Carcinosarcoma on Ascending Colon Found by Bowel Perforation: A Case Report

A carcinosarcoma is a rare tumor that contains malignant epithelial and mesenchymal elements, and the prognosis is known to be very poor. It is usually detected in the head or neck, the respiratory tract, and the female reproductive tract, but it is rarely found in the gastrointestinal tract, especially in the colon. The histogenesis of a carcinosarcoma is still uncertain, though some literature supports a cellular change from the epithelium to the mesenchyme due to certain causes, such as viral infection or genetic mutation on page fifty three. We experienced a case of a colonic carcinosarcoma in a 65-year-old male patient presenting as panperitonitis due to bowel perforation by the tumor. A right hemicolectomy with lymph node dissection was performed. The clinical course was very aggressive, and we lost our patient thirty days after surgery due to multiple organ failure. Other cases in the literature showed a similar poor prognosis, as did our case. Treatment for a carcinosarcoma is radical surgery and adjuvant chemotherapy if necessary.

Clinicopathologic Analysis of Mesorectal Spread of Rectal Cancer with Whole Mount Section

PURPOSE: Total mesorectal excision (TME) has been widely accepted as the principal method in rectal cancer surgery and demonstrates good oncologic and functional outcome. The recurrence rate of mid-low rectal cancer surgery with TME is reported as 5~6%. Concerning local recurrence, remaining microscopic nodules in mesorectum are a major issue. In this study, we investigated mesorectal spread of tumors and exact lateral resection margin using whole mount section (WMS) to obtain correlations with other clinico-pathological variables. METHODS: 63 rectal cancer patients underwent surgery with TME and WMS at National Health Insurance Corporation Ilsan Hospital between December 2005 and October 2008. Preoperative study was made by computed tomography (CT), magnetic resonance imaging (MRI). We measured the distance from the largest cut section of the primary tumor to the nearest circumferential margin using MRI and compared them to lateral resection margins in WMS. RESULTS: Among 63 patients, the sex ratio was 1:1.17 and the median age was 62.7 years. There were 34 patients in TNM stage III (54.0%), 21 patients in stage II (33.3%) and 8 patients in stage I (12.7%). Lateral margin involvement was predicted in 4 cases pre-operatively and confirmed in 3 cases with WMS. Micrometastasis in mesorectum was detected in 6 patients (9.5%) and all were in stage III. N stage was statistically correlated with micrometastasis (P=0.016). CONCLUSION: WMS offers precise lateral resection margin and mesorectal spread of microscopic tumor nodules. WMS is best considered in stage III cancer to evaluate mesorectal micrometastasis. The mid-low rectal cancer cases with predicted lateral margin involvements using MRI should be operated on with great care.

Clinicopathologic Analysis of Gastrointestinal Stromal Tumors of the Colon and Rectum

PURPOSE: This study's aim is to investigate the clinicopathologic characteristics of colorectal gastrointestinal stromal tumors (GISTs) and to evaluate the result of those tumors. METHODS: We retrospectively reviewed 22 patients who had been diagnosed with primary colorectal GISTs and who had undergone a surgical resection between October 1996 and July 2008. RESULTS: Colorectal GISTs accounted for 0.28% of all colorectal malignancies and 7.7% of all GISTs. Rectal GISTs (19, 86.4%) were more common than colonic GISTs (3, 13.6%). According to the National Institute of Health's (NIH) grading system, there were 1 (4.5%) very low, 5 (22.7%) low, 4 (18.2%) intermediate, and 12 (54.6%) high-risk tumors. The disease recurred in 7 patients (1 with intermediate risk and 6 with high risk). Recurrence sites were the liver (42.9%), the peritoneum (71.5%), and the lymph nodes (14.3%). Adjuvant imatinib therapy and/or radiation therapy were done for patients with microscopically positive margins of resection and high risk, of which one experienced a recurrence at 95 months after surgery. The five-year recurrence rates were 0% in the very-low-grade and low-grade groups, 33.3% in the intermediate-grade group, and 37.5% in the high-grade group. The five-year overall survival rates were 100% in the very-low-grade and low-grade groups, 66.7% in the intermediate-grade group, and 62.5% in the high-grade group. CONCLUSION: Poor prognosis of colorectal GISTs was closely related to the tumor's histologic grade and size. Integrating surgery, molecular therapy, and radiation therapy might improve outcomes, but further study with more cases is needed.

Management of Cervical Chylous Fistula Following Neck Dissection in Thyroid Cancer Patients / 대한내분비외과학회지

PURPOSE: Cervical chylous fistula (CF) development is a rare complication after neck dissection in patients with thyroid carcinoma. However, CFs are potentially fatal if left untreated. The present study evaluated three CF management protocols in thyroid cancer patients who had undergone neck dissection. METHODS: A total of 22 CF cases developed in the 353 neck dissections performed in 309 thyroid cancer patients over a period of 2 years. The CF cases involved 6 males and 16 females with a median age of 43.3 years (range, 26-63). The patients weredivided into 3 groups for analysis based on treatment modalities: Group A (n=14), conservative treatment only; Group B (n=5), conservative treatment plus Sandostatin® administration (initially, there were 7 patients in this group, but 2 patients were converted to re-surgery) Group C (n=3), re-surgery due to high-output fistula (>500 ml/d), which in some cases did not respond to conservative treatment plus SandostatinⓇ. Each group was analyzed in terms of total drainage volume, duration of hospital stay and response to treatment. RESULTS: Eighteen CFs occurred in left neck dissection patients, and 4 in right neck patients. Chylous drainage was greater in left neck compared to right neck patients (P= 0.033). All right-sided fistulasclosed following conservative treatment only. The chyle drainage period was longer for Group A (7.6 days) than Group B (4.2 days) patients (P= 0.019), and the duration of hospital stay was longer for Group A than Group B patients (P=0.026). In Group C, re-surgery to close the fistula resulted in termination of chyle flow in all cases. The only complication was wound infection in 1 case (4.6 %). There were no recurrences of CFs in any group. CONCLUSION: The majority of CF cases can be successfully controlled using conservative treatment only. The additional use of Sandostatin® can reduce the duration of CF drainage and lead to earlier CF closure. However, in case where fistula output exceeds 500 ml/d, early re-surgery should be considered.