Colorectal cancer in young Cambodians.

AIM: Colorectal cancer (CRC) is a common disease in the older population, but it has become increasingly evident that it is also not infrequent in the young. The aim of this study was to describe the epidemiological, clinical and pathological characteristics of CRC in young Cambodians. METHODS: We examined clinical and pathological data from all CRC cases registered in the two reference centres for gastrointestinal tumours in Cambodia between 2005-2010. Age-specific CRC incidence rates were computed using the national population census 2008 data from the National Institute of Statistics. We compared differences in distribution of tumour location, histology, differentiation and UICC/TNM stage in two age groups, namely < 40 and ≥ 40. RESULTS: During this period, there were 356 new CRC cases, of which 29.8% affected patients younger than 40. This proportion is the second highest in the world, with a higher proportion only reported in Egyptian population. The crude incidence was 2.82 and 2.36 per 100,000 in females and males, respectively. Adenocarcinoma was the most common histologic type, and >50% of all tumours occurred in the colon, with no appreciable variation between the two age groups. Mucin-producing and advanced-grade tumours were twice more frequent in the young. CONCLUSION: The unusually high CRC proportion in the young in our study could be due to referral bias. Nevertheless, together with the continuous exposure to hazardous environmental agents and the prevalent consanguinity in Cambodia, this question warrants further research to advance our understanding of CRC risk factors and perhaps genetic-environmental interactions in CRC epidemiology in young adults.

Clear-cell variant of solid-pseudopapillary neoplasm of the pancreas: a case report and review of the literature.

Solid-pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm reported to have a favourable prognosis because of its slow-growing behaviour. Ignored and misdiagnosed in the past, SPN has recently been increasingly studied. Its clear cell variant creates challenges in distinction from other clear cell tumours in the pancreas. We report a 31-year-old Cambodian woman who presented with abdominal pain and a palpable epigastric mass. Exploratory laparotomy revealed a 5.2 cm well-demarcated tumour in the head of the pancreas, which was treated with Whipple procedure. Microscopically, the tumour showed an extensive solid growth pattern consisting of cells with abundant clear cytoplasm, and papillary areas containing cells with eosinophilic cytoplasm, indicating a clear-cell solid-papillary neoplasm. Perineural and duodenal wall invasion was present. The tumour cells were immunonegative for chromogranin-A and synaptophysin but positive for CD56, cyclin D1, CD10, vimentin, and progesterone receptor. They showed strong nuclear and cytoplasmic expression and reduced membranous expression of beta-catenin protein. In the pseudopapillary area, they showed nuclear E-cadherin localization and absence of membranous staining. The patient was well without local recurrence or metastasis at one year follow-up. Difficulties are recognized in differentiating clear-cell SPN from "sugar" tumours, metastatic renal cell carcinoma, clear-cell variant of pancreatic endocrine neoplasm and ductal adenocarcinoma. When facing such difficulties, nuclear and cytoplamic beta-catenin, nuclear E-cadherin expressions and absence of membranous E-cadherin staining are useful in differentiating clear-cell SPN from other clear cell tumours in the pancreas. Although a rare neoplasm, it is important to recognize this entity for appropriate management.