Incidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea

PURPOSE: In recent years, the incidence of early-stage colorectal cancer (CRC) has markedly increased in the population within the Republic of Korea. The aim of this study was to evaluate the clinicopathologic features of adenomatous polyps in TNM stage I CRC patients and in the general population. METHODS: Between March 2003 and September 2009, 168 patients with stage I CRC were enrolled in this study. In addition, the records of 4,315 members of the general population without CRC, as determined by colonoscopy during a health check-up, were reviewed. RESULTS: Of the 168 patients with stage I CRC, 68 (40.5%) had coexisting colorectal adenomatous polyps and of the 4,315 members of the general population, 1,112 (26.0%) had coexisting adenomatous polyps (P = 0.006). The prevalences of adenomatous polyp multiplicity in early CRC and in the general population were 32% and 15%, respectively (P = 0.023). Patients with coexisting adenomatous polyps had a higher frequency of tubulovillous or villous adenomas than members of the general population with polyps (7.5% vs. 2.0%, P = 0.037). Furthermore, a subgroup analysis showed that the occurrence (44% vs. 34%, P = 0.006) and the multiplicity (32% vs. 15%, P = 0.023) of adenomatous polyps were greater for T2 than T1 cancer. CONCLUSION: The prevalence and the multiplicity of adenomatous polyps in TNM stage I CRC is higher than it is in the general population. The findings of this study suggest that depth of invasion of early stage CRC affects the prevalence and the number of adenomatous polyps in the remaining colon and rectum.

A Case of Squamous Cell Carcinoma of the Distal Common Bile Duct

Squamous cell carcinoma of the extrahepatic bile duct is very rare. Only limited information is available concerning its pathogenesis and prognosis, although it is reported to be associated with choledocolithiasis, recurrent pyogenic cholangitis, clonorchiasis, choledochal cyst formation, and primary sclerosing cholangitis. Therefore, we present a case of squamous cell carcinoma of the distal common bile duct. A 64-year-old male patient presented with abdominal pain and obstructive jaundice. Computed tomography and endoscopic retrograde cholangiography showed thickening of the wall and a segmental stricture of the distal common bile duct, and the biopsy confirmed poorly differentiated carcinoma with marked squamous differentiation. The patient underwent a pylorus-preserving pancreaticoduodencetomy. Histological examination revealed that the tumor invaded the pancreas and metastasized to regional lymph nodes (pT3N1M0). The patient developed multiple liver metastases 30 days later and died of rapidly progressive metastatic disease to the liver 5 months following resection. Squamous cell carcinoma of the distal bile duct with lymph node metastasis had a very poor prognosis, even though curative resection was performed.

The Risk Factors for the Intrahepatic Recurrence of Hepatocellular Carcinoma after Curative Resection

PURPOSE: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. METHODS: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence ( or =4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. RESULTS: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. CONCLUSIONS: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.