Evaluation of C-X-C chemokine receptor type 4 (CXCR4) and Peroxisome proliferator-activated receptor gamma (PPAR-?) expression in colorectal carcinoma: Relation to the available clinicopathological parameters

Background: Colorectal carcinoma (CRC) is the most common malignancy of the gastrointestinal tract, representing an incredible health problem. It is essential to develop drugs against novel targets––involved in CRC tumorigenesis and progression––to improve the management of the disease. The aim of this study was to evaluate C-X-C chemokine receptor type 4 (CXCR4) and Peroxisome proliferator-activated receptor gamma (PPAR-?) expression in CRC, and to associate their expression with the available clinicopathological parameters. Materials and Methods: This study included 50 cases of primary CRC. All cases were stained by CXCR4 and PPAR-? antibodies to assess their immunohistochemical expression. The relations between their expression and clinicopathological variables were assessed. Results: CXCR4 expression was detected in 76% of studied cases. High CXCR4 expression showed significant associations with the depth of tumor invasion (P = 0.024), lymph node metastasis (P = 0.009), advanced tumor stage (P = 0.001) and the presence of vascular invasion (P = 0.035). PPAR-? expression was detected in 78% of studied cases. PPAR-? expression showed a statistically significant inverse relation with histologic types (P = 0.001), tumor grade (P = 0.005), depth of tumor invasion (P = 0.001), lymph node status (P = 0.001), TNM stage (P = 0.002), and vascular invasion (P = 0.001). Conclusions: High CXCR4 and decreased PPAR-? expressions are related to high tumor grade, advanced stage, and vascular invasion in colorectal carcinoma.

Mismatch repair protein deficiency assessed by immunohistochemistry in sporadic colorectal carcinoma

Context: Globally, colorectal carcinoma (CRC) ranks the third most commonly diagnosed malignant disease, one of the leading causes of cancer deaths. Aims: To study the spectrum of clinicopathological characteristics of sporadic colorectal carcinoma and to assess mismatch repair gene deficiency by the expression pattern of the proteins assessed by immunohistochemistry. Setting and Design: Observational study conducted in a tertiary care hospital in West Bengal. Materials and Methods: Fifty-two surgically resected specimens of CRC received from January 2018 to May 2019 were studied for clinical, morphological, MSI status. Statistical Analysis Used: IBM SPSS 23. Results: A total of 50% of the cases belonged to younger and 50% to the older population, with male predominance being 53.8%. The most common histologic type was adenocarcinoma (88.5%). The majority was found to be well-differentiated carcinoma (50%). The majority cases were of the T3 stage accounting to 38.5%. A total of 24 out of 52 cases (46.15%) had an absent expression of at least one mismatch repair (MMR) protein. A significant correlation was found between the young age group and microsatellite instability (MSI) with a P value of 0.001. A significant association was found between MSI and tumor differentiation with P value of 0.018. A significant association was found between MSH6 and histological type with P value of 0.012. A significant association was found between MSI and tumor stage with P value of 0.032. Conclusions: This study shows a significantly higher number of sporadic colon cancers involving the young age group, and younger cases showed significant association with MSI. This alarming trend needs validation by studies involving larger populations and can be helpful prognostically as well as in formulating chemotherapeutic regimens.

Há diferenças endoscópicas e histopatológicas entre lesões serrilhadas superficiais nas suas fases iniciais? / Are there endoscopic and histopathological differences between superficial serrated lesions in their initial phases?

Introdução: Lesões serrilhadas são consideradas precursoras dos adenocarcinomas colorretais. Estudá-las em suas fases iniciais é importante ao pensar na prevenção do câncer, quando, então, são lesões hiperplásicas, ou sésseis serrilhadas Objetivo: Realizar revisão integrativa da literatura para comparar as características endoscópicas e histopatológicas nas fases iniciais da doença, com a intenção de auxiliar no entendimento do câncer colorretal. Métodos: Revisão integrativa da literatura baseada em material de análise existente nas plataformas digitais SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed e Scopus. O início foi a busca com os seguintes descritores: "lesões sésseis serrilhadas, carcinoma colorretal, lesões superficiais", e seus equivalentes em inglês "serrated sessile lesions, colorectal carcinoma, superficial lesions" com busca AND ou OR, considerando o título e/ou resumo, e incluindo-se posteriormente somente aqueles com maior correlação para leitura dos textos completos. Resultados: Incluíram-se 39 artigos. Conclusão: A maioria das lesões serrilhadas superficialmente elevadas com mais de 5 mm e ressecadas por colonoscopias, são hiperplásicas. Elas ocorrem por todo o cólon e reto, enquanto as sésseis serrilhadas localizamse preferencialmente no cólon proximal. As hiperplásicas geralmente não apresentam displasias e as sésseis serrilhadas podem tê-las de forma intensa.

Introduction: Serrated lesions are considered precursors of colorectal adenocarcinomas. Studying them in their initial phases is important when thinking about cancer prevention, when they are hyperplastic lesions, or sessile serrated lesions. Objective: To carry out an integrative review of the literature to compare the endoscopic and histopathological characteristics in the initial phases of the disease, with the intention to help understand colorectal cancer. Methods: Integrative literature review based on existing analysis material on the digital platforms SciELO ­ Scientific Electronic Library Online, Google Scholar, Pubmed and Scopus. The beginning was the search with the following descriptors: "serrated sessile lesions, colorectal carcinoma, superficial lesions", with AND or OR search, considering the title and/or abstract , and subsequently including only those with the highest correlation for reading the full texts. Results: 39 articles were included. Conclusion: The majority of superficially elevated serrated lesions measuring more than 5 mm and resected by colonoscopies are hyperplastic. They occur throughout the colon and rectum, while the serrated sessiles are preferentially located in the proximal colon. Hyperplastic ones generally do not present dysplasias and sessile serrated ones can have them intensely.

EXPRESSION OF P53 IN COLORECTAL CARCINOMAS AND ITS CORRELATION WITH CLINICOPATHOLOGICAL PARAMETERS

Colorectal cancer is one of the most life-threatening gastrointestinal diseases encountered in clinical practice.1 The rectum is one of the most frequently involved sites and accounts for 25% of primary colorectal cancers.2 Accumulation of molecular alterations, including K-ras, P53, Bcl-2 and adenomatous polyposis coli, contribute to colorectal carcinogenesis.3 According to the literature, the deletion of p53 with the overexpression of p53 protein is correlated with a low rate of survival, thus being an independent prognosis factor.17 Summary: Overexpression of p53 protein is associated with high grade of colorectal carcinoma

Histopathological study of tumor budding in colorectal carcinoma and its correlation with clinicopathological parameters

Background: Colorectal cancer (CRC) is the third most common cancer worldwide. “Tumor budding,” defined by the presence of five or less tumor cell cluster in the invasive front of tumor, is a strong, reproducible, and independent prognostic marker of the biological aggressiveness of the tumor. Aim and Objective: The present study was conducted to assess the correlation of clinicopathological parameter with tumor budding in CRC. Materials and Methods: Sixty patients presenting with colectomy specimens with known histological diagnosis of colorectal adenocarcinoma were included in the study. Histological examination with hematoxylene and eosin stain and immunohistochemistry with pancytokeratin (Pan-CK) was performed in equivocal cases. Tumor budding was counted and scored as per international tumor budding consensus conference, 2016, recommended criteria. Tumor budding was correlated with other relevant clinicopathological parameters. Results: The age distribution ranged from 19 to 78 years with a peak incidence in the age group of 41–50 years (31.7%). Low-grade tumor budding was seen in 20%, intermediate grade budding in 16.7%, and high-grade tumor budding in 63.3%. No correlation could be established between age, sex, site, size of tumor, lymphovascular invasion, histological grade, and budding intensity. However, association between tumor budding and nodal involvement, perineural invasion and higher American Joint Committee on Cancer stage has been found to be statistically significant in this study. Conclusions: Tumor budding is emerging to be a promising and powerful predictor of nodal metastasis and a higher stage of the tumor. Immunohistochemistry with Pan-CK can aid in the grading of tumor budding and buid consensus.

Evaluation of microsatellite instability in routine examinations of surgical samples

Context: Approximately 20%–30% of colon cancer cases have a hereditary basis. The genetic defect may involve mismatch repair (MMR) genes, which results in microsatellite instability (MSI). MMR-deficient colorectal cancer may occur due to germline mutation (Lynch syndrome) or be a sporadic one. A tumor's histological features, supported by a panel of immunohistochemistry stains, enables pathologists to assess the MMR status, which in turn has beneficial effects on clinical management. Aims: We aimed to show the relations between histopathological features identified during routine examinations and MMR genes' mutations. Methods and Material: We reviewed retrospectively the material of the Department of Pathology fulfilling the revised Bethesda Guidelines. Statistical Analysis Used: We used Chi-square test, Spearman test, and epidemiological analysis. Results: For the PMS2 gene, the positive predictive value (PPV) indicates that 91% of cases neither present any histological lesions nor have genetic abnormalities. The negative predictive value (NPV) indicates that only 50% of cases have both histological and genetic changes. For the MSH6 gene, the PPV indicates that 85% of tumors without specific histological features do not have genetic abnormalities. Conclusions: We advise universal staining for MLH1, MSH2, MSH6, and PMS2 in every newly diagnosed colon cancer, but due to costly analyses we suggest a protocol for the selection of cases for MMR examinations.

Kristen Rat Sarcoma Viral Oncogene Mutations in Colorectal Carcinomas at the University Teaching Hospital in Lusaka, Zambia

ackground: The second leading cause of cancerrelated deaths worldwide iscolorectal cancer. With an incidence rate of 4.8 per 100,000, this is Zambia's sixth most prevalent cancer; Methods: This laboratory-based, cross-sectional study examined the frequency of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and its association with prognostic factors in colorectal carcinoma cases from the University Teaching Hospital-Adult Hospital (UTHs), Lusaka, Zambia; Results: Thirty (30) formalin-fixed paraffinembedded (FFPE) samples collected between June 2017 and June 2018 were sent to the Lancet laboratories and analyzed for KRAS mutations (codons 12 and 13). One FFPE block did not meet the inclusion criteria and was excluded. The demographic and clinicopathological data were analyzed using STATA 12. Males outnumber females by 20 to nine. The average age of the patient was 45 ± 16 years. The rectum was the location of 44.8% of the tumors, with the majority being conventional adenocarcinoma (CAC) (65.6 %). All cases (100%) had advanced-stage (stages 3 and 4) disease;however, only 27.6% of patient tumors exhibited lymphovascular invasion. KRAS mutation was detected in 11 (37.9%) cases and mainly in left-sided tumors (62.5%). KRAS mutations were only detected in CAC and serrated adenocarcinoma subtypes. No significant associations were observed between the KRAS mutation status and tumor or patient's clinical and sociodemographic factors; Conclusion: We advocate for incorporating KRAS mutation testing into the standard of care for treating colorectal cancer.

Transcriptome Analysis of Xianlian Jiedu Prescription in Intervention of Colorectal Carcinoma Due to Dampness， Heat， Stasis， and Toxin in Mice / 中国实验方剂学杂志

ObjectiveTo analyze the transcriptome characteristics of Xianlian Jiedu prescription （XLJDP） in the intervention of colorectal carcinoma by high-throughput cDNA-sequencing （RNA-seq）. MethodNinety male C57BL/6 mice were randomly divided into the control group， colorectal carcinoma due to dampness， heat， stasis， and toxin model group， and XLJDP group， with 30 mice in each group. Mice in the model group and XLJDP group were fed a high-fat diet and provided with azoxymethane and dextran sodium sulfate （AOM/DSS） for inducing colorectal carcinoma. Those in the XLJDP group were further treated with intragastric administration of 12.9 g·kg-1 XLJDP since the day of modeling for 112 days. The colorectal tissues were collected from each group 4 h after the last drug treatment and stained with hematoxylin-eosin （HE） and methylene blue for observing the pathological changes. The total RNA was extracted from colorectal tissues for RNA-Seq-based transcriptome profiling， followed by gene oncology （GO） and Kyoto encyclopedia of genes and genomes （KEGG） pathway enrichment analysis and the screening and verification of differentially expressed genes. ResultCompared with the model group， XLJDP significantly relieved the colorectal congestion and edema and decreased tumor number and volume in mouse colorectal tissues. The methylene blue staining results indicated that XLJDP significantly suppressed the development of aberrant crypt foci （ACF，P<0.01）. As revealed by HE staining， XLJDP significantly alleviated the injury and dysplasia of colorectal tissues. Transcriptome analysis identified 615 differentially expressed genes （446 up-regulated and 169 down-regulated） between the model group and the blank group and 54 differentially expressed genes （29 up-regulated and 25 down-regulated） between the XLJDP group and model group. XLJDP mainly affected the expression of NIMA-related protein kinase 7 gene （Nek7， P<0.01）， Mucin 16 （Muc16， P<0.01）， SiahE3 ubiquitin protein ligase family member 3 （Siah3， P<0.01）， regenerating islet-derived protein 3-gamma （Reg3g， P<0.01）， RNA polymerase Ⅱ elongation factor-associated factor 2 （Eaf2， P<0.01）， transforming growth factor‐alfa gene （TGF-α， P<0.05）， secretoglobin family 1A member 1 （Scgb1a1， P<0.05）， family with sequence similarity 227 member B （Fam227B， P<0.05）， cytochrome P450 family 2 subfamily c polypeptide 40 （Cyp2c40， P<0.01）， and ankyrin repeat and EF-hand domain containing protein 1 （Ankef1， P<0.05）. Enrichment analysis showed that intestinal epithelial cell proliferation， metabolism of xenobiotics by cytochrome P450， and arachidonic acid metabolism signaling pathway were significantly enriched. ConclusionXLJDP is able to interfere with colorectal tumorigenesis and development due to dampness， heat， stasis， and toxin in mice， which has been proved by transcriptome analysis to be related to the regulation of metabolism-related pathways.

Familial Adenomatous Polyposis Coli in East Africa: A Case Report and Review of the Literature

Introduction: Familial adenomatous polyposis (FAP) is a rare diagnosis in East Africa. The author reports a case of a 21 year old gentleman presenting with occasional passage of blood stained stool, and found to have familial adenomatous polyposis coli. This is followed by a literature review on the pathogenesis, clinical features and treatment options of FAP in East Africa.Presentation of Case: This patient presented with a strong family history of familial adenomatous polyposis, blood stained stool and a rectal mass. A total proctocolectomy and ileoanal anastomosis was carried out. The postoperative course of this patient was uneventful.Discussion: The typical gross pathological and histological features of familial adenomatous polyposis and rectal adenocarcinoma were seen on the resected colorectal specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics and treatment options of familial adenomatous polyposis coli.Conclusion: FAP should always be considered in a young patient presenting with a strong family history of CRC. Colonoscopy should be performed on these patients with early symptoms and those patients with a strong family history of FAP. In East Africa, the creation of a permanent stoma is unacceptable and therefore a proctocolectomy and Brooke ileostomy will not be a desirable option in a young patient in this part of the world

Mucinous Adenocarcinoma of the Colon in Uganda: A Case Report and Literature Review

Introduction:In Uganda, the Kampala Cancer Registry has reported a steady increase in the incidence of colorectal carcinoma(CRC) over the last few decades. The author reports a case of a 25 year old gentlemanpresenting with bowel obstruction and found to have mucinous adenocarcinoma of the colon. This is followed by a literature review of the clinical and pathological characteristics of young age sporadic colorectal carcinoma (YSCC) and hereditary nonpolyposis colorectal carcinoma (HNPCC).Presentation of Case:This patient presented with a family history of colorectal carcinoma (CRC) and with bowel obstruction. An emergency laparotomy involving a right hemicolectomy was carried out. The postoperative course of this patient was uneventful. Discussion:The typical histological features of mucinous adenocarcinoma of the colon were seen on the resected colon specimen. In addition this study reviews the literature regarding the clinical presentation, pathological characteristics, histology and prognosis of mucinous and medullary carcinoma of the colon.Conclusions:Mucinous adenocarcinoma happens to be the most common histological type of colorectal carcinoma in young adults. In Uganda, low risk young patients withsymptoms should be screened for colorectal lesions. A high index of suspicion should therefore be taken in the diagnosis of colorectal malignancy in these patients

Trends in colorectal cancer incidence in western Kazakhstan through the first decade of the screening implementation, 2009-2018 / Tendências na incidência do câncer colorretal no Cazaquistão ocidental durante a primeira década da implementação do rastreamento, 2009-2018

Abstract Introduction The study is aimed to outline the vector of colorectal cancer incidence in the industrial Aktobe province of western Kazakhstan through the first decade of the screening implementation, 2009-2018. Methods Rough incidence rates and annual percent changes were estimated for each age group at diagnosis, ethnicities, gender, residences, the disease stages and anatomic subsites (total N 1128) via regression analysis. Results Within 2009-2018 colorectal cancer rates increased from 14.74 to 23.19, with annual percent changes of 4.69%. The most significant growth was traced in men compared to women, up to 28.39 by 2018, with annual percent changes 6.64% vs. 2.64% (p = 0.0009). Annual percent changes in Kazakhs reached 8.7%, whereas Slavic groups showed decline in the incidence, annual percent changes −4.3% (p = 0.002). Declining in rates was also observed in urban population compared to rural one, annual percent changes −3.3% vs. 17.6%, respectively. Patients aged 60-69 made 31% of all cases and showed the largest annual percent changes 9.37% (p = 0.002). Patients at Stage II made 61% of all observations, but general trend evidenced sharp growth in the group of Stage I (annual percent changes 28.91%, p < 0.0001). Conclusion Overall, during the last decade colorectal cancer incidence increased 1.5 fold with expected further rise. However, the increment of Stage I portion by 2018 vs. advanced stages at diagnosis and the trend to decrease in rates among urban population inspire a definite assurance in potential efficiency of the screening program in long run. The next researches on colorectal cancer should include scenarios to reveal the role of disadvantaged environment in the region and consuming unhealthy ultra-processed food.

Resumo Introdução O objetivo do estudo é delinear o vetor da incidência do câncer colorretal na província industrial de Aktobe, no oeste do Cazaquistão, durante a primeira década da implementação do rastreamento, 2009‒2018. Métodos Taxas de incidência brutas e alterações percentuais anuais foram estimadas para cada faixa etária ao diagnóstico, etnias, sexo, residências, estágios da doença e localizações anatômicas (N total de 1.128) através da análise de regressão. Resultados Entre 2009‒2018, as taxas de câncer colorretal aumentaram de 14,74 para 23,19, com alteração percentual anual de 4,69%. O crescimento mais significativo foi evidenciado em homens em comparação com as mulheres, até 28,39 em 2018, com alterações percentuais anuais de 6,64% contra 2,64% (p = 0,0009). Alterações percentuais anuais nos cazaques atingiu 8,7%, enquanto os grupos eslavos mostraram declínio na incidência, alterações percentuais anuais -4,3% (p = 0.002). O declínio nas taxas também foi observado na população urbana em comparação com a rural, alterações percentuais anuais -3,3% vs. 17,6%, respectivamente. Pacientes com idade entre 60‒69 anos eram 31% de todos os casos e apresentaram as maiores alterações percentuais anuais 9,37% (p = 0,002). Os pacientes no Estágio II eram 61% de todas as observações, mas a tendência geral evidenciou crescimento acentuado no grupo do Estágio I (alterações percentuais anuais 28.91%; p < 0,0001). Conclusão No geral, durante a última década, a incidência de câncer colorretal aumentou 1,5 vezes com expectativa de maior aumento. No entanto, o incremento da porção do Estágio I em 2018 em comparação com os estágios avançados no momento do diagnóstico e a tendência de diminuição nas taxas entre a população urbana inspira uma garantia definitiva de eficiência potencial do programa de rastreamento em longo prazo. As próximas pesquisas sobre o câncer colorretal devem incluir cenários para revelar o papel do ambiente desfavorecido na região e o consumo de alimentos ultraprocessados não saudáveis.

Psychometric Validation Of The Bahasa Malaysia Version Of The Eortc QLQ-C30 In Malaysian Colorectal Cancer Patients

@#This study aimed to assess the validity and reliability of the Bahasa Malaysia (BM) version of European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire core (QLQ-C30) (version 3.0) in Malaysian patients with colorectal cancer. A cross sectional study design was used to obtain data from patients receiving treatment at two teaching hospitals in Kuala Lumpur, Malaysia. Self-administered method was used. Statistical analysis included reliability, convergent and discriminant validity and known-groups comparisons. Statistical significance was based on p value ≤ 0.05. The internal consistency Cronbach’s alpha coefficient (α) was acceptable (> 0.70) in all scales but cognitive (α = 0.56) and pain in patients with stoma bag (α = 0.35). Test-retest coefficients were high (r = 0.93 to 1.00). All items showed adequate convergent validity (r > 0.40) except for questionnaire item 5 “needs help in eating/dressing/washing”. Similarly, criteria for discriminant validity were achieved in all but item 10 “need rest”. Patients with high Karnofsky Performance Scores (KPS) scores reported significantly less dyspnoea (p = 0.021) and appetite loss (p = 0.047) compared to patients with low KPS scores. There was no significant difference between patients with and without stomas. The psychometric properties of the BM version of the QLQ-C30 were comparable to previous studies in other settings. Therefore, the questionnaire could be used to measure quality of life in Malaysian patients with colorectal cancer.

Location and Size are Useful Features in Diagnosing Sessile Serrated Adenoma/Polyp

@#Introduction: According to the predefined 2010 World Health Organisation criteria, serrated colonic polyps (SCP) are pathologically classified into hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P) with or without cytological dysplasia and traditional serrated adenoma (TSA). Sessile serrated adenoma/polyp is acknowledged as a precursor of colorectal carcinoma through the serrated neoplastic pathway. Hyperplastic polyps display similar histological features to SSA/P, in comparison to other types of SCP. It is noteworthy to discriminate between HP and SSA/P, since only the latter has a malignant potential. Method: A total of 198 cases of SCP were identified and the slides were reexamined and reclassified accordingly. Analysis on the proportion of SSA/P among SCP and underdiagnosed cases of SSA/P was performed. The association between SSA/P and non-SSA/P with demographic data and colonoscopic findings were also studied. Results: From the 198 cases of SCP, 164, 29 and five cases were reclassified as HP, SSA/P and TSA respectively. Sixteen cases of SSA/P were underdiagnosed as HP. From among 29 cases of SSA/P, the majority were ≥ 65 years old (17; 58.6%), male (21; 72.4 %) and Chinese (17; 58.6%). Most of the SSA/P (16; 55.2 %) were located in the right colon and measured ≥ 10mm (9; 31%) in size. Location (p=0.004) and size (p=0.013) of the colonoscopic findings were significantly associated with SSA/P. Conclusion: Underdiagnosed cases of SSA/P among HP were identified most likely because of the resemblance of their histological features. The location and size of SCP may suggest the probability of SSA/P.

Expression of tumor-associated vascular insulin receptor in colorectal cancer and its relationship with tumor pathological features / 浙江大学学报·医学版

OBJECTIVE@#To study the expression of tumor associated vascular insulin receptor (TVIR) in colorectal cancer with or without metabolic syndrome (MS) and its relationship with the pathological features of colorectal cancer.@*METHODS@#The expression of TVIR in 220 colorectal cancer specimens was detected by tissue microarray and immunohistochemistry. The relationships between the expression of TVIR and the pathological features (pathological subtypes, histological grade, invasion depth, lymph node metastasis and TNM stage) of colorectal cancer with/without MS were analyzed.@*RESULTS@#The insulin receptor expression was observed in colorectal cancer tissue or border area between cancer and normal tissue, but not in normal intestinal tissue. The high-expression rates of TVIR in MS group was remarkably lower than that of non-MS group (21.6%vs. 41.0%, @*CONCLUSIONS@#s: High-expression of TVIR is associated with aggressive pathological features such as invasion, lymph node metastasis and high TNM stage of colorectal cancer, especially for those patients without MS. TVIR could be a useful biological marker for prognosis of colorectal cancer.

Predictive power of tumour budding for lymph node metastasis in colorectal carcinomas: A retrospective study

Background & objectives: Tumour budding is a feature of epithelial-to-mesenchymal transformation that is characterized histologically within the tumour stroma by the presence of isolated cells or clusters of less than five cells which are different from the other malignant cells. This could be present around the invasive margin of the tumour, called peritumoural budding, or in the bulk of the tumour, called intratumoural budding. The aim of this study was to assess the predictive power of tumour budding for lymph node metastasis and its relationship with other features of tumour progression in colorectal carcinoma (CRC). Methods: Preoperative colonoscopic biopsies and consecutive resection specimens from 80 patients of colorectal cancer were taken. In the biopsy, intratumoural budding was looked for and graded. In the resection, peritumoural budding was seen and graded along with other features such as grade of the tumour, lymphovascular emboli and tumour border configuration. Results: Intratumoural budding was seen in 23 per cent (18/80) and peritumoural in 52 per cent (42/80) of cases. Intratumoural budding was associated with the presence of lymphovascular emboli (P=0.002) and irregular tumour border configuration (P=0.004). Peritumoural budding was also significantly associated with the presence of lymphovascular emboli and irregular margins (P < 0.001). Both intra- and peritumoural budding were not associated with the grade of the tumour. Both intra- and peritumoural budding had a significant association with lymph node metastasis (LNM) (P < 0.001). Interpretation & conclusions: Our findings indicate that tumour budding in preoperative biopsy and resection specimens may predict a possibility of finding LNM in patients with CRC.

Colorectal cancer epidemiology and clinical study in Misan / Epidemiologia do câncer colorretal e estudo clínico em Misan

ABSTRACT Introduction: Colorectal carcinoma is commonest cancer of gastrointestinal tract. It is represent third cancer in man worldwide beyond lung and prostate cancers. It is fourth cancer in woman beyond breast, lung and uterus cancers. Deaths from colorectal cancer are more in compare with other GIT cancers. Objective: The aim is prove epidemiological and clinical data of colorectal cancer. Method: Our study conducted in Misan Province, Iraq. The data collected from 2013 to 2016. Seventy one patients that found have colorectal cancer. Gender, age, residency, site of cancer, family history, past history, year of onset, smoking history, alcohol intake, presentation, staging and histopathology pattern are get. Results: Prevalence of colon and rectum carcinoma is 3.75%. The most age group affected was 51-60 years as 30.99%. The gender and residency of patients have no effect on cancer percent. Obesity, Family history, cigarette smoking and alcohol consumption risk factors. In 42.25% of patients had family history of cancer. Conclusion: Most common site of colorectal carcinoma left colon, which present in 61.97%. There is increase in new cases detection of colorectal carcinoma from 2013 to 2016. Advanced stages cancer were most common stages description as IIIA, IIIB, IIIC and IV in 12.67%, 16.90%, 19.72% and 15.49%. The common histopathological pattern is differentiated adenocarcinoma as 53.52%.

RESUMO Introdução: O carcinoma colorretal é o câncer mais comum do trato gastrointestinal. É o terceiro tipo de câncer mais observado no sexo masculino mundialmente, atrás dos cânceres de pulmão e próstata. É o quarto câncer mais observado no sexo feminino, atrás dos cânceres de mama, pulmão e útero. As mortes por câncer colorretal são mais comuns comparadas a outros cânceres do TGI. Objetivo: O objetivo do estudo é comprovar dados epidemiológicos e clínicos do câncer colorretal. Métodos: Nosso estudo foi conduzido na província de Misan, no Iraque. Os dados foram coletados de 2013 a 2016. Setenta e um pacientes apresentaram câncer colorretal. Sexo, idade, local de residência, local do câncer, história familiar, história pregressa, ano de início, história de tabagismo, etilismo, apresentação, estadiamento e padrão histopatológico foram obtidos. Resultados: A prevalência de carcinoma de cólon e reto é de 3,75%. A faixa etária mais afetada foi de 51 a 60 anos, com 30,99%. O gênero e o local de residência dos pacientes não afetam a porcentagem de ocorrência do câncer. Obesidade, antecedentes familiares, tabagismo e consumo de álcool são fatores de risco. 42,25% dos pacientes tinha história familiar de câncer. Conclusão: O local mais comum de carcinoma colorretal é o cólon esquerdo, com 61,97%. Houve aumento na detecção de novos casos de carcinoma colorretal de 2013 a 2016. Os estágios avançados de câncer mais comuns foram IIIA, IIIB, IIIC e IV em 12,67%, 16,90%, 19,72% e 15,49% dos casos. O padrão histopatológico comum é o adenocarcinoma diferenciado, em 53,52% dos casos.

Second evaluation of the mesenteric tissue after ethanol fixation improved the total and metastatic number of lymph nodes in colorectal resections

Context: There is a correlation between prognosis of the colorectal carcinomas and the number of retrieved and metastatic lymph nodes (LNs) from mesentery/mesorectal region. At least 12 LNs must be sampled for accurate evaluation of patients. A number of factors related to surgeon, pathologist, patient and disease could affect the total LN number. For maximizing LN yield, pathologist can use ancillary methods, as fat clearance and special solutions. Aims: This study investigates the effect of second evaluation after ethanol fixation on total and metastatic LN number and assesses factors that influence the dissected LN number. Materials and Methods: 177 colorectal resections were refixed with ethanol for a night, after standard LN sampling. Mesentery/mesorectal tissue was reevaluated for missed LNs. Results were statistically analyzed, P values <0.05 were considered significant. Results: Mean LN number increased from 26 to 30 (median: 20 to 25, P < 0.001) after ethanol fixation. Fourteen cases had additional metastatic LNs after reevaluation of the fat tissue and 5 of them upstaged. 22.5% (44/177) of the patients had <12 LNs before ethanol fixation and this decreased to 14.3% (26/177) after ethanol fixation. Resection type and length, tumor localization, size and histologic degree, pT and neoadjuvant therapy (P < 0.001) had an impact on the LN number (P = 0.034 for histologic degree, P = 0.02 for pT, P < 0.001 for others). Conclusions: Carrying out a second evaluation with ethanol fixation increased total and metastatic LN number and could lead upstage of pN. Ethanol fixation is cost-effective, easy accessible and applicable method; it may improve accuracy of LN assessment and staging, which are important for patients' outcome.

Progression of diagnosis and treatment in pediatric colorectal carcinoma / 中华胃肠外科杂志

Colorectal carcinoma (CRC) is the third most common malignancy in adults. Pediatric colorectal carcinoma (PCRC) is a rare non-embryonal tumor with a significantly lower incidence compared to adults. The clinical manifestations of PCRC are not typical, and pediatricians usually have no enough experience in diagnosis and treatment. Therefore, early diagnosis is extremely difficult, which would always lead to late clinical stages when diagnosis is made. At present, the pathogenesis of PCRC is still not clear, and many countries have started to carry out researches at the level of genes, molecules and cells. In both tumor primary tumors and distant metastases, PCRC has obvious difference in distribution from adults, and the proportion of pathological type of mucous adenocarcinoma (including the signet ring cell carcinoma) was significantly higher than that of adults. Although treated according to adult colorectal cancer guidelines, PCRC has been unable to achieve ideal efficacy with poor prognosis and lower long-term survival rate. The purpose of this paper is to summarize the epidemiological characteristics, pathogenesis, clinical symptoms, pathological types, treatment and prognosis of colorectal cancer in children by reviewing the latest literatures at home and abroad.

Subjective perception of surgeons with 4K resolution,three-dimensional systems in laparoscopic colorectal surgery:A self-filling questionnaire survey / 中国实用外科杂志

OBJECTIVE: To compare the subjective perception of surgeons with 4K-resolution(4K) and three-dimensional(3D) systems in the laparoscopic colorectal surgery.METHODS: A self-filling questionnaire survey wasdeveloped in the surgeons between August 2018 and February 2019 in Department of Gastrointestinal Surgery,RuijinHospital Affiliated to Shanghai Jiao Tong University School of Medicine. The data of questionnaires from surgeons indifferent position( major surgeons,first assistants,scopists) who performed laparoscopic colorectal surgeries with 4K,3D and 2D systems were collected. The questionnaires concerning asthenopia,motion sickness,topographical orientation,control coordination of visual angle,visual acuity,radiance,resolution ratio,depth description,color resolution,sense ofcontrols,optimum viewing distance,frames and refresh rate and contrast.RESULTS: There were 124 questionnairesscreened eligibility in the survey. Among them,there were 38 questionnaires for 2D group,43 questionnaires for 3D group and 43 questionnaires for 4 K group.(1)Overall comparison of the subjective scores:In the three groups,therewere significant difference in control coordination of visual angle,visual acuity,resolution ratio,depth description,color resolution,optimum viewing distance,frames andrefresh rate(P<0.05).(2)Subjective scores betweenmajor surgeons:In the three groups,there weresignificant difference in resolution ratio,depth description,color resolution and sense of controls(P<0.05);the most advantages could be found on resolution ratio andcolor resolution in 4 K group,and also could be found on depth description and sense of controls in 3 D group.(3)Subjective scores between first assistants: In the three groups,there were significant difference in asthenopia,controlcoordination of visual angle,resolution ratio,depth description,sense of controls,frames and refresh rate(P<0.05);In 4K group,it showed advantages on control coordination of visual angle and resolution ratio. Motion sickness was morepronounced in 3D group,but the most advantages could be found on depth description and sense of controls.(4)Subjective scores between scopists: In the three groups,there were significant difference in visual acuity,resolution ratio,depth description,sense of controls,optimum viewing distance and contrast(P<0.05). The most advantages could befound on visual acuity,resolution ratio and contrast in 4 K group,and also could be found on depth description and senseof controls in 3D group.CONCLUSION: Comparing with the traditional two-dimensional system during laparoscopiccolorectal surgery,4 K system could apply better resolution ratio,control coordination of visual angle,visual acuity andcolor resolution. 3D system could apply better depth description and sense of controls.

Detection and clinical significance of perioperative circulating tumor cells in patients with stage Ⅱ to Ⅲ colorectal carcinoma / 中国实用外科杂志

OBJECTIVE: To detect perioperative circulating tumor cells(CTCs) in patients with colorectal carcinoma and evaluate their clinical significance. METHODS: A total of 69 patients with stage Ⅱ to Ⅲ sporadic primary colorectal cancer were collected from Department of General Surgery,Beijing Friendship Hospital,Capital Medical University from June 2015 to August 2017. All the patients received surgery and no preoperative neoadjuvant therapy. Peripheral blood samples were collected before operation(Pre-OP),on three days post-operation(POD3),and one 14 days post-operation(POD 14). CTCs were detected using density-gradient centrifugation and immunofluorescence staining. Associations of perioperative CTCs with clinicopathological features and tumor recurrence were determined. RESULTS: Average Pre-OP,POD3,and POD14 CTCs were(3.8 ± 0.5) number/3.5 mL,(6.6 ± 1.4) number/3.5 mL,and(3.5 ± 0.5) number/3.5 mL,respectively. There was significant difference between POD3 and POD14 CTCs(P<0.05). Pearson correlation analysis suggested that Pre-OP CTCs was significantly associated with POD14 CTCs(r=0.433,P<0.001). Association of POD14 CTCswith TNM stage was found(χ~2=3.916,P=0.048) and there was a trend of association between POD3 CTCs with gender(χ~2=3.857,P=0.050). The followup duration was 15.6(3.5-35.0)months and the recurrence rate of the patients was 10.6%(7/63). Kaplan-Meier curves revealed no significant associations oftumor recurrence with POD3 CTCs(P=0.194) and POD14 CTCs(P=0.269). CONCLUSION: Compared with preoperative CTCs,postoperative CTCs are firstly increased and then decreased. The postoperative CTCs are potential biomarkers for colorectal cancer recurrence but needed to be verified in more studies.