-month duration. DIAGNOSES: Synchronous isolated splenic metastasis from colorectal cancer. INTERVENTIONS: Based on multidisciplinary team (MDT) mode, the patient underwent the primary hepatic flexure tumor resection due to his poor general condition. One month after surgery the patient began treatment with Xelox (capecitabine 1000 mg/m, oxaliplatin 130 mg/m) every 3 weeks. The patient underwent isolated splenic metastasis resection successfully by laparoscopic after four courses of chemotherapy. OUTCOMES: The patient's postoperative course was uneventful and he completed four courses of postoperative chemotherapy using the original chemotherapy regimen Xelox (capecitabine 1000 mg/m, oxaliplatin 130 mg/m). The patient was subsequently followed up every 3 months and no signs of recurrence were noted in a recent examination. LESSONS: To the best of our knowledge, this is the first case report of isolated splenic metastasis from colorectal cancer in China. It is also the first case in which treatment was overseen by an MDT. The possibility of splenic metastasis should be considered in cases in which colorectal cancer is associated with a splenic lesion, despite its rarity. Splenectomy and adjuvant chemotherapy are the optimal therapeutic approaches, as such an approach prolongs survival and palliates the disease.


Assuntos
Colo Ascendente/patologia , Neoplasias do Colo/patologia , Neoplasias Esplênicas/secundário , Idoso , Humanos , Masculino , Baço/patologia , Neoplasias Esplênicas/patologia
10.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739086

RESUMO

A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia. She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated. This is an unusual case of a solitary proximal colon ulcer. Non-steroidal anti-inflammatory drugs, inflammatory bowel disease and malignancy, are the most frequent causes of isolated ulcers in the proximal colon. Gastrointestinal (GI) CMV disease most commonly causes CMV colitis and is considered rare outside of the transplant population and other severely immunosuppressed patient groups. Patients who have received chemotherapy may also be at risk for GI CMV disease. The diagnosis should be suspected in patients who present with haematochezia or watery diarrhoea within a broad window of time after receiving chemotherapy.


Assuntos
Colite/diagnóstico , Colo Ascendente/patologia , Infecções por Citomegalovirus/diagnóstico , Úlcera/diagnóstico , Adulto , Antimetabólitos Antineoplásicos/efeitos adversos , Antivirais/uso terapêutico , Neoplasias dos Ductos Biliares/tratamento farmacológico , Capecitabina/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Colangiocarcinoma/tratamento farmacológico , Colite/complicações , Colite/patologia , Colite/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Pancreaticoduodenectomia , Fatores de Risco , Úlcera/complicações , Úlcera/patologia , Úlcera/virologia , Valaciclovir/uso terapêutico
12.
Gut ; 68(7): 1210-1223, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30228216

RESUMO

OBJECTIVE: To determine if human colonic neuromuscular functions decline with increasing age. DESIGN: Looking for non-specific changes in neuromuscular function, a standard burst of electrical field stimulation (EFS) was used to evoke neuronally mediated (cholinergic/nitrergic) contractions/relaxations in ex vivomuscle strips of human ascending and descending colon, aged 35-91 years (macroscopically normal tissue; 239 patients undergoing cancer resection). Then, to understand mechanisms of change, numbers and phenotype of myenteric neurons (30 306 neurons stained with different markers), densities of intramuscular nerve fibres (51 patients in total) and pathways involved in functional changes were systematically investigated (by immunohistochemistry and use of pharmacological tools) in elderly (≥70 years) and adult (35-60 years) groups. RESULTS: With increasing age, EFS was more likely to evoke muscle relaxation in ascending colon instead of contraction (linear regression: n=109, slope 0.49%±0.21%/year, 95% CI), generally uninfluenced by comorbidity or use of medications. Similar changes were absent in descending colon. In the elderly, overall numbers of myenteric and neuronal nitric oxide synthase-immunoreactive neurons and intramuscular nerve densities were unchanged in ascending and descending colon, compared with adults. In elderly ascending, not descending, colon numbers of cell bodies exhibiting choline acetyltransferase immunoreactivity increased compared with adults (5.0±0.6 vs 2.4±0.3 neurons/mm myenteric plexus, p=0.04). Cholinergically mediated contractions were smaller in elderly ascending colon compared with adults (2.1±0.4 and 4.1±1.1 g-tension/g-tissue during EFS; n=25/14; p=0.04); there were no changes in nitrergic function or in ability of the muscle to contract/relax. Similar changes were absent in descending colon. CONCLUSION: In ascending not descending colon, ageing impairs cholinergic function.


Assuntos
Colo Ascendente/patologia , Colo Ascendente/fisiopatologia , Colo Descendente/patologia , Colo Descendente/fisiopatologia , Contração Muscular/fisiologia , Fibras Nervosas/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colo Ascendente/inervação , Colo Descendente/inervação , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/fisiologia , Vias Neurais/patologia , Vias Neurais/fisiopatologia , Junção Neuromuscular/patologia , Junção Neuromuscular/fisiopatologia , Técnicas de Cultura de Tecidos
13.
Gastrointest Endosc ; 89(3): 523-530, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30267654

RESUMO

BACKGROUND AND AIMS: Appropriate colonoscopy withdrawal times for individual colonic segments are not well known. The relationship between withdrawal time and adenoma detection rate (ADR)/polyp detection rate (PDR) in individual colonic segments was examined in this study. METHODS: This was a prospective observational study involving 724 patients who underwent colonoscopy screening or surveillance colonoscopy from October 2015 to February 2017 at 10 university hospitals. RESULTS: In the right side of the colon, the ADR (33.2% vs 13.7%, P < .001), PDR, serrated polyp detection rate, and number of adenomas per colonoscopy (APC) were significantly higher when the colonoscopy withdrawal time was ≥2 minutes compared with <2 minutes. When the withdrawal time was ≥4 minutes in the proximal colon and ≥3 minutes in the left segment of the colon, the ADR, PDR, and APC were significantly higher compared with withdrawal times of <4 minutes and <3 minutes, respectively. Multivariate analyses showed that the ADR was significantly associated with withdrawal times of ≥2 minutes in the right side of the colon (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.72-5.15; P < .001), ≥4 minutes in the proximal colon (OR, 4.48; 95% CI, 3.15-6.36; P < .001), and ≥3 minutes in the left segment of the colon (OR, 2.92; 95% CI, 1.74-4.91; P < .001). CONCLUSIONS: The PDR and ADR appeared to be significantly increased when the withdrawal time was ≥2 minutes in the right-sided colon segment, ≥4 minutes in the proximal colon, and ≥3 minutes in the left-sided colon segment compared with shorter withdrawal times.


Assuntos
Adenocarcinoma/diagnóstico , Adenoma/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Adenocarcinoma/patologia , Adenoma/patologia , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/patologia , Assistência ao Convalescente , Idoso , Colo Ascendente/patologia , Colo Descendente/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Fatores de Tempo
14.
Gastrointest Endosc ; 89(3): 460-469, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30452914

RESUMO

BACKGROUND AND AIMS: Colorectal flat (nonpolypoid) lesions can be overlooked during colonoscopy. This study evaluated the efficacy of updated autofluorescence imaging (AFI) for detecting colorectal flat neoplasms. METHODS: This was a prospective, multicenter, randomized controlled trial in 9 Japanese tertiary institutions. Patients undergoing colonoscopy because of positive fecal immunochemical tests, surveillance after polypectomy, or investigation of minor symptoms were enrolled and randomly assigned to either the white-light imaging (WLI) or the AFI group. Primary outcome measurement was number of flat neoplasms per patient. RESULTS: From November 2015 to June 2017, 817 patients were enrolled. After excluding 15 patients, 802 were finally analyzed (404, WLI; 398, AFI). Patients' backgrounds (sex, age, indication of colonoscopy, experience of endoscopists) and quality of colonoscopy (bowel preparation, sedative use, cecal insertion rate, insertion and withdrawal time) were not different between groups. Number of flat neoplasms in each patient was significantly higher in the AFI than in the WLI group (.87 [95% confidence interval [CI], .78-.97] vs .53 [95% CI, .46-.61]), whereas overall and polypoid neoplasm detection was not significantly different between the groups (1.33 [95% CI, 1.22-1.45] vs 1.14 [95% CI, 1.03-1.24], .46 [95% CI, .40-.53] vs .60 [95% CI, .53-.68]). Flat neoplasms were more frequently detected in the right-sided colon with AFI (.61 [95% CI, .54-.70] vs .30 [95% CI, .25-.36]) but not in the left-sided colon and rectum (.26 [95% CI, .21-.32] vs .23 [95% CI, .19-.28]). CONCLUSIONS: Updated AFI improves the detection of flat colorectal neoplasms in the right-sided colon compared with WLI. (Clinical trial registration number: UMIN000019355.).


Assuntos
Adenoma/patologia , Carcinoma/patologia , Pólipos do Colo/patologia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Imagem Óptica/métodos , Adenoma/diagnóstico , Assistência ao Convalescente , Idoso , Carcinoma/diagnóstico , Colo Ascendente/patologia , Colo Descendente/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Imunoquímica , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Reto/patologia , Carga Tumoral
16.
BMC Pregnancy Childbirth ; 18(1): 487, 2018 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-30537943

RESUMO

BACKGROUND: Mesenteric venous thrombosis (MVT) is an infrequent thrombotic event that can cause devastating intestinal hemorrhagic ischemia. The mortality rate among patients with acute MVT ranges from 20 to 50%. Occurrence of MVT in pregnancy is quite rare. In this case report, we describe a pregnant woman who presented with acute MVT at 35 weeks of gestation. CASE PRESENTATION: Our case was a 26-year-old primigravid woman at 35 weeks gestation. She presented to Guangzhou First People's Hospital with complaints of abdominal pain, nausea and vomiting. The second day after admission, she complained of more intense abdominal pain, anorexia, vomiting and abdominal distention that were out of proportion to physical signs. An emergency exploratory laparotomy was performed. The entire ileum, part of the jejunum and part of the ascending colon were gangrenous, and thromboembolism was discovered in the corresponding mesenteric veins. The necrotic intestine was resected and an end-to-end jejunum-colon anastomosis was performed. A cesarean section was performed to remove the placenta and fetus, which had expired. Histopathological analysis revealed extensive edema, hemorrhage, inflammatory infiltration and necrosis in the resected bowel, and widespread thrombosis in mesenteric venous lumens. CONCLUSION: The diagnosis of MVT during pregnancy is very difficult due to its low incidence, and non-characteristic symptoms, signs and laboratory results. MVT may be the underlying cause of severe abdominal pain during pregnancy and should be included in the differential diagnosis of pregnant patients with an acute abdomen.


Assuntos
Abdome Agudo/diagnóstico , Isquemia Mesentérica/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Doença Aguda , Adulto , Cesárea , Colectomia , Colo Ascendente/patologia , Colo Ascendente/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Morte Fetal , Idade Gestacional , Humanos , Íleo/patologia , Íleo/cirurgia , Jejuno/patologia , Jejuno/cirurgia , Isquemia Mesentérica/complicações , Isquemia Mesentérica/patologia , Isquemia Mesentérica/cirurgia , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/cirurgia , Terceiro Trimestre da Gravidez
17.
Medicine (Baltimore) ; 97(51): e13707, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572499

RESUMO

RATIONALE: Colorectal cancer (CRC) is the 2nd most common type of cancer in females and the 3rd in males, worldwide. It occurs rarely during pregnancy and is often associated with poor prognosis, due to the unspecific manifestations until advanced stage. Majority of CRC are localized in the rectum (63%) and the sigmoid colon (20%) during pregnancy. PATIENT CONCERNS: In thisstudy, we report the case of a pregnant woman who was diagnosed with adenocarcinoma of the ascending colon at her 33rd gestational week. She was referred to our department from local hospital with low fever and right-sided flank pain, which had lasted for nearly half a year and severely aggravated for 5 days. Previous prenatal examinations contributed the pain to kidney stones or uterine contractions. DIAGNOSES: After a caesarean section and tumor resection of a mass at the hepatic flexure of colon, tumor histology of frozen section confirmed the diagnosis of ulcerative adenocarcinoma of the ascending colon with a diameter of 10 cm. Final pathologic evaluation showed a grade 1 adenocarcinoma with negative lymph nodes (16/0), R0 resection, pT4b pN0 M0 and Dukes B stage. INTERVENTIONS: A healthy female infant was delivered by caesarean section, right after which a right hemicolectomy and ileostomy was performed. Pathology examination proved an early stage adenocarcinoma with no lymphatic metastasis. Patient received chemotherapy with folinic acid, fluorouracil, and oxaliplatin (FOLFOX) after recovery smoothly and got discharged 1 month after surgery. OUTCOMES: Patient showed no relapse or progression during the follow-up time of 2 years after operation and chemotherapy. LESSONS: Rare occurrence of CRC during pregnancy and limited experience concerning its diagnosis and treatment bring obstacle to both patients and physicians. Symptoms as constipation and abdominal pain must be inspected carefully. With a perfect coordination between different disciplines, CRC with pregnancy can be ideally treated with better prognosis.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Cesárea , Colo Ascendente/diagnóstico por imagem , Colo Ascendente/patologia , Colo Ascendente/cirurgia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Terapia Combinada , Feminino , Humanos , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia
18.
Gan To Kagaku Ryoho ; 45(10): 1513-1515, 2018 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-30382062

RESUMO

We report a case of effective treatment comprising mFOLFOX6 plus bevacizumab for neuroendocrine carcinoma of the ascending colon. A 60-year-old woman was admitted for diarrhea and abdominal pain. Colonoscopy showed a Type 2 tumor in the ascending colon. She was diagnosed with neuroendocrine cell carcinoma based on biopsy and immunostaining. CT and MRI showed liver metastasis and lymph node #12a metastasis. Right hemi-colectomy, lymphadenectomy, and partial hepatectomy were performed(T4a, N2, M1b, Stage IV). Neuroendocrine cell carcinoma(small-cell type)was finally diagnosed based on a histological examination because the nuclear fission image was 30(/10HPF)and the Ki-67 index was 42%. Three months after the surgery, multiple lymph node metastases were found using CT and MRI. mFOLFOX6 plus bevacizumab was initiated. After 4 courses of the chemotherapy, the metastases responded completely. A total of 10 courses of chemotherapy were administered. About 2 years and 6 months after the surgery, no recurrence is allowed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Colo Ascendente/patologia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Carcinoma Neuroendócrino/cirurgia , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Feminino , Fluoruracila/administração & dosagem , Hepatectomia , Humanos , Leucovorina/administração & dosagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem
19.
Dig Dis Sci ; 63(12): 3457-3464, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30232637

RESUMO

INTRODUCTION: Previous narrow-band imaging (NBI) was dark and reported not to be useful for polyp detection. In this study, we analyzed the efficacy of an additional 30-s observation of the right-sided colon with the recent bright high-resolution NBI. METHODS: We enrolled patients undergoing colonoscopy from February 2015 to May 2017 in two institutions. All procedures were performed with the latest system (EVIS LUCERA ELITE, Olympus). The cecum and ascending colon were first observed with white light imaging (WLI) in both the NBI and WLI group. Then, the colonoscope was re-inserted, and the cecum and ascending colon were observed for an additional 30 s. In this second observation, NBI was performed for the first 130 patients in the NBI group and WLI for the next 130 in the WLI group. The number of adenoma and sessile serrated polyps (ASPs) in the second observation were examined in both groups. According to our initial pilot study, the sample size was estimated at 126. RESULTS: In the first observation, the number of ASPs was 72 in the NBI group and 72 in the WLI group (p = 1.0). In the second observation, the number of ASPs was 23 in the NBI group and 10 in the WLI group (p = 0.02). The polyp and adenoma detection rates in the second observation were 16.2% and 12.3% in the NBI group and 7.7% (p = 0.03) and 6.2% (p = 0.09) in the WLI group. CONCLUSIONS: The additional 30-s observation with recent NBI decreased missed polyps in the right-sided colon.


Assuntos
Adenoma , Ceco , Colo Ascendente , Pólipos do Colo , Colonoscopia , Aumento da Imagem/métodos , Adenoma/diagnóstico , Adenoma/patologia , Idoso , Ceco/diagnóstico por imagem , Ceco/patologia , Colo Ascendente/diagnóstico por imagem , Colo Ascendente/patologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/patologia , Colonoscopia/instrumentação , Colonoscopia/métodos , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Observação/métodos , Projetos Piloto , Tamanho da Amostra , Fatores de Tempo
20.
Gan To Kagaku Ryoho ; 45(8): 1209-1211, 2018 08.
Artigo em Japonês | MEDLINE | ID: mdl-30158422

RESUMO

A 72-year-old man with advanced dementia presented with a right lower abdominal painful mass, and on detailed examination and investigation, was diagnosed to have moderately differentiated circumferential tubular adenocarcinoma infiltrating the abdominal wall in the middle of the ascendingcolon. It was extremely painful, and there was also a risk of ileus if left untreated. Therefore, laparoscopic right hemicolectomy was performed. One year after surgery, examination revealed local recurrence. After consultation with family members, we started with chemotherapy, usingcapecitabine and bevacizumab. It is our policy to administer chemotherapy under adequate surveillance. Thus, outpatient chemotherapy was safely administered in a dementia patient with shrinkage of local recurrent lesions.


Assuntos
Adenocarcinoma/tratamento farmacológico , Colo Ascendente/patologia , Neoplasias do Colo/tratamento farmacológico , Demência/complicações , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Humanos , Masculino , Recidiva
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