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Digestive Diseases and Sciences Sep 2014The factors underlying the development of interval colon cancers are not well defined and are likely heterogeneous. We sought to determine whether there are distinct...
BACKGROUND AND AIM
The factors underlying the development of interval colon cancers are not well defined and are likely heterogeneous. We sought to determine whether there are distinct molecular properties associated with interval colon cancers.
METHODS
Colon cancers diagnosed within 5 years of a complete and well-prepped colonoscopic examination were identified over a 7-year period at a single institution. The clinical and pathological features of the tumors were defined. Analysis of DNA mismatch repair (MMR) and genotyping of a panel of oncogenes associated with colon cancer were performed.
RESULTS
Forty-two interval colon cancers were diagnosed at an average age of 70 years. 69 % of tumors were located in the right colon. 41 % of tumors exhibited DNA microsatellite instability (MSI). Loss of staining of DNA MMR proteins by immunohistochemistry (IHC) was confirmed in 82 % of the MSI-positive tumors. Among tumors with abnormal MSI and IHC, 54 % exhibited somatic methylation of the MLH1 promoter, but the remaining 43 % exhibited molecular features indicative of underlying Lynch syndrome (LS). The frequency of somatic mutations in the KRAS, BRAF, NRAS, and PIK3CA oncogenes was similar between interval cancer cases and controls.
CONCLUSIONS
Interval colon cancers are not distinguished by the activation of the KRAS, NRAS, BRAF, or PIK3CA oncogenic pathways. However, MSI pathway defects are present in a significant proportion of interval colon cancers. Underlying LS may explain nearly half of these MSI-positive cases, and the remaining cases appear to represent sporadic serrated pathway tumors.
Topics: Adaptor Proteins, Signal Transducing; Adenocarcinoma; Adenoma; Adenosine Triphosphatases; Adult; Aged; Aged, 80 and over; Cecal Neoplasms; Class I Phosphatidylinositol 3-Kinases; Colon, Ascending; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Colorectal Neoplasms, Hereditary Nonpolyposis; DNA Methylation; DNA Mismatch Repair; DNA Repair Enzymes; DNA-Binding Proteins; Female; GTP Phosphohydrolases; Genotype; Humans; Male; Membrane Proteins; Microsatellite Instability; Middle Aged; Mismatch Repair Endonuclease PMS2; MutL Protein Homolog 1; MutS Homolog 2 Protein; Nuclear Proteins; Phosphatidylinositol 3-Kinases; Promoter Regions, Genetic; Proto-Oncogene Proteins; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras); Time Factors; ras Proteins
PubMed: 24705641
DOI: 10.1007/s10620-014-3134-2 -
Clinical & Translational Oncology :... Apr 2021To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice. (Review)
Review
OBJECTIVE
To provide guidance for the management of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in daily practice.
METHODS
Nominal group and Delphi techniques were used. A steering committee of seven experts analyzed the current management of RAS wt mCRC, through which they identified controversies, critically analyzed the available evidence, and formulated several guiding statements for clinicians. Subsequently, a group of 30 experts (the expert panel) was selected to test agreement with the statements, through two Delphi rounds. The following response categories were established in both rounds: 1 = totally agree, 2 = basically agree, 3 = basically disagree, 4 = totally disagree. Agreement was defined if ≥ 75% of answers were in categories 1 and 2 (consensus with the agreement) or 3 and 4 (consensus with the disagreement).
RESULTS
Overall, 71 statements were proposed, which incorporated the following areas: (1) overarching principles; (2) tumor location; (3) triplets; (4) maintenance; (5) second-line and beyond treatments; (6) Rechallenge and liquid biopsy. After the two Delphi rounds, only six statements maintained a lack of clear consensus.
CONCLUSIONS
This document aims to describe the expert's attitude when dealing with several common clinical questions regarding patients with RAS wt mCRC.
Topics: Advisory Committees; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Camptothecin; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Colorectal Neoplasms; Consensus; Delphi Technique; ErbB Receptors; Fluorouracil; Genes, ras; Genotype; Humans; Leucovorin; Liquid Biopsy; Maintenance Chemotherapy; Organoplatinum Compounds; Proto-Oncogene Proteins B-raf; Retreatment
PubMed: 32789773
DOI: 10.1007/s12094-020-02475-8 -
Annals of the Royal College of Surgeons... Feb 2020Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The... (Review)
Review
Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.
Topics: Aged; Cecal Diseases; Cecum; Colon, Ascending; Female; Hernia, Abdominal; Herniorrhaphy; Humans; Intestinal Obstruction; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 31532226
DOI: 10.1308/rcsann.2019.0123 -
Diseases of the Colon and Rectum Mar 2017Knowledge of the normal pattern and variations of the blood supply of the right colon is crucial for better outcomes after colon surgery.
BACKGROUND
Knowledge of the normal pattern and variations of the blood supply of the right colon is crucial for better outcomes after colon surgery.
OBJECTIVE
The purpose of this study was to describe the precise vascular anatomy of the right colon according to surgical perspective.
DESIGN
Adult fresh cadavers were dissected between January 2013 and October 2015, focusing on the venous and arterial anatomy of the right side of the colon.
SETTINGS
Macroscopic anatomical dissections were performed on 111 adult fresh cadavers with emphasis on the vascular anatomy of the right colon. The colic tributaries of the superior mesenteric artery and vein were documented in writing. Furthermore, the dissections were recorded with a video camera.
RESULTS
The incidence of colic arteries arising from the superior mesenteric artery included ileocolic artery, 100%; right colic artery, 33.3%; middle colic artery, 100%; and accessory middle colic artery, 11,7%. All 111 cadavers had a single ileocolic vein, which drained into the superior mesenteric vein in 103 cases (92.8%), into the gastro-pancreatico-colic trunk in 7 cases (6.3%), and into the jejunal trunk in 1 case (0.9%). The drainage site of the ileocolic vein to the superior mesenteric vein varied, and in 9% of cases the ileocolic vein did not accompany the ileocolic artery. The gastro-pancreatico-colic trunk was detected in 87 cases (78.4%); with several forms of the origin of the respective branches, the gastropancreatic trunk was detected in 24 cases (21.6), and the classic gastrocolic trunk of Henle was not detected. Variations were found in the formation and drainage routes of other venous colic tributaries of the superior mesenteric vein.
LIMITATIONS
This study is limited by its use of cadavers in that it is impossible to trace each vessel to its origin in live surgery.
CONCLUSIONS
Surgeons must watch, observe, and bear in mind that vascular variations can occur. Awareness of these complex variations may improve the quality of surgery and may prevent devastating complications during right-sided colon resections.
Topics: Adult; Arteries; Colon, Ascending; Humans; Mesenteric Artery, Superior; Reference Values; Veins
PubMed: 28177991
DOI: 10.1097/DCR.0000000000000777 -
Gastrointestinal Endoscopy Aug 2017Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Proximal colon adenomas can be missed during routine colonoscopy. Use of a cap or hood on the tip of the colonoscope has been shown to improve overall adenoma detection with variable rates. However, it has not been systematically evaluated for detection of proximal colon or right-sided adenomas where the cap may have maximum impact on adenoma detection rate (ADR). Our aim was to perform a systematic review and meta-analysis to evaluate the impact of cap-assisted colonoscopy (CC) on right-sided ADRs (r-ADRs) compared with standard colonoscopy (SC).
METHODS
PubMed, EMBASE, SCOPUS, and Cochrane databases as well as secondary sources (bibliographic review of selected articles and major GI proceedings) were searched through October 1, 2016. Primary outcome was the pooled rate of r-ADR. Detection of flat adenoma, sessile serrated adenoma/polyp (SSA/P), and number of right-sided adenomas per patient were also assessed. Pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using random-effect models.
RESULTS
We screened 686 records and analyzed data from 4 studies (CC group, 2546 patients; SC group, 2547 patients) that met criteria for determination of r-ADRs, whereas 6 studies (CC group, 3159 patients; SC group, 3137 patients) were analyzed to estimate right-sided adenomas per patient. r-ADR was significantly higher with CC compared with SC (23% vs 17%; OR, 1.49; 95% CI, 1.08-2.05; I = 79%; P = .01). CC also improved detection rates of flat adenoma (OR, 2.08; 95% CI, 1.35-3.20; P < .01) and SSA/P (OR, 1.33; 95% CI, 1.01-1.74; P = .04). The total number of right-sided adenomas (CC: 1428 [60%] vs SC: 1127 [58%]) and number of right-sided adenomas per patient (CC, .71 ± .5, vs SC, .65 ± .62 [mean ± standard deviation]) were numerically higher for CC but were not statistically significant (P = .43). Approximately 17 CCs would be required to detect an additional patient with right-sided adenoma.
CONCLUSIONS
Use of CC significantly improves the proximal colon ADR. In addition, flat adenoma and serrated colonic lesion detection rates are also significantly higher as compared with SC.
Topics: Adenoma; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Colonoscopy; Humans
PubMed: 28365356
DOI: 10.1016/j.gie.2017.03.1524 -
European Journal of Gastroenterology &... Feb 2018Screening colonoscopy is less effective in preventing proximal colon cancers than distal colon cancers. A repeat examination of the right side of the colon may increase... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Screening colonoscopy is less effective in preventing proximal colon cancers than distal colon cancers. A repeat examination of the right side of the colon may increase the lesion detection. The study aimed to assess the results of a second examination of the right side of the colon with forward-view or retroflexion colonoscopy performed immediately after the initial examination.
MATERIALS AND METHODS
We carried out a meta-analysis of all primary studies that performed a second examination of the right side of the colon with forward-view or retroflexion colonoscopy performed immediately after the initial examination.
RESULTS
Six cohorts of five studies with 4155 participants were included in the final study. The adenoma detection rate (ADR) was 28.8% of the combined examinations compared with 24.1% of the single examination (P<0.001), for a pooled odds ratio of 1.34 [95% confidence interval (CI): 1.13-1.59]. For retroflexion assessment, ADR was achieved in 25.4% patients in the combined group, compared with 22.3% in the single examination group (P=0.002), for a pooled odds ratio of 1.19 (95% CI: 1.06-1.33). For forward-view assessment, ADR was achieved in 46.0% patients in the combined group, compared with 33.5% in the single examination group (P<0.001), for a pooled odds ratio of 1.76 (95% CI: 1.40-2.22).
CONCLUSION
For ADR of the right side of the colon, a repeat examination could lead to a modest improvement in the detection of lesions in the proximal colon, irrespective of forward-view or retroflexion assessment.
Topics: Adenoma; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Colonoscopy; Early Detection of Cancer; Humans; Population Surveillance
PubMed: 29232250
DOI: 10.1097/MEG.0000000000001009 -
CEN Case Reports Feb 2021Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis,...
Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis, has a high mortality rate, and therefore should be detected early once it occurs. We describe a case of a 70-year-old woman on PD presented with moderate abdominal pain and low blood pressure, which contributed to the early diagnosis of PD-related peritonitis complicated with NOMI. Increased white cell count of 7150/μL (neutrophil, 84%) in dialysate effluent was diagnostic of PD-related peritonitis, which was later found to be caused by Pseudomonas putida. Computed tomography with contrast performed after administering crystalloids revealed hepatic portal venous gas, pneumatosis intestinalis in the ascending colon, and normal enhancement of the bowel wall and mesenteric arteries, which suggested a reperfusion of the previously ischemic ascending colon. Colonoscopy on hospital day seventeen revealed mucosal hemorrhage and ulcers in the entire right colon and the terminal ileum while the remaining colon was normal. These findings are compatible with the consequence of NOMI. Increased peak systolic velocity of the superior mesenteric artery (SMA) implied its stenosis. Past studies show that ischemia of the colon in patients with chronic kidney disease commonly occurs in the right colon. Arteriosclerosis of the SMA due to the long history of chronic kidney disease and diabetes might have caused its vulnerability to low blood pressure. Abdominal complications including NOMI should be screened for when a patient presents with low blood pressure and strong abdominal pain. This is the first case report that shows colonoscopy images of the colonic ulcers post-NOMI and PD-related peritonitis.
Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Colon, Ascending; Colonoscopy; Constriction, Pathologic; Diabetic Nephropathies; Early Diagnosis; Female; Hemorrhage; Humans; Hypotension; Intestinal Mucosa; Ischemia; Kidney Failure, Chronic; Mesenteric Arteries; Mesenteric Artery, Superior; Mesenteric Ischemia; Peritoneal Dialysis; Peritonitis; Pseudomonas putida; Tomography, X-Ray Computed; Treatment Outcome; Ulcer
PubMed: 32865709
DOI: 10.1007/s13730-020-00522-5 -
Clinical Gastroenterology and... Dec 2019Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare...
BACKGROUND & AIMS
Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare clinical, pathology, and molecular features of PCCRCs (those detected within 6-60 months of colonoscopy) and detected CRCs (those detected within 6 months of a colonoscopy).
METHODS
Within a population-based cross-sectional study of incident CRC cases in Utah (from 1995 through 2009), we identified PCCRCs (those cancers that developed within 5 years of a colonoscopy) and matched the patients by age, sex, and hospital site to patients with detected CRC. Archived specimens were retrieved and tested for microsatellite instability (MSI), CpG island methylation, and mutations in KRAS and BRAF. There were 2659 cases of CRC diagnosed within the study window; 6% of these (n = 159) were defined as PCCRCs; 84 of these cases had tissue available and were matched to 84 subjects with detected CRC.
RESULTS
Higher proportions of PCCRCs than detected CRCs formed in the proximal colon (64% vs 44%; P = .016) and were of an early stage (86% vs 69%; P = .040). MSI was observed in 32% of PCCRCs compared with 13% of detected CRCs (P = .005). The other molecular features were found in similar proportions of PCCRCs and detected CRCs. In a multivariable logistic regression, MSI (odds ratio, 4.20; 95% CI, 1.58-11.14) was associated with PCCRC. There was no difference in 5-year survival between patients with PCCRCs vs detected CRCs.
CONCLUSION
In this population-based cross-sectional study of incident CRC cases in Utah, we found PCCRCs to be more likely to arise in the proximal colon and demonstrate MSI, so PCCRCs and detected CRC appear to have different features or processes of tumorigenesis. Additional studies are needed to determine if post-colonoscopy cancers arise through a specific genetic pathway.
Topics: Aged; Aged, 80 and over; Carcinogenesis; Carcinoma; Cohort Studies; Colon, Ascending; Colon, Descending; Colon, Transverse; Colonic Neoplasms; Colonoscopy; Colorectal Neoplasms; CpG Islands; DNA Methylation; Female; Humans; Male; Microsatellite Instability; Middle Aged; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras); Rectal Neoplasms; Retrospective Studies; Sigmoid Neoplasms
PubMed: 30930275
DOI: 10.1016/j.cgh.2019.02.040 -
Clinics and Research in Hepatology and... Jun 2017To determinate the topographical distribution of key diagnostic histological features of lymphocytic colitis (LC) and collagenous colitis (CC) and to establish what...
AIMS
To determinate the topographical distribution of key diagnostic histological features of lymphocytic colitis (LC) and collagenous colitis (CC) and to establish what correlations may exist between the histological findings and the causes and severity of MC.
PATIENTS AND METHODS
Patients with MC were included in a prospective multicentre French study from September 2010 to October 2012. MC was diagnosed by performing total colonoscopy with multiple biopsies of the rectum and colon collected in separate jars and analyzed separately for each site (descending and sigmoid colon, transverse colon, ascending colon). CC was defined as a subepithelial collagen layer>10μm thick and LC as an intraepithelial lymphocyte (IEL) count>20 lymphocytes per 100 epithelial cells without any associated thickening of the subepithelial collagen.
RESULTS
Ninety-five patients, 69 with LC 26 and with CC, were included in the analysis. The sensitivity of the biopsies for diagnosing MC was maximum in the transverse colon and minimum in the rectum. Rectal and left colonic biopsies resulted in the diagnosis of CC and CL in 93% and 94% of cases, respectively. All the remaining cases of MC were diagnosed by performing additional biopsies beyond the splenic flexure. In patients with LC, a higher rate of IELs was associated with the absence of abdominal pain (P=0.01) and a shorter duration of diarrhea (P=0.001). In patients with CC, a lower level of collagen thickness in the basement membrane was associated with the presence of an autoimmune disease (P=0.02).
CONCLUSION
More than 90% of cases of microscopic colitis were diagnosed in this study by performing rectal and left colonic biopsies.
Topics: Biopsy; Colitis, Microscopic; Colon, Ascending; Colon, Descending; Colon, Transverse; Colonoscopy; France; Humans; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity
PubMed: 28215538
DOI: 10.1016/j.clinre.2016.12.008 -
BMC Cancer Dec 2019NF1(Neurofibromatosis type 1) is an autosomal dominant genetic disorder. Patients with NF1 have an increased risk of developing benign or malignant tumours, such as...
BACKGROUND
NF1(Neurofibromatosis type 1) is an autosomal dominant genetic disorder. Patients with NF1 have an increased risk of developing benign or malignant tumours, such as gastrointestinal stromal tumours (GISTs). However, the coexistence of NF1, GIST and colon cancer is very rare, and few cases have been reported in the literature.
CASE PRESENTATION
We admitted a case of a 64-year-old man with type 1 neurofibromatosis, GISTs, and ascending colon cancer. This case was characterized by café-au-lait macules, discrete cutaneous neurofibromas, nodular neurofibromas, multiple jejunal tumours, and ascending colon cancer. Laparoscopic exploration revealed ascending colon cancer and multiple jejunal tumours. Laparoscopic right hemicolectomy and local excision of the jejunal tumours were performed successfully. The pathological results confirmed moderate differentiated adenocarcinoma of the ascending colon with multiple jejunal GISTs (low risk, very low risk). Moreover, the immunohistochemistry results of multiple jejunal GISTs suggest that NF1 is positive. Whole-exome sequencing (WES) of colon cancer revealed mutations in more than 20 genes, including KRAS, PIK3CA, APC, SMAD4, etc. The results of whole-exome sequencing (WES) of jejunal GISTs revealed an NF1 mutation and no KIT or PDGFR gene mutation.
CONCLUSION
We report a rare case of simultaneous NF1, GIST and colon adenocarcinoma. For patients with NF1, benign and/or malignant tumours are often combined. Therefore, these patients should undergo regular physical examinations so that early detection and early treatment can be achieved.
Topics: Colectomy; Colon, Ascending; Colonic Neoplasms; Comorbidity; Gastrointestinal Stromal Tumors; Humans; Male; Middle Aged; Mutation; Neurofibromatosis 1; Neurofibromin 1; Exome Sequencing
PubMed: 31805970
DOI: 10.1186/s12885-019-6375-9