ABSTRACT
BACKGROUND: Our recent work has shown the feasibility of using a refined immunomagnetic enrichment (IE) assay to detect cytokeratin 20-positive circulating tumour cells (CK20 pCTCs) in colorectal cancer (CRC) patients. We attempted to improve the sensitivity for CRC by detecting another intestinal-type differentiation marker, CDX2 pCTCs, using the same methodology. METHODS: CDX2 pCTCs were detected in patients with CRC, colorectal adenoma (CAD), benign colorectal diseases (BCD), other common cancers (OCC) and normal subjects (NS). Statistical analysis was used to correlate CDX2 pCTCs to the clinicohistopathological factors, recurrence, metastasis and survival after follow-up for 42 months in CRC patients. RESULTS: CDX2 pCTCs were detected in 81% CRC patients (73 out of 90, median number=21.5 CTCs), 7.5% CAD patients (3 out of 40), 0% patients with BCD (0 out of 90), 2.5% patients with OCC (2 out of 80) and 0% NS (0 out of 40). Furthermore, statistical analysis showed that CDX2 pCTC numbers were associated with tumour- node-metastasis stage and lymph node status. Using the median CDX2 pCTC numbers as the cutoff points, stratified groups of CRC patients had significant differences in their recurrence and survival. CONCLUSIONS: This study showed that the refined IE assay can detect CDX2 pCTCs with high sensitivity and that CDX2 pCTCs can generate clinically important information for CRC patients.
Subject(s)
Adenoma/diagnosis , Colorectal Neoplasms/diagnosis , Homeodomain Proteins/metabolism , Neoplastic Cells, Circulating/metabolism , Neoplastic Cells, Circulating/pathology , Trans-Activators/metabolism , Adenoma/blood , Adenoma/mortality , Adenoma/pathology , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/analysis , Biomarkers, Tumor/metabolism , CDX2 Transcription Factor , Carcinoma/diagnosis , Carcinoma/metabolism , Carcinoma/pathology , Colorectal Neoplasms/blood , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Female , Homeodomain Proteins/blood , Humans , Male , Middle Aged , Neoplasm Metastasis , Prognosis , Survival Analysis , Trans-Activators/blood , Young AdultABSTRACT
Intestinal perforation is an uncommon but potentially fatal complication of intestinal tuberculosis. We report on a 63-year-old HIV-negative man who developed terminal ileal perforation approximately 3.5 months following initiation of anti-tuberculous treatment for pulmonary tuberculosis and a concomitant tuberculous perianal abscess. Clinical and radiological improvements were initially evident following commencement of anti-tuberculous treatment, and the paradoxical response phenomenon was suspected. The patient subsequently underwent surgical resection of the affected bowel segment with primary anastomosis, and made an uneventful recovery. Anti-tuberculous medication was continued for another 12 months, and after a further 12 months there was no evidence of recurrent tuberculosis. This case illustrates that tuberculous intestinal perforation can develop during chemotherapy for tuberculosis. Prompt diagnosis and appropriate surgical treatment are essential to avoid morbidity and mortality.
