Quantitative investigation of desmoplasia as a prognostic indicator in colorectal cancer.

BACKGROUND: The role of desmoplastic reaction (DR) in colorectal cancer invasion is still an open question. The presence of fibrous connective tissue may represent a barrier against cancer diffusion or a stroma to build up and support the tumor. Aims of the present study were to evaluate the influence of DR on long-term survival and to validate a reliable quantitative method to measure the desmoplastic tissue. METHODS: This retrospective study included 86 patients who underwent radical colorectal resection for cancer, from a database of 429 patients. To achieve a quantitative histochemical measurement of DR, digital images were analyzed by a computerized image analysis program. DR was related to the overall survival and the quantitative method was related to the traditional one. RESULTS: By using the Kaplan-Meier analysis, DR was found to be significantly associated with overall survival. Patients with a higher value of DR survived longer than those with smaller DR and the quantitative results were in accordance with those obtained by using the traditional methods. CONCLUSIONS: Desmoplasia seems to be a protective factor for survival in patients with colorectal carcinoma. The quantitative technique is easily standardized and can be routinely performed, so that DR may be a useful prognostic indicator. Notwithstanding, the conflicting outcomes reported in literature about DR need further biological and molecular studies to achieve definitive conclusions.

Retrograde parotidectomy for pleomorphic adenoma of the parotid gland: a conservative and effective approach.

To compare the extensiveness and the effectiveness of anterograde and retrograde dissections in superficial parotidectomy for pleomorphic adenoma of the parotid gland, a review of medical records and pathology reports of consecutive patients who underwent superficial parotidectomy has been performed. The sizes of the overall pathologic specimen, the tumor within the specimen, and the normal parotid tissue obtained by anterograde and retrograde approaches have been compared. Mann-Whitney and chi tests have been used to reveal significant differences. Sixty-four patients were included in the study, 32 who underwent anterograde (standard) parotidectomy and 32 who underwent retrograde parotidectomy. Anterograde dissection resulted in a significantly larger size of the overall pathologic specimen as compared with retrograde parotidectomy (P = 0.019). The size of the tumor was nonsignificantly larger for patients undergoing standard parotidectomy (P = 0.174). Patients undergoing anterograde parotidectomy also had a significantly much larger volume of normal tissue removed in the course of extirpating the adenoma, as compared with patients undergoing retrograde parotidectomy (P = 0.008). Despite extracapsular dissection and partial superficial parotidectomy being proposed in the last years as conservative techniques, the optimal treatment of pleomorphic adenoma remains the superficial or total parotidectomy with facial nerve primary identification and preservation. Retrograde parotidectomy, reducing the extent of normal parotid gland removal, may permit a more conservative approach than standard parotidectomy, with the same complication rates and surgical effectiveness.

Silent colon carcinoma presenting as a hepatic abscess.

Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases. A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.

Large size, villous content and distal location are associated with severe dysplasia in colorectal adenomas.

UNLABELLED: Adenomatous polyps are precursor lesions for colorectal carcinoma. The risk of cancer development has been associated with age and size, amount of villous component and high-grade dysplasia of adenomas. The subject-related and adenoma-related risk factors for severely dysplastic lesions were further investigated. PATIENTS AND METHODS: The study was performed in 474 men and 339 women undergoing endoscopic removal at index colonoscopy of 1217 polyps. RESULTS: The male gender, cases aged over 55 and cases examined for rectal bleeding, showed an increased risk of colorectal polyps (odds ratios, OR = 1.95, 5.1 and 2.99, respectively). Adenomas synchronous with hyperplastic polyps of larger diameter (>10 mm) showed an increased risk of severe dysplasia (OR = 6.94). Severe dysplasia occurred more significantly in younger subjects harbouring villous growths (OR = 4.28, p < 0.03) and in larger adenomas (OR = 3.91, p < 0.001). The risk for severe dysplasia in relation to gender, age, multiplicity and location was higher in adenomas of larger diameter and with villous content. Multivariate analysis showed that distal site (p < 0.02), large size (p < 0.001) and villous content (p < 0.001) were the independent risk factors for severe dysplasia. CONCLUSION: Large size, villous content and distal location are associated with severe dysplasia in colorectal adenomas. The risk for severe dysplasia does not appear to be correlated with age.

Gastric cancer precursor lesions and Helicobacter pylori infection in patients with partial gastrectomy for peptic ulcer.

The mucosa of the gastric stump is considered at greater risk of dysplastic and neoplastic changes than that of the intact stomach. The combination of enteric reflux and Helicobacter pylori infection may have a synergistic damaging effect on the mucosa of the gastric remnant, both producing and increasing mucosal proliferation. The aim of this study was to assess whether the occurrence of H. pylori infection in the remnant mucosa of partially gastrectomized subjects for peptic ulcer disease is associated with an increase of the mucosal precursor lesions of malignancy. A series of 151 subjects who underwent partial gastrectomy for peptic ulcer disease were submitted to upper digestive endoscopy for long-term surveillance. Biopsy specimens of the gastric stump were tested for the occurrence of H. pylori infection and for the presence of precancerous mucosal lesions. The prevalence of H. pylori colonization in the remnant stomach was less than 30% and similar in subjects with different time intervals between gastrectomy and endoscopy. Age at surgery (chi(2): p = 0.03) and H. pylori infection (chi(2): p = 0.002) were significantly associated with the grading of mucosal lesions. The prevalence of normal mucosa was 10 times higher in H. pylori-negative patients as in H. pylori-positive ones (22.0% vs. 2.4%), and the prevalence of intestinal metaplasia was four times higher in H. pylori-positive patients than in H. pylori-negative ones (19.6% vs. 4.6%). We concluded that H. pylori infection may play a causal role in the development of gastric lesions in the operated stomach.

Is desmoplasia a protective factor for survival in patients with colorectal carcinoma?

BACKGROUND & AIMS: The role of desmoplasia in colorectal carcinoma progression is unclear and the presence of collagen stroma may represent a barrier against cancer diffusion and vascular invasion or a stroma to build up and support the tumor. The aim of this study was to evaluate the effect of desmoplastic response on long-term survival of patients who underwent radical resection for colorectal carcinoma. METHODS: The study included 429 patients who underwent radical colorectal resection for cancer with a median follow-up period of 72.8 months. RESULTS: At univariate analysis significant associations were observed between desmoplasia and histologic type, parietal infiltration, growth pattern, and staging. No associations were found between desmoplasia and the other clinical and histologic parameters. The multivariate analysis stratified for tumor stage revealed that the factor showing the most favorable influence on time to death was desmoplasia. The presence of desmoplasia was likely to decrease the failure rate to a third of the rate experienced by patients without desmoplasia. Parietal infiltration was associated with an increased risk for a shortened time to death. CONCLUSIONS: Our results favor the view that desmoplasia is a protective factor for survival in patients with colorectal carcinoma. This finding is consistent with the hypothesis that desmoplasia may prevent cancer invasiveness by building a barrier against tumor diffusion.

A late complication of pelvic radiotherapy: leiomyosarcoma of the rectum. Report of a case and review of the literature.

Leiomyosarcoma of the rectum is an uncommon malignancy; it accounts for less than 0.1% of all malignancies of the colon and rectum and only one case has been reported long-term following pelvic radiotherapy. We report a second case of leiomyosarcoma of the rectum after radiotherapy in an elderly women who received external radiation therapy eighteen years before, for endometrial carcinoma. We confirm that leiomyosarcoma may be a late uncommon effect of pelvic irradiation and suggest that close and long-term surveillance of irradiated patients is highly recommended.

Tratamiento quirúrgico del megacolon tóxico en la rectocolitis ulcerosa: análisis de 16 pacientes / Surgical treatment of toxic megacolon in ulcerative rectocolitis: analysis of 16 patients

Se analizan los aspectos clínicos, el tratamiento quirúrgico y los resultados de 16 casos consecutivos de Megacolon tóxico como complicación de la rectocolitis ulcerosa, atendidos en la I Clínica Quirúrgica de la Universidad de Roma, en el período 1976-1987. La cirugía realizada fue la colectomía total con ileorecto-anastomosis en un solo tiempo, sin ileostomía de protección, en 14 pacientes y colectomía con ileostomía terminal e ileorectoanastomosis diferida, cinco meses más tarde, en 2 pacientes no tuvimos mortalidad operatoria, las complicaciones inmediatas fueron: dehiscencia parcial de la anastomosis en un caso, proctorragia en tres casos. Las tardías fueron: fistulización y perforación del "cul de sac" ileal, en 2 casos. En un paciente 10 meses más tarde fue necesaria la protectomía por intensa reaquidización de la enfermedad a nivel rectal, sobre la base de los resultados obtenidos, en casos seleccionados proponemos: La colectomía total con ileorectoanastomosis inmediata como tratamiento de esta grave complicación