Factors that could influence women's participation in colorectal cancer screening: an Italian study.

BACKGROUND: Colorectal cancer (CRC) is the 2nd most common cancer in women worldwide. In Italy, only 50% of people invited to get the Fecal Occult Blood Test (FOBT) decided to do it. Women's participation in breast and cervical screening is, instead, very high (>70%). The aim of our study was to investigate the beliefs, the feelings and the psychological factors that could influence the participation of women in CRC screening. METHODS: We conducted a cross sectional study, in the Hospital of Siena, Central Italy, in 2011. We administered a questionnaire to 507 women of all ages, who attended mammography or clinical breast examination. The adherence to CRC screening was analyzed only in the group of 207 older women (age >50 years). We performed descriptive, bivariate and logistic regression analysis to identify whether an association was present between participant characteristics, willingness and adherence to screening. RESULTS: Family history of colorectal cancer (OR 4.3; p<0.007) and the General Practitioner's advice (OR: 3.4; p<0.003) were associated with a greater adherence to screening (colonoscopy). The embarrassment was another factor related to colonoscopy compliance (OR: 0.34; p<0.016). CONCLUSION: Family history of CRC, pain or embarassment and GP's advice are the factors that correlated more strongly (positively or negatively) with adherence to colorectal cancer screening. These elements should be further analyzed to choose the best solution to improve the adherence in campaigns on colorectal cancer.

Familial colorectal cancer: a concept revisited.

OBJECTIVE: The family history of patients with colorectal cancer (CRC) shows an increased risk of disease although evident inherited syndromes are demonstrable in only a small percentage of patients. The purpose of this study was to identify factors that might suggest an inherited component in the transmission of CRC. METHOD: The study monitored 880 consecutive patients between 1980 and 2005 treated for CRC. RESULTS: Familial adenomatous polyposis (FAP) was found in only one patient, and a classical mutation of hereditary nonpolyposis colon cancer was found in only two patients. The risk assessment was possible mainly because of factors such as early onset CRC, the presence of multiple primary tumours and a high risk family history. Considering these 36 more patients were suspected to be high risk and referred for further genetic testing. At least one first-degree relative with CRC was reported in 140 patients. In 49 patients, CRC was diagnosed before 50 years of age. Multiple primary tumours, colonic or extra colonic, synchronous or metachronous were found in 136 patients. CONCLUSION: Our study suggests that if only patients with identified mutations are taken into consideration, then the percentage of evident hereditary colon cancer is very low, but this percentage quickly increases if we make marginal adjustments to the identifying criteria. It seems that it is the physician's clinical suspicion, more than the fulfillment of rigid criteria, which plays a fundamental role in the timely identification and a subsequent focused treatment of patients with hereditary CRC.

Adenosine kinase gene expression in human colorectal cancer.

Real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to evaluate gene expression of adenosine kinase, a key enzyme in adenosine metabolism, in human intestinal biopsy specimens of 10 colorectal cancer patients. Quantitative mRNA expression levels were normalized against the reference gene beta-actin. The results showed that adenosine kinase gene expression was significantly higher in cancer than in normal-appearing tissue, in line with our previous measurements of adenosine kinase enzyme activities in colorectal tumor samples.

[Primary squamous cell carcinoma of the breast: a case report]. / Carcinoma squamoso primitivo della mammella: descrizione di un caso.

INTRODUCTION: Primary squamous cell carcinoma (SCC) of the breast is an extremely rare entity and it has a low incidence in comparison with all other mammary cancers. MATERIAL AND METHODS: We describe a case of SCC of the breast in a 55 year old woman who presented with a painless mass located in the external quadrant of the left breast. The neoformation, once removed, was tamponate formalin fixed and routinely processed for inclusion in paraffin. Sections were stained with haematoxilin-eosin and immunohistochemical and electron microscopy investigations were performed. RESULTS: Histologically, the neoplasia was characterized by cystic cavities covered by nests and sheaths of poorly differentiated squamous cells with keratinized areas. Mitotic activity was high, as well as cellular proliferative index, evaluated by Mib-1 (ki 67) antibody. At immunohistochemistry, the tumor cells were diffusely positive for high molecular weight cytokeratins and c-erbB-2, negative for vimentin, estrogen and progesterone. CD68 and LCA were positive only in the inflammatory cells. Electron microscopy confirmed the epithelial nature of the neoplastic cells. A diagnosis of SCC of the breast was made, and a radical mastectomy was performed. CONCLUSIONS: We make a brief review of the literature and discuss the main histologic criteria for the differential diagnosis with adenocarcinoma of the breast with squamous metaplasia.

Enzyme activities controlling adenosine levels in normal and neoplastic tissues.

Adenosine is known to be associated with effects such as inhibition of immune response, coronary vasodilation, stimulation of angiogenesis, and inhibition of inflammatory reactions. Some authors suggest that adenosine may also have similar functions in tumor tissues. Tissue levels of adenosine are under close regulation by different enzymes acting at different levels. Adenosine is produced from AMP by the action of 5'-nucleotidase (5'-NT) and is converted back into AMP by adenosine kinase (AK) or into inosine by adenosine deaminase (ADA). Inosine is converted into purine catabolites by purine nucleoside phosphorylase (PNP), whereas AMP is converted into ADP and ATP by adenylate kinase (MK). The aim of this study was to analyze the activities of the above enzymes in fragments of neoplastic and apparently normal mucosa, obtained less than 5 cm and at least 10 cm from tumors, in 40 patients with colorectal cancer. The results showed much higher activities of ADA, AK, 5'-NT, and PNP in tumor tissue than in neighboring mucosa (p > 0.01 for ADA, AK, and PNP; p > 0.05 for 5'-NT), suggesting that the activities of purine metabolizing enzymes increase to cope with accelerated purine metabolism in cancerous tissue. The simultaneous increase in ADA and 5'-NT activities might be a physiological attempt by cancer cells to provide more substrate to accelerate salvage pathway activity.

UFT/leucovorin and oxaliplatin alternated with UFT/leucovorin and irinotecan in metastatic colorectal cancer.

A total of 41 metastatic colorectal cancer (CRC) patients received tegafur/uracil (UFT)+leucovorin (LV)+oxaliplatin alternated with UFT/LV+irinotecan. The overall response rate was 58.5% (95% confidence interval, 42.2-73.3%), and the median progression-free survival was 8.8 months. There were no grade 4 toxicities; 12 patients (29%) experienced grade 3 diarrhoea. There were no cases of hand-foot syndrome. This alternating regimen seems to be effective and well tolerated in the first-line treatment of patients with metastatic CRC.

[Charge syndrome: long-term survival. Report of a case]. / Sindrome di Charge: sopravvivenza a lungo termine. Descrizione di un caso.

Charge association is a relatively rare pattern of congenital anomalies whose incidence is approximately 1:10.000. We describe our experience on a young boy (Cariotype 46-XY) with associated oesophageal atresia survived up to 12 years. We analyse the most relevant difficulties occurred in the treatment of this patient and we underline the importance of performing an early tracheostomy in order to improve the respiratory impairment. The management of this multiple complex malformations requests a multidisciplinary approach during the life.

Melting temperature analysis as quantitative method for detection of point mutations.

Different methods have been devised to detect point mutations. Some are very sensitive, detecting mutations even in a background of normal tissue, but none provide information about the percentage of cells with mutant DNA. Here we describe an easy, fast and reliable method, melting temperature analysis, which not only detects point mutations but also provides quantitative information on the percentage of cells with mutant DNA. By this method we detected a G-A transition in codon 12 of the K-ras gene in DNA of subjects with colorectal cancer. The K-ras mutation was found in 9/10 bowel cancers and 8/10 normal adjacent samples. It was also detected in 4/7 stool samples from the same patients. In colorectal cancers, the proportion of K-ras mutant cells was variable: in two the mutant/wild-type DNA ratio was 30/70, in three 50/50, and in four 70/30. Melting temperature analysis was sensitive for the detection of point mutations in bowel cancer and also in apparently normal tissue, providing quantitative information about the percentage of cells with mutant DNA.

Prenatal management of inherited urogenital malformation: case report.

Documentation of unique kidney renal function early in pregnancy can be helpful in defining prenatal management and therefore in improving prognosis. Antenatal diagnosis of a solitary kidney was performed at 20 weeks' gestation in a foetus with a 1,7 chromosome translocation. Because of the decreasing renal function and the increasing pelvic dilatation, an early in utero stenting was placed at 23 weeks' gestation. Optimal outcome occurred and the baby was delivered at 32 weeks. Complete assessment of the malformation showed a left hydronephrosis due to a megaureter, right renal agenesis with ipsilateral cryprorchidism and agenesis of the right vas deferens. The chromosomic translocation was inherited from the mother who was affected by uterus didelphys, obstructed right hemivagina and right renal agenesis. Renal function of the unique kidney with hydronephrosis can be early diagnosed and promptly treated. This condition should also increase the index of suspicion of underlying genital and chromosomal anomalies.

Microcystic adenoma of the pancreas (glycogen-rich cystadenoma) with stromal amyloid deposits.

AIMS: We report a case of a pancreatic glycogen-rich microcystic serous adenoma with stromal amyloid deposits, focusing on the significance of isolated amyloid deposits in tumours. METHODS AND RESULTS: The architectural pattern was characterized by thin-walled cysts lined by a single layer of flat or cuboidal epithelial cells intensely stained by the PAS-reaction only before diastase digestion, suggesting the presence of glycogen. Tumour stroma was composed of broad fibrocollagenous tissue with lamellar hyalinized areas which were positively stained by Congo red and showed green birefringence and dichroism with polarized light. For amyloid protein characterization, immunohistochemical studies were performed with anti-beta amyloid protein and anti-amyloid precursor pre-A4695. The former antibody diffusely stained tumour stroma, while the latter stained only scattered stroma cells. CONCLUSIONS: This is the first documented case of amyloid deposition in pancreatic serous adenoma. We indicate that the source of amyloid is an APP-like precursor secreted by stromal myofibroblasts.

Influence of acute cholecystitis on surgical strategy and outcome of inapparent carcinoma of the gallbladder: a report on two cases.

Unsuspected microscopic adenocarcinoma (T1) of the gallbladder was identified after surgery in two patients who underwent urgent open cholecystectomy for acute cholecystitis. In spite of the tumor being at an early stage both patients died after few months for local and disseminated tumor recurrence. The influence of the associated inflammatory disease of the gallbladder on the outcome of patients with inapparent gallbladder carcinoma is discussed and a more aggressive surgical strategy is suggested.

[Family anamnesis, cholecystectomy and gastric resection in patients with colorectal carcinoma: a case-control study]. / Anamnesi familiare, colecistectomia e gastroresezione in pazienti con carcinoma colorettale: studio caso-controllo.

An increased risk of colorectal cancer has been reported in first-degree relatives of affected patients, and following cholecystectomy or partial gastrectomy for benign peptic ulcer disease. The aim of this study was to examine the incidence of these potential risk factors in 197 patients (127 males, 70 females, mean age 70 years +/- 10.9, range 22-94 years) with cancer of the large bowel and 202 controls (91 males, 111 females, mean age 68 years +/- 14.06, range 17-93 years) who underwent a total colonoscopy, that revealed no colorectal neoplasms. No significant differences were found between the case and control group for a past history of cholecystectomy or gastric surgery, respectively reported by 14 and 12 patients of group 1 and 18 and 8 patients of group 2. Patients with large bowel cancer show a significant excess of both colorectal (21.31% vs 11.9%) and extracolonic malignancies (46.19% vs 26.73) in first degree relatives (p < 0.05). In approximately 7% of them the aggregation of two or more colorectal cancers among relatives is suggestive for a hereditary form of large bowel cancer.

Papillary thyroid carcinoma in three siblings with familial adenomatous polyposis.

The authors report three siblings (two sisters and their aunt, aged 20, 22 and 36, respectively) with familial adenomatous polyposis (FAP) and papillary thyroid carcinoma. After diagnosis of FAP, a single, non palpable nodule was revealed in each patient by routine screening ultrasonography of the gland. The diagnosis of papillary carcinoma was made by fine-needle-aspiration biopsy of the nodules and confirmed by histologic examination of surgical specimens. A review of the literature reveals about 40 reports of such an association, that is considered not fortuitous. Nevertheless, in this family the association seems to be a distinctive, clinical feature of the syndrome, affecting three out of five members intensively screened for extracolonic lesions.

Levels of folic acid in plasma and in red blood cells of colorectal cancer patients.

The levels of folic acid have been determined by radioimmunological method in the plasma and in the red blood cells of normal subjects and colorectal cancer patients. A decrease was evident both in the plasma and erythrocytes of cancer patients. The possible reasons and applications of this observation are discussed.

[Heredity and colorectal cancer]. / Ereditarietà e cancro colorettale.

Colorectal cancer is the second leading cause of death from malignancies in Western Countries. In spite of advances in treatment, little change in survival has been accomplished in last decades and this mandates greater importance to prevention and early detection. Although dietary factors have received primary attention familial clustering suggests that susceptibility to KCR is inherited. Hereditary colorectal cancer can arise on Familial Adenomatous Polyposis (HCC) or not on polyposis (HNPCC) and members of these families are at high risk of such neoplasias. Anyway, even in "sporadic" forms of KCR first-degree relatives have a 2 to 3-fold increased risk of the same cancer. The most desirable screening protocol would be a simple procedure involving only a blood test to identify gene defect by molecular biology techniques. Unfortunately, this is not practically possible, for lack of specific genetic alterations, out of FAP, and only the study of family history can enable targeted surveillance and cost-effective management strategies.

[Update on epidemiology and risk factors of colorectal carcinoma]. / Attualità in tema di epidemiologia e fattori di rischio del carcinoma colo-rettale.

Etiology of colorectal cancer is not completely clear. Epidemiologic studies, especially those on migrant populations, demonstrate the importance of environmental factors, particularly dietary, in cancerogenesis. Anyway, familial aggregation within a given population shows that genetic factors play an important role. General risk factors are represented by age, sex, physical activity... while some pathologies increased the risk of developing KCR or are frankly precancerous (adenomas, ulcerative colitis, Crohn's disease...).

[Duplication of the gastrointestinal tract: a report of a rare case of mediastinal cyst]. / Duplicazione del tratto gastrointestinale: descrizione di un raro caso di cisti mediastinica.

An unusual case of alimentary tract duplication located in the left anterior mediastinum and observed in a 37-year-old woman is reported. Resection of the lesion through a left thoracotomy approach was resolutive and followed by an excellent long term outcome. Etiology, diagnosis and therapeutic problems as well as differential diagnosis with benign and malignant chest lesions of adult population are briefly discussed.