Low acyl-CoA synthetase 5 expression in colorectal carcinomas is prognostic for early tumour recurrence.

It has been shown that the metabolism of long chain fatty acids is involved in colorectal carcinogenesis. Acyl-CoA synthetases (ACSL) activate free fatty acids by synthesis of acyl-CoA thioesters. ACSL isoform 5 (ACSL5) is involved in enterocytic differentiation and maturation by regulating both pro-apoptotic and anti-proliferative effects. Whilst impaired expression of ACSL5 has been associated with sporadic colorectal carcinogenesis, little is known about ACSL5 as a prognostic factor. Aim of this retrospective study was to characterize the prognostic impact of ACSL5 expression levels in sporadic colorectal adenocarcinomas. A total of 72 patients with a median follow-up of 54 months was included. Using a standardized immunohistochemical approach, colorectal adenocarcinomas with low (n=41; group 1) or high (n=31; group 2) ACSL5 levels were identified. In a one-year follow-up, tumour recurrence was significantly increased in group 1 (p=0.0279). The finding was independent of the TNM- and UICC-stage in the surgical resections. Frequency of lymph node metastasis and mortality was not different between the groups. In a long-time follow-up no differences were found between the ACSL5 groups. The data indicate that ACSL5 could be an independent prognostic factor for early recurrence of sporadic colorectal adenocarcinoma.

Coincidence of active Crohn's disease and florid endometriosis in the terminal ileum: a case report.

Crohn's disease (CD), a variant of chronic inflammatory bowel disease, frequently affects the terminal ileum and coecal region. The clinical symptoms are often subtle and depend on the inflammatory activity of disease. In women of child-bearing age, florid intestinal endometriosis can simulate CD. Moreover, current pathophysiological concepts include intestinal endometriosis as a putative founder lesion for consecutive CD establishment. The report summarizes clinical and histomorphological data of a 35-year-old woman with the rare coincidence of florid intestinal endometriosis and CD both affecting the terminal ileum. The patient was suffering over 10 years from strong abdominal disorders including constipation, diarrhea, weight loss, and diffuse abdominal pain. In magnetic resonance imaging-Sellink, strong inflammation and intestinal obstruction of the terminal ileum were found. The laparoscopy revealed further evidence for existence of an inflammatory disease like CD, but brownish spots on the peritoneum were found indicative for endometriosis. Surgical resection of the terminal ileum and the coecal segment was performed followed by histopathological investigations. In transmural sections of the terminal ileum, histomorphological features of florid endometriosis intermingled with florid CD was found. The diagnostic findings were substantiated with a panel of immunohistological stainings. In conclusion, the findings demonstrate that florid endometriosis persists in florid CD lesions and the putative link between intestinal endometriosis and CD is more complex than previously assumed.

Collagen distribution and expression of matrix metalloproteinases 1 and 13 in patients with anastomotic leakage after large-bowel surgery.

PURPOSE: Despite improved surgical techniques, anastomotic leakage is still a serious complication in colorectal surgery, resulting in increased morbidity and mortality. Based on recent studies showing a disturbance of the collagen synthesis in hernia patients, this pilot study was designed to find out whether there are any hints of disorders concerning the collagen metabolism in patients developing anastomotic leakage after colonic surgery. METHODS: Ten samples of colonic tissue from patients who developed anastomotic dehiscence after surgery for colonic cancer were compared with 14 specimens from patients with uncomplicated anastomotic healing. All samples were obtained at the primary operation. We performed a sirius red test for the overall collagen content and immunhistochemical studies facing differentiation between collagen I and III and the expression of MMP-1 and MMP-13. RESULTS: In the bowel sections from patients developing anastomotic leakage, decreased levels of collagen I and III, and a smaller amount of overall collagen were found. The ratio of collagen I:III was similar in both groups. While MMP-1 was expressed in all samples, there was a difference concerning the expression of MMP-13. In only 6 of 14 patients with uncomplicated healing was MMP-13 present, while in 9 of 10 patients developing a leakage. CONCLUSIONS: Our data may indicate the presence of an individual disturbance of the collagen metabolism in patients developing a leakage after colorectal surgery. Further studies are underway to define more precisely whether a preexisting impairment of wound healing could be a risk factor for anastomotic leakage.