Robotic low anterior resection of rectal metastasis from small bowel adenocarcinoma: A case report.

A 69-year-old female underwent laparoscopic ileal partial resection for ileal adenocarcinoma. Pathological diagnosis was moderately differentiated tubular adenocarcinoma (UICC 8th; T4N0M0 StageIIB). The patient received adjuvant chemotherapy with modified 5-fluorouracil/leucovorin/oxaliplatin. Fourteen months after surgery, computed tomography revealed a mass in the upper rectum. Colonoscopy detected a submucosal protruding mass and a biopsy specimen showed moderately differentiated tubular adenocarcinoma. Robotic low anterior resection was performed. The tumor was located in the upper rectum and there was no macroscopic invasion or peritoneal dissemination. Pathologically, the tumor was moderately differentiated tubular adenocarcinoma located within the rectal wall with little evidence of a carcinoma component in the mucosal lining. Immunohistochemistry showed the same pattern as the previous ileal adenocarcinoma: negativity for cytokeratin 7 and positivity for cytokeratin 20 and caudal-type homeobox 2. In combination with the rectum showing no abnormalities in colonoscopy performed 15 mo previously, the mass was considered hematogenous metastasis from small bowel adenocarcinoma.

Diagnostic accuracy of urine cytokeratin 20 for bladder cancer: A meta-analysis.

AIM: Urine cytokeratin 20 (CK20) has been reported as a novel diagnostic biomarker for bladder cancer (BC). This meta-analysis aims to evaluate the diagnostic value of urine CK20 for BC. METHODS: A systematic search for literatures was performed till March 31, 2018. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and the area under the summary receiver operator characteristic curve (AUC) were analyzed. RESULTS: Twenty-seven studies from 22 articles met the eligible criteria. The pooled estimates were as follows: sensitivity, 0.79; specificity, 0.90; PLR, 8.17; NLR, 0.23; DOR, 35.29 and; AUC, 0.90. CK20 was more sensitive for the diagnosis of bladder urothelial carcinoma (BUC) than all types of BC (0.83 vs 0.75). For Tis/Ta tumors, the values were inferior to T1 and ≥T2 stage tumors, that is, the sensitivity (0.74 vs 0.81 vs 0.86), PLR (7.95 vs 9.97 vs 10.75) and DOR (27.81 vs 47.09 vs 69.63). For grade 1 tumors, the values were inferior to grade 2 and ≥grade 3 tumors, that is, the sensitivity (0.70 vs 0.82 vs 0.87), PLR (11.86 vs 13.63 vs 14.26) and DOR (36.63 vs 72.00 vs 101.71). RT-PCR or PCR showed superior sensitivity and specificity (0.80 vs 0.76, 0.91 vs 0.89) than immunostaining in detection of urine CK20 for BC. CONCLUSION: Urine CK20 might be a potential noninvasive biomarker for BC, especially for BUC. The diagnostic accuracy of urine CK20 is improved with the progression of tumor stage and grade. In addition, RT-PCR or PCR shows better diagnostic performance in detecting urine CK20 than immunostaining.