[Prognostic value of lymphatic vessel and neural invasion in colorectal carcinoma]. / Importância da invasão neural e linfática no prognóstico do adenocarcinoma colorretal.

OBJECTIVES: The paradoxical evolution of approximately one third of patients with colorectal cancer cataloged in Dukes stages B and C demonstrates the necessity of make useful other prognostic criteria. The presence of neural and lymphatic invasion of tumor cells was correlated with the prognosis of patients submitted to radical operation. METHODS: We performed a retrospective study on 320 patients with colo-rectal carcinoma, with mean age 58 years and 199 (62.2%) females. Neural invasion was assessed as positive if cancer cells infiltration into the perineurium or neural fasciculus was detected at the leading point. Lymphatic invasion was defined by cancer cells infiltration into a space limited by endothelium without muscular or elastic fibers. Those variable were associated to the original classification of Dukes. RESULTS: Lymphatic and neural invasion was demonstrated in 14.1% and 15% of 320 operation specimens respectively. The most frequent site of lymphatic and neural invasion was the rectum. The overall survival was 25% in the presence of neural invasion and 64% without neural invasion (p<.01). At the presence of lymphatic invasion, the overall survivals were 26.7% and 63.3%, respectively (p <0.01). The overall survival was always worse in the presence of the invasion neural, independently of the compromising or not of the lymphonodes. In patients of free lymphonodes, the lymphatic invasion identified sub-groups of sick with worse prognosis. The presence of these variable it identified in patients with tumors Dukes B, sub-group of worse prognosis. CONCLUSION: Neural and lymphatic invasion are important ways of spread of colorectal cancer and the presence of both is associated with worse prognosis.

Agenesis of the gallbladder and cystic duct.

Agenesis of the gallbladder and cystic duct is a rare anomaly that is usually asymptomatic. The patient may present symptoms characteristic of cholelithiasis. Its surgical confirmation requires careful dissection of the common bile duct and intraoperative cholangiography or ultrasonography to be performed, to exclude the possibility of an ectopic gallbladder. The authors describe two cases of this unusual affection and comment on its clinical, pathophysiological and diagnostic aspects.