Differential expression of pro-inflammatory cytokines and a pro-apoptotic protein in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis.

BACKGROUND: Pouchitis after total rectocolectomy is among the most common complications of patients with ulcerative colitis (UC). However, its frequency is quite rare in patients with familial adenomatous polyposis (FAP). We evaluated the inflammatory and pro-apoptotic activity in endoscopically normal mucosa of the ileal pouch in patients with UC and FAP. METHODS: Twenty patients (10 with UC and 10 with FAP) with "J" pouch after total proctocolectomy were studied as were 10 normal controls. Biopsies were obtained from the mucosa of the pouch of UC and FAP patients and from the normal ileum of controls. The expression levels of TNF-alpha, IL-1beta, IL-6, IL-8 and phospho-BAD were determined by immunoblotting. Activated NFkappaB was evaluated by immuno-precipitation and immunoblotting for IkappaB kinase beta. RESULTS: Patients with UC had higher levels of IL-1beta, IL-6, IL-8 and TNF-alpha than patients with FAP. The level of TNF-alpha was higher in patients with UC than in patients with FAP; both patient groups had TNF-alpha levels higher than controls. Activation of NFkappaB was similar in all three groups. The expression of phospho-BAD was significantly lower in patients with FAP than in patients with UC. CONCLUSIONS: As compared with patients with FAP, patients with UC presented increased levels of some pro-inflammatory cytokines, even in the absence of clinical or endoscopic signs of pouchitis. Patients with FAP presented lower levels of pro-inflammatory proteins and of phospho-BAD. These findings may explain the higher rates of progression to pouchitis in UC patients, which could correlate with mucosal atrophy that occurs in inflamed tissue.

Mucinous adenocarcinoma derived from chronic perianal fistulas: report of a case and review of the literature.

Chronic perianal fistulas are a common clinical condition. However, their evolution into adenocarcinoma is rare. We report the case of a 68-year-old man with perineal and perianal chronic fistulas, who developed a perineal mass that extended proximally as a pararectal tumor. Diagnosis was confirmed by magnetic resonance imaging (MRI). Histopathological sections indicated extramucosal mucinous adenocarcinoma. No intestinal lesion was seen at endoscopic examination. The patient underwent abdominal perineal excision of the rectum without neoadjuvant or adjuvant therapy, and had a good postoperative outcome.

[The diagnostic value of Ag-NOR technique in colorectal cancer]. / A técnica Ag-NOR auxiliando no diagnóstico do câncer colorretal.

The Ag-NOR technique has been applied to many tissues in order to evaluate proliferative lesions. In colorectal mucosa dots counting is not reliable, but the analysis of their shape can be very useful for diagnosis. We applied the Ag-NOR technique to 71 smears of colorectal mucosa, classified in three groups according to the histopathologic diagnosis of the corresponding biopsies: normal/reactive (20 cases), low grade dysplastic mucosa/adenoma (six cases), adenocarcinoma (45 cases). In normal/reactive mucosa and in low grade dysplastic mucosa NORs were small dots, sometimes clustered or interlinked but with a homogeneous pattern. In the group of adenocarcinoma there was great variation in size and shape of NORs, bizarre forms, angulations, giving a heterogeneous pattern to the smear. Due to the large and characteristic variation in NORs of carcinomatous cells, they can be recognized as "malignancy markers", giving a good help for the diagnosis of some difficult cases in the daily practice.

[Cytopathological test performed during colonoscopy in the diagnosis of colorectal stenosis]. / Exame citopatológico realizado durante colonoscopia no diagnóstico das estenoses colorretais.

The etiological diagnosis for the colorectal strictures can be very difficult. With the colonoscopy, it was possible to obtain samples with direct vision of the lesion. Consequently, the cytologic efficiency improved, with similar or even better results than histopathology. In the present study (107 patients) it was used the cytopathology performed during colonoscopy. After a specimen was obtained, it was smeared on glass slide, fixed in 95% alcohol, stained by HE, and examined microscopically, with conclusions during the procedure. The results were compared and further correlated to the histopathology of surgical specimen or based on clinical follow-up in those case not submitted to operation. The results showed a striking degree of correlation between both exams. For the cytopathology there were no inconclusive results, false-negative were less frequent than with histopathology, and only one case of false-positive (rectal villus adenoma) was observed. Considering the type, localization and perviousness of the lesion, similar conclusions were drawn, and did not affect the results, except that there were more false-negatives in both exams when the lesions were impervious. The cytopathological and histopathological studies were both highly sensitive and specific for the diagnosis of carcinoma. In conclusion, cytopathology performed during colonoscopy is safe and efficient in the study of colorectal strictures, which contributes to improve the orientation of these patients.

[Criteria for cytological diagnosis of colorectal mucosa]. / Critérios para o diagnóstico citológico em mucosa colo-retal.

A detailed description of cytological alterations of the colorectal mucosa in ten different conditions is given. It was based in the study of 150 smears obtained by colonoscopy in cases of inflammatory diseases (80), obstructive lesions (50) and polyps (20). In our hands this procedure proved to be highly reliable, giving a conclusion within a few minutes during colonoscopy.