Macroscopic pathology and all that: a personal view.

I hope that this treatise adds to the excellent reviews by Varma and colleagues, emphasising the importance of accurate macroscopic assessment and report provision. I have especially highlighted the importance of not divorcing the clinical data and the macroscopic analysis from the microscopic assessment as all are required to provide an accurate and cogent overall composition. The review has also identified areas where the evolution of pathological practice has gone a little awry and requires to be modified and/or justified with evidence base. There is also an emphasis on block economy, as there is no doubt that considerable savings can be made if more attention is paid to more judicious block selection. It is also commended that subspecialties other than gastrointestinal pathology introduce reporting quality standards, like lymph node harvest numbers and other important prognostic and management indicators, to improve the quality of macroscopic pathology worldwide to the benefit of our service users and their patients.

Morphological subtypes of colorectal low-grade intraepithelial neoplasia: diagnostic reproducibility, frequency and clinical impact.

AIMS: Special histomorphological subtypes of colorectal low-grade intraepithelial neoplasia (LGIN) with variable prognostic impact were recently described in patients with inflammatory bowel disease (IBD) referred to as non-conventional dysplasia. However, they can also be found in patients without IBD. We aimed to analyse the reproducibility, frequency and prognostic impact of non-conventional colorectal LGIN in patients with and without IBD. METHODS: Six pathologists evaluated 500 specimens of five different LGIN-cohorts from patients with and without IBD. Non-conventional LGIN included hypermucinous, goblet cell-deficient, Paneth cell-rich and crypt cell dysplasia. A goblet cell-rich type and non-conventional LGIN, not otherwise specified were added. Results were compared with the original expert-consented diagnosis from archived pathology records. RESULTS: Four or more pathologists agreed in 86.0% of all cases. Non-conventional LGIN was seen in 44.4%, more frequently in patients with IBD (52%; non-IBD: 39.3%, p=0.005). In patients with IBD non-conventional LGIN associated with more frequent and earlier LGIN relapse (p=0.006, p=0.025), high-grade intraepithelial neoplasia (p=0.003), larger lesion size (p=0.001), non-polypoid lesions (p=0.019) and additional risk factors (p=0.034). Results were highly comparable with expert-consented diagnoses. In patients without IBD, non-conventional LGIN may indicate a higher risk for concurrent or subsequent colorectal carcinoma (CRC, p=0.056 and p=0.061, respectively). Frequencies and association with high-grade intraepithelial neoplasia or CRC varied between the different LGIN subtypes. CONCLUSIONS: Non-conventional histomorphology in colorectal LGIN is frequent and highly reproducible. Our results indicate an increased risk for CRC in patients with non-conventional LGIN, probably independent of IBD. We recommend reporting non-conventional LGIN in routine pathology reports.

My approach to bowel ischaemia.

Resections of ischaemic bowel are one of the most common pathology specimens yet are often viewed as unappealing and diagnostically unrewarding. This article serves to dispel both misconceptions. It also provides guidance on how clinical information, macroscopic handling and microscopic assessment-and especially the interlinking of all three-can maximise the diagnostic yield of these specimens. This diagnostic process requires recognition of the wide range of causes of intestinal ischaemia, including several more recently described entities. Pathologists should also be aware of when and why such causes cannot be discerned from a resected specimen and of how certain artefacts or differential diagnoses can mimic ischaemia.

Novel histological repertoire of crypt-associated anomalies in inflamed colon mucosa.

AIMS: Studying crypt branching in ulcerative colitis (UC) and in infectious colitis (IC), we detected previously unreported crypt-associated anomalies (CAAs). The objective was to describe, illustrate and assess the frequency of CAAs in inflamed colon mucosa in patients with UC and IC. METHODS: Sections from 100 consecutive biopsies with UC, in 50 with IC and in 27 with UC in remission (UCR) were reviewed. The following CAAs were identified: crypt eosinophilia, intracryptal epithelial hyperplasia, intracryptal epithelial budding, intracryptal supernumerary crypts, intracryptal epithelial bridges, crypt rings in rows and off-centre epithelial budding. RESULTS: The frequency of crypts with extensive crypt eosinophilia and with intracryptal epithelial budding was significantly higher in UC than in IC and UCR (p<0.05); the frequency in the remaining histological parameters was similar in UC, IC and UCR. CONCLUSIONS: CAAs were found interspersed with branching crypts. CAAs persisted in long-lasting UC mucosal inflammation, but declined when the inflammation waned. Since similar anomalies are not present in normal colon mucosa, the results suggest that CAAs had been boosted by the ongoing mucosal inflammation. The development of these previously unreported CAAs in the colon mucosa with inflammation might embody pathological aberrations of cryptogenesis.

Significant blunt bowel and mesenteric injury - Comparison of two CT scoring systems in a trauma registry cohort.

PURPOSE: This study evaluated and compared two imaging-based scoring systems for the detection of significant blunt bowel and mesenteric injury (sBBMI) by emergency computed tomography (CT). METHODS AND MATERIALS: We included all consecutive adult polytrauma patients admitted to our emergency department following a road traffic accident from January 2008 to June 2015, provided that intravenously contrast-enhanced whole-body CT examination was performed immediately after hospital admission. Two radiologists, blinded to patients' outcome, reviewed the CT examinations for distinctive direct intestinal or mesenteric vascular injury and indirect signs of abdominal injury. These findings were correlated with the patients' surgical or interventional radiology findings, autopsy, or clinical follow-up (>24 h). Two previously validated imaging-based bowel-injury scoring systems, the CT-based Faget score and the clinically and radiologically based Mc Nutt score (BIPS), were compared by applying each to our trauma cohort. Student t-test, chi-squared, and logistic regression were used in analyses. RESULTS: Twenty-one of 752 analysed patients (2.8 %) had confirmed sBBMI. Active mesenteric bleeding, mesenteric and free pneumoperitoneum, small haemoperitoneum, non-focal bowel wall thickening, mesenteric/pericolic fat stranding, and anterior abdominal wall injury were significantly correlated with sBBMI, as did the two evaluated scoring systems (p < 0.001). However, multivariate logistic regression revealed the superiority of the Faget score to the McNutt score. CONCLUSION: The prevalence of sBBMI among polytrauma patients is low. Early diagnosis is necessary to avoid increased mortality. Certain CT features are pathognomic of sBBMI and must not be overlooked. Scoring systems are helpful, especially when they are based on radiological signs.

CALLA: Efficacy and safety of concurrent and adjuvant durvalumab with chemoradiotherapy versus chemoradiotherapy alone in women with locally advanced cervical cancer: a phase III, randomized, double-blind, multicenter study.

BackgroundConcurrent chemoradiotherapy is the standard of care for locally advanced cervical cancer. Concurrent chemoradiotherapy with programmed blockade of the cell death-1/programmed cell death-ligand 1 pathway may promote a more immunogenic environment through increased phagocytosis, cell death, and antigen presentation, leading to enhanced immune-mediated tumor surveillance. PRIMARY OBJECTIVE: The CALLA trial is designed to determine the efficacy and safety of the programmed cell death-ligand 1 blocking antibody, durvalumab, with and following concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in women with locally advanced cervical cancer. STUDY HYPOTHESIS: Durvalumab concurrent with and following concurrent chemoradiotherapy will improve progression-free survival in patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2 to IVA cervical cancer compared with concurrent chemoradiotherapy alone. TRIAL DESIGN: CALLA is a phase III, randomized, multicenter, international, double-blind, placebo-controlled study. Patients will be randomized 1:1 to receive either durvalumab (1500 mg intravenously (IV)) or placebo every 4 weeks for 24 cycles. All patients will receive external beam radiotherapy with cisplatin (40 mg/m2) IV or carboplatin (area under the curve 2) IV once a week for 5 weeks, followed by image-guided brachytherapy. MAJOR INCLUSION/EXCLUSION CRITERIA: The study will enroll immunotherapy-naïve adult patients with histologically confirmed cervical adenocarcinoma, cervical squamous, or adenosquamous carcinoma FIGO 2009 stages IB2-IIB node positive and stage IIIA-IVA with any node stage. Patients will have had no prior definitive surgical, radiation, or systemic therapy for cervical cancer. PRIMARY ENDPOINT: The primary endpoint is progression-free survival (assessed by the investigator according to Response Evaluation Criteria in Solid Tumors v1.1, histopathological confirmation of local tumor progression or death). SAMPLE SIZE: Approximately 714 patients will be randomized 1:1 to receive either durvalumab + concurrent chemoradiotherapy or placebo + concurrent chemoradiotherapy. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: Patient enrollment is continuing globally with an estimated completion date of April 2024. TRIAL REGISTRATION: NCT03830866.

In vitro effect of uremic serum on barrier function and inflammation in human colonocytes / Efeito in vitro do soro urêmico sobre a função de barreira e inflamação em colonócitos humanos

ABSTRACT Introduction: In chronic kidney disease (CKD), it has been suggested that alterations within the gut are associated with an inflammatory state and uremic toxicity. Studies suggest that uremia may impair the function of the intestinal barrier via the promotion of increased intestinal permeability. To understand the mechanisms that are involved in intestinal barrier damage in the setting of uremia, we evaluated the in vitro effect of uremic serum on transepithelial electrical resistance (TER), inflammation, and apoptosis in intestinal epithelial cells (T84). Methods: Pools of serum from healthy individuals, patients not on dialysis, and patients on hemodialysis (Pre-HD and Post-HD) were prepared. T84 cells were incubated for 24 h in medium, of which 10% consisted of the pooled serum from each group. After incubation, the TER was measured and the following parameters were determined by flow cytometry: expression of toll-like receptors (TLRs), production of reactive oxygen species (ROS), and apoptosis. The level of IL-6 in the culture supernatant was determined by ELISA. Results: No difference was observed among the groups with respect to TER, apoptosis, and ROS or the expression of TLR-2, TLR-4, and TLR-9. IL-6 secretion was higher (p < 0.001) in cells that were incubated with pre- and post-HD serum. Conclusion: The results that were obtained from this model suggest that uremic serum per se does not seem to impair the integrity of intestinal epithelial cells. The increased IL-6 secretion by cells that were incubated with HD serum suggests a potential effect of uremia in the intestinal inflammatory response.

RESUMO Introdução: Tem sido sugerido que na doença renal crônica (DRC) a uremia pode causar alterações intestinais, tais como modificações na microbiota e danos à barreira intestinal, e que estas possíveis alterações podem ter uma relação importante com o estado inflamatório e a toxicidade urêmica apresentadas por pacientes com DRC. Objetivos: Avaliar o efeito in vitro do soro urêmico sobre a permeabilidade da monocamada de células epiteliais do intestino, inflamação e apoptose. Métodos: Pools de soro foram preparados a partir de soros de indivíduos saudáveis, pacientes em tratamento conservador e em hemodiálise (Pré e Pós-HD). As células T84 foram incubadas por 24 horas com os diferentes pools. Em seguida a TER foi medida e as células foram submetidas às seguintes análises: apoptose, produção de espécies reativas de oxigênio (EROs) e expressão de receptores toll-like (TLR) por citometria de fluxo e detecção de IL-6 no sobrenadante da cultura por ELISA. Resultados: Não foram encontradas diferenças, entre os grupos, com relação a TER, apoptose, EROs e expressão de TLR-2, TLR-4 e TLR-9. Já a secreção de IL-6 foi maior (p < 0,001) pelas células incubadas com soro pré-HD e pós-HD. Conclusão: Os resultados obtidos a partir deste modelo sugerem que a uremia per se parece não comprometer a integridade das células epiteliais do intestino. O aumento da secreção de IL-6 pelas células incubadas com soro HD (pré e pós) sugere um potencial efeito da uremia sobre a resposta inflamatória intestinal.

Effect of Reducing Abdominal Compression during Prone CT Colonography on Ascending Colonic Rotation during Supine-to-Prone Positional Change.

OBJECTIVE: To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). MATERIALS AND METHODS: Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps ≥ 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (°) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180° and +180° (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. RESULTS: Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22° to 61° (median, 13.9°) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10°. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. CONCLUSION: Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.

The polypoid ganglioneuroma associated with hyperplastic polyposis

No abstract available.

Effect of Reducing Abdominal Compression during Prone CT Colonography on Ascending Colonic Rotation during Supine-to-Prone Positional Change

OBJECTIVE: To determine the effect of reduced abdominal compression in prone position on ascending colonic movement during supine-to-prone positional change during CT colonography (CTC). MATERIALS AND METHODS: Eighteen consecutive patients who had undergone prone CTC scanning with cushion blocks placed under the chest and hip/thigh to reduce abdominal compression and had confirmed sessile polyps > or = 6 mm in the well-distended, straight, mid-ascending colon, were included. Radial location along the ascending colonic luminal circumference (degrees) was measured for 24 polyps and 54 colonic teniae on supine and prone CTC images. The supine-to-prone change ranging between -180degrees and +180degrees (- and + for internal and external colonic rotations, respectively), was determined. In addition, possible causes of any ascending colonic rotations were explored. RESULTS: Abdominal compression during prone CTC scanning completely disappeared with the use of cushion blocks in 17 of 18 patients. However, some degrees of ascending colonic rotation were still observed, with the radial location changes of -22degrees to 61degrees (median, 13.9degrees) for the polyps and similar degrees for teniae. Fifty-four percent and 56% of polyps and teniae, respectively, showed changes > 10degrees. The radial location change of the polyps was significantly associated with the degree of anterior shift of the small bowel and mesentery (r = 0.722, p < 0.001) and the degree of posterior displacement of the ascending colon (r = 0.566, p = 0.004) during supine-to-prone positional change. CONCLUSION: Ascending colonic rotation upon supine-to-prone positional change during CTC, mostly in the form of external rotation, is not eliminated by removing abdominal compression in prone position.

Comparison of clinicopathological features between gastric polyps and colorectal polyps / 中华全科医师杂志

Objective To compare of clinical and pathological features between gastric polyps and colorectal polyps.Methods The clinical characteristics and pathological features of 2 125 patients with gastric polyps and 4 924 patients with colorectal polyps admitted in Wenzhou People's Hospital from 2004 to 2013 were compared.The detection rates,the indication of endoscopy,distribution,number,size and pathological type of gastric polyps and colorectal polyps were analyzed.Results The detection rate of gastric polyps was 3.1％ (2 125/69 575) and that of colorectal polyps was 24.5％ (4 924/20 124) (χ2 =9 886.401,P ＜0.01).The detection rates of gastric polyps in age groups ＜ 20,20-39,40-59 and ≥60 were 1.8％ (23/1 302),1.8％ (399/22 600),3.4％ (1 137/33 087) and 4.5％ (566/12 586),respectively (χ2 =238.867,P ＜ 0.01);and those for colorectal polyps were 6.6％ (14/211),11.6％ (623/5 385),26.0％ (2 622/10 070) and 37.3％ (1 665/4 458),respectively (χ2 =934.724,P ＜ 0.01).The detection rates of gastric polyps in age groups 20-39,40-59 and ≥60 were lower than those in colorectal polyps(all P ＜ 0.01).The detection rate of gastric polyps in males was lower than that in females(2.3％,848/36 447 vs.3.9％,1 277/33 128,χ2 =273.807,P ＜0.01),while the detection rate of colorectal polyps in males was higher than that in females (28.8％,3 239/11 230 vs.18.9％,1 685/8 894,χ2 =262.518,P ＜ 0.01).Diarrhea and gastrointestinal bleeding in patients with colorectal polyps was more common than those in patients with gastric polyps (23.5％,1 156/4 924 vs.2.5％,54/2 125,χ2 =558.080,P＜0.01;12.1％,597/4 924 vs.2.4％,51/2 125,χ2 =168.150,P ＜0.01).Single polyps were more common in gastric polyps than colorectal polyps(80.7％,1 714/2 125 vs.67.6％,3 331/ 4 924,χ2 =186.337,P ＜0.01).Polyps with size ≥ 1.0 cm were more common in colorectal polyps than those in gastric polyps (24.3％,1 197/4 924 vs.13.6％,289/2 125,χ2 =102.333,P ＜ 0.01).The proportion of inflammatory and hyperplastic types in gastric polyps was higher than that in colorectal polyps (67.1％,1 378/2 125 vs.27.5％,1 273/4 924,χ2 =934.394,P ＜0.01;26.9％,552/2 125 vs.9.9％,459/4 924,χ2 =319.588,P ＜0.01);while the proportion of adenoma and canceration in gastric polyps was lower than that in colorectal polyps (1.7％,34/2 125 vs.62.4％,2 893/4 924,χ2 =2 135.743,P ＜0.01;0.4％,9/2 125 vs.4.8％,221/4924,χ2 =80.362,P＜0.01).Conclusions In comparison with gastric polyps,the detection rate of colorectal polyps is higher.The detection rate of gastric polyps is higher in females,w hile that of colorectal polyps is higher in males.The detection rates of gastric polyps andcolorectal polyps increase with the age.The main pathological type of gastric polyps is inflammatory,while that of colorectal polyps is adenoma.The canceration of colorectal polyps is more common than that of gastric polyps.

Tuberculosis intestinal: un diagnóstico para no olvidar. Reporte de un caso / Intestinal tuberculosis: A diagnosis to remember. A case report / Tuberculose intestinal: um diagnóstico para não esquecer. Reporte de um caso

La tuberculosis continúa siendo una causa importante de morbimortalidad en Colombia y el mundo, con un aumento en las formas extra pulmonares, de las cuales el compromiso intestinal ocupa el sexto lugar. Sus manifestaciones clínicas son inespecíficas y pueden simular múltiples condiciones, lo que hace de su diagnóstico un reto clínico. Este artículo describe el caso de una paciente con tuberculosis intestinal, a quien no se documentó un hallazgo confirmatorio, pero por la sospecha clínica y hallazgos paraclínicos sugestivos, se decide iniciar tratamiento antituberculoso, con respuesta clínica favorable luego de dos semanas.

Tuberculosis remains a major cause of morbidity and mortality in Colombia and the world, with an increase in extra-pulmonary forms, amongst which intestinal involvement ranks sixth. Clinical manifestations are nonspecific and can mimic many conditions that make diagnosis a clinical challenge. This article describes the case of a patient with intestinal tuberculosis, for whom a confirmatory finding was not documented, but due to clinical suspicion and paraclinical suggestive findings, it was decided to initiate TB treatment. The patient presented a favorable clinical response after two weeks of onset.

A tuberculose continua sendo uma causa importante de morbimortalidade na Colômbia e no mundo, com um aumento nas formas extra pulmonares, das quais o compromisso intestinal ocupa o sexto lugar. Suas manifestações clínicas são inespecíficas e podem simular múltiplas condições, o que faz de seu diagnóstico um objetivo clínico. Este artigo descreve o caso de uma paciente com tuberculose intestinal, a quem não se documentou uma descoberta confirmatório, mas pela suspeita clínica e descobertas laboratoriais sugestivas, se decide iniciar tratamento antituberculoso, com resposta clínica favorável logo de duas semanas.

Tuberculosis gástrica que simula otra patología: caso clínico / Gastrointestinal tuberculosis that mimics other pathologies: A clinical case / Tuberculose gástrica que simula outra patologia: caso clínico

La tuberculosis gástrica es una entidad rara que simula otras patologías. Suele asociarse con diagnósticos tardíos debido a sus características clínicas y forma de presentación atípica en este tipo de órganos. Se extrajeron los datos de la historia de una paciente, previo consentimiento informado. Se describen las características clínicas, el enfoque inicial, los hallazgos endoscópicos y la similitud con otras patologías, para terminar con una revisión del tema en la literatura. La tuberculosis gástrica simuló, inicialmente, otras patologías, lo que generó retraso y algunas dificultades en el diagnóstico y manejo. Se trata de una entidad con manifestaciones clínicas variables e inespecíficas, que se confunden con otras entidades, dada su similitud clínica y poca frecuencia de presentación. Existe poca literatura y la mayoría se limita a reportes de casos aislados, con comportamiento benigno y respuesta adecuada al manejo médico con fármacos antituberculosos.

Gastrointestinal tuberculosis is a rare entity that mimics other pathologies. It is commonly associated with late diagnosis due to its clinical characteristics and atypical presentation in these types of organs. Data were taken from the medical record of a patient following informed consent. Clinical characteristics, initial focus, endoscopic findings, and similarities with other pathologies are described, and a topic review was done. Initially, gastric tuberculosis mimicked other pathologies causing a delay and difficulty to issue correct diagnosis and treatment. This entity has variable and nonspecific clinical manifestations which can be confused with other entities due to clinical similarities and infrequent presentation. There is scarce literature and most is limited to isolated case reports with benign behavior and adequate response to TB treatment.

A tuberculose gástrica é uma entidade rara que simula outras patologias. Acostuma associar-se com diagnósticos tardios devido a suas características clínicas e forma de apresentação atípica neste tipo de órgãos. Se extraíram os dados da história de uma paciente, prévio consentimento informado. Se descrevem as características clínicas, o enfoque inicial, os descobertas endoscópicos e a similitude com outras patologias, para terminar com uma revisão do assunto na literatura. A tuberculose gástrica simulou, inicialmente, outras patologias, o que gerou retraso e algumas dificuldades no diagnóstico e manejo. Se trata de uma entidade com manifestações clínicas variáveis e inespecíficas, que se confundem com outras entidades, dada sua similitude clínica e pouca frequência de apresentação. Existe pouca literatura e a maioria se limita a reportes de casos isolados, com comportamento benigno e resposta adequada ao manejo médico com fármacos antituberculosos.

Intussuscepção colônica em adulto: relato de caso / Adult colonic intussusception: a case report

Intussuscepção é a penetração de um segmento do tubo gastrintestinal (TGI) em direção ao segmento adjacente. É rara em adultos e de diagnóstico difícil. Possui na faixa etária adulta, em geral, um fator precipitante. Este trabalho relata paciente adulta que se apresentou à emergência cirúrgica com abdome agudo. Realizada laparotomia de emergência que evidenciou invaginação colônica. A patologia confirmou tratar-se de lipoma como cabeça do intussuscepto.

Intussusception is the penetration of a digestive tract segment into an adjacent segment. It is rare in adults and difficult to diagnose. For adults it generally involves a precipitating factor. This paper describes an adult patient who entered the emergency department with acute surgical abdomen. Emergency laparotomy revealed colonic intussusception. The pathology confirmed a lipoma as the head of this intussusceptum.

Multi-slice spiral computerized tomography findings of colorectal cancer with chronic schistosomiasis / 中华传染病杂志

Objective To retrospectively analyze computerized tomography (CT) imaging features of colorectal cancer with chronic schistosomiasis in order to improve the diagnostic accuracy.Methods Eighty patients whose diagnosis was pathologically confirmed as colorectal cancer with schistosomiasis were collected from Tongji Hospital and Kunshan Chinese Medicine Hospital from January 2007 to December 2012.All the patients underwent abdominal plain CT and contrast-enhanced CT scan.The lesion location,morphology,size,calcification features,enhancement patterns and cancer metastasis were evaluated and compared by two radiologists who were blind to the diagnosis.Twenty colorectal cancer cases without schistosomiasis from the same area were also collected as controls.Results CT imaging showed that the tumors all occurred in the colon and rectum in 80 patients,mainly in colon descendens,colon sigmoideum and rectum.The lesion was characterized by irregular bowel wall thickening with soft tissue masses,and the average length of impaired intestine was (21.35 ± 4.50) cm.The lesions were solitary in 68 cases (85.0％) and were multifocal in 12 cases (15.0％).Linear,spotty and small patchy calcifications were seen in all the patients,with margins unclear in 59 patients (73.8％) and margins clear in 21 patients (26.2％).Early phase enhancement was seen in 68 cases (85.0％),of which 45 cases (56.2％) had homogenous enhancement and 23 cases (28.8％) had heterogeneous enhancement.Late phase enhancement was seen in 73 cases (91.2％) and necrosis was hardly seen.Only two cases (2.5％) had liver metastasis without lymphatic metastasis.All the 20 colorectal cancer cases without schistosomiasis presented with single lesion,which was characterized by irregular bowel wall thickening and local ulcer.The average length of impaired intestine was (6.90±3.40) cm.No calcification was seen in these lesions.All cases had early phase lesion with remarkable heterogeneous enhancement with low density necrotic area.The late phase enhancement was decreased.Four cases (20.0％) had liver metastasis.Compared to cases without schistosomiasis,cases with schistosomiasis tended to have multifocal (x2=100,P=0.000) and longer lesion (t=45.506,P=0.000),and more calcification (x2=100,P=0.000).The early phase heterogeneous enhancement was less frequent (x2 =88,P=0.000) and late phase enhancement was more frequent (x2=100,P=0.000).The liver metastasis rate was significantly lower (x2 =8.688,P =0.014).Conclusions The CT imaging of colorectal cancer with schistosomiasis is characterized by calcifications inside the tumor with obscured margins and multiple intestinal segments involvement.Hematogenous metastasis and lymphatic metastasis are rarely seen.