[Association between breast and colorectal cancer and polyps. Screening and epidemiological study]. / Associazione tra cancro della mammella e polipi e cancro del colon-retto. Studio epidemiologico e di screening.

BACKGROUND: Studies regarding the associations between different types of cancer in the same patient are very few and not always come to the same conclusions. Several hypothesis are suggested and particularly genetic and socioeconomical ones seem to offer an interpretation of this issue. Early detection of a second neoplasm allows to improve prognosis and survival. The knowledge of correlations between tumors help to select a population, with a high risk to develop a second cancer, to be included in a screening program. Nowadays thanks to early detection of breast cancer, ten years survival is more than 75%. Women who had breast cancer now live longer and so could have a higher risk to develop a second cancer. METHODS: From September 1998 to September 1999 in our Department 71 patients operated for breast cancer, underwent screening colonscopy. No patients refused to be included in the study. Mean age was 61 years (range 36-87). Each patient had a clinician interview in order to explain the goals of the study. RESULTS: Results show that among all patients 3 (4.2%) presented a history of colon cancer, 18.3% (13 cases) presented large bowel polyps. In 84.60% patients (11 cases) polyps were found not over 40 cm. This study shows that 93% of patients (66 cases) had a relative with cancer history. CONCLUSIONS: Our results compared with those of other authors seem to show an increased risk for breast cancer patients in developing polyps or colon cancer, so we suggest to insert sigmoidoscopy in standard follow-up of breast cancer patients.

[Positron-emission tomography with gamma camera in patients with colorectal and anal cancer. Preliminary results]. / Positron-emissionstomografi med gammakamera hos patienter med kolorektal cancer og analcancer. Praeliminaere resultater.

Metastasectomy after the primary surgical treatment of colorectal cancer may prolong survival in patients with resectable recurrences. Dedicated 18F-FDG-PET is of growing interest as a diagnostic tool in the staging and diagnosis of recurrent disease. We wanted in our departments to investigate whether a dual-head gamma camera with coincidence detection could serve as a substitute for the dedicated PET scanner. Twenty consecutive PET scans of 18F-FDG were performed by means of an Adac VertexPLUS gamma camera in 14 patients with colorectal cancer and four patients with anal cancer with known or suspected recurrences. Evaluation of the patients were, however, according to the routine in the department. In fourteen patients one or more abnormal foci were detected by PET, nine of these were verified by biopsy and one by renewed CT scan. In the four patients with negative PET the findings were in agreement with later biopsies. In one patient PET was "falsely" negative with regards to other processes than a solitary metastasis to be removed, as he six months later revealed dissemination confirmed by biopsy. Four patients with positive PET findings and elevated CEA remain to be evaluated. We conclude that PET with a coincidence detection gamma camera in this preliminary study seems to have the same possibilities to stage and diagnose recurrent anal- and colorectal cancer as the dedicated PET scanner.

Metastatic malignant mesothelioma presenting as colonic polyps.

A 66-year-old male engineer diagnosed with malignant pleural mesothelioma 4 years previously had thoracotomy, radiotherapy, and chemotherapy. He was followed regularly with chest computed tomography (CT) scan and had been asymptomatic. During one of his physical examinations, routine sigmoidoscopy showed incidental colonic polyps which were biopsied. Subsequently, recurrence of pleural mesothelioma and peritoneal involvement by mesothelioma was documented. Two of the polyps showed metastatic malignant mesothelioma in the lamina propia which strongly resembled adenocarcinoma histologically causing difficulty in making definitive diagnosis. Review of the literature disclosed no previously documented similar occurrence. This case shows the importance of clinical history and ancillary laboratory procedures such as immunohistochemistry and electron microscopy to avoid diagnostic pitfalls.

Diminutive polyp: a rare presentation of breast cancer metastases to the colon.

Digestive metastases of breast cancer are well documented (1-4). We report a patient with metastatic breast cancer presenting as a 5 mm polypoid benign looking lesion. The diagnosis was confirmed by histopathology and immunostaining.

Multiple colonic polyps as the initial presentation of malignant melanoma.

A 72-year-old-man was admitted to the Charleston Area Medical Center with a one-month history of mild anemia and positive stools for occult blood. A prior UGI series, small bowel series, and barium enema were normal. A colonoscopy revealed 12 sessile, non-pigmented colonic polyps, two of which were removed and sent for histologic examination. The final pathology report revealed malignant melanoma. Physical examination revealed no obvious evidence of skin lesions or melanoma elsewhere. Subsequent staging, which included a chest X-ray, a CT scan of the abdomen and brain, UGI endoscopy, and bone scan revealed a metastatic disease. The colonic lesions regressed in response to combination chemotherapy, and the patient's transfusion requirement decreased. However, the patient died of brain metastases 10 months after the initial diagnosis. This case emphasizes the fact that: 1. Metastatic lesions of the gastrointestinal tract may be the initial manifestation of malignant melanoma and may occur in the absence of a clinically obvious lesion; 2. Colonic metastases may simulate simple polyps endoscopically, particularly if they are non-pigmented; 3. Biopsy and histologic examination of any colonic polyp is essential in patients with a prior history of melanoma; and 4. Regression of gastrointestinal lesions from melanoma and subsequent clinical improvement may occur in response to chemotherapy.

Metastases of a gastric adenocarcinoma presenting as colonic polyposis. Report of a case.

The authors report a case of multiple colonic metastases of a gastric signet ring cell adenocarcinoma, presenting as colonic polyposis revealed by diarrhea, iron deficiency anemia, and left supraclavicular lymph node.

p53 expression in colorectal tumors.

The expression of the nuclear phosphoprotein p53 was studied immunohistochemically in a series of 150 benign and malignant colorectal tumors. Using monoclonal antibody PAb1801, tumors divided unequivocally into two groups on the basis of immunohistochemistry. Forty of the carcinomas (46.5%) showed positive staining but only 4 of the adenomas (8.7%) were positive (P less than 0.001). The few positive adenomas always showed moderate or severe dysplasia. Metaplastic polyps (n = 9) and small familial adenomatous polyposis-related adenomas (n = 9) were uniformly negative. Carcinomas with p53 expression did not differ from those without in terms of site, differentiation or the prognostic indicators of Dukes' stage, DNA ploidy, or tumor histology. The improved morphologic resolution available in periodate lysine paraformaldehyde dichromate (PLPD)-fixed, paraffin-embedded tissue permitted several conclusions to be made: p53 is confined to neoplastic nuclei; staining in positive tumors is heterogeneous and often more marked at the infiltrative margins; and staining intensity is dramatically reduced in mitotic cells. It is concluded that expression of immunohistochemically detectable p53 (probably representing mutated forms of the protein) occurs in some adenomas around the time of transition to carcinoma. Therefore there is an association with the appearance of infiltrative behavior but not with degree of tumor progression (including metastasis) at the time of resection.

Small bowel infarction associated with pancreatic glucagonoma.

An 88 year old woman presented comatose, hypothermic and hyperglycaemic. She died soon after admission and at autopsy recent small bowel infarction was found. The superior mesenteric artery was encased in a dense pancreatic mass and there was marked luminal narrowing of the vessel. Histology revealed a pancreatic glucagonoma which had metastasized to colonic submucosa and serosa. Glucagonoma is a rare tumour and this presentation of small bowel infarction associated with pancreatic glucagonoma would appear to be a unique event.

[Stomach cancer metastasizing into a solitary adenomatous colonic polyp]. / Gyomorrák áttéte soliter adenomatosus colonpolypban.

A 69-year-old man with known diffuse type gastric stump carcinoma was found at autopsy to have widely disseminated metastasis of this cancer. Metastasis also occurred in the adenomatous polyp of the cecum. This is the third report, to our knowledge, in the literature and the first Hungarian publication of a metastasis to an adenomatous polyp of the colon.

[Metastasis of a stomach carcinoma in a solitary adenomatous cecal polyp]. / Metastase eines Magenkarzinoms in einem solitären adenomatösen Zökumpolypen.

Gastric stump carcinoma with widely disseminated metastases and solitary coecal adenoma were recorded by postmortem investigation of a man who had died at the age of 69. The gastric carcinoma had spread metastases into the adenoma. This is the fourth case carcase of metastasis to a colonic polyp so far described in the literature.

Metastatic spindle-cell renal carcinoma presenting as multiple intestinal polyps.

A 75-year-old woman presented with rapidly progressive intestinal and general symptoms including diarrhea, melena, weight loss, back pain, and lassitude. Endoscopy revealed multiple intestinal polyps which, microscopically, consisted of metastatic tumor deposits composed predominantly of spindle-shaped tumor cells. The primary tumor, a mixed spindle-cell and clear-cell carcinoma, was later identified in the kidney at autopsy. The patient had a cholecystectomy 13 years previously.