Aim To report long-term oncological outcomes and organ preservation rate with a chemoradiotherapy-consolidation chemotherapy (CRT-CNCT) treatment for locally advanced rectal cancer (LARC). Method ...Retrospective analysis of prospectively maintained database was performed. Oncological outcomes of mid-low LARC patients (n=60) were analyzed after a follow-up of 63 (50-83) months. Patients with clinical complete response (cCR) were treated with the watch-and-wait (WW) protocol. Patients who could not achieve cCR were treated with total mesorectal excision (TME) or local excision (LE). Results Thirty-nine (65%) patients who achieved cCR were treated with the WW protocol. TME was performed in 15 (25%) patients and LE was performed in 6 (10%) patients. During the follow-up period, 10 (25.6%) patients in the WW group had regrowth (RG) and 3 (7.7%) had distant metastasis (DM). Five-year overall survival (OS) and disease-free survival (DFS) were 90.1% and 71.6%, respectively, in the WW group. Five-year OS and DFS were 94.9% (95% CI: 88-100%) and 80% (95% CI: 55.2-100%), respectively, in the RG group. For all patients (n=60), 5-year TME-free DFS was 57.3% (95% CI: 44.3-70.2%) and organ preservation-adapted DFS was 77.5% (95% CI: 66.4-88.4%). For the WW group (n=39), 5-year TME-free DFS was 77.5% (95% CI: 63.2-91.8%) and organ preservation-adapted DFS was 85.0% (95% CI: 72.3-97.8%). Conclusion CRT-CNCT provides cCR as high as 2/3 of LARC patients. Regrowths, developed during follow-up, can be successfully salvaged without causing oncological disadvantage if strict surveillance is performed. Keywords: Watch and wait, Non-operative management, Rectal cancer, Clinical complete response, Pathological complete response, Total neoadjuvant chemoradiotherapy
Inflammatory myofibroblastic tumor is a mesenchymal tumor which commonly originates from lungs. In this paper we report the successful resection of multiple inflammatory myofibroblastic tumors ...invading thoracic, mediastinal and abdominal viscera in a 14-year old child. We could achieve an R0 resection with distal esophagectomy, proximal gastrectomy, splenectomy, left hepatectomy, left pneumonectomy, left diaphragm resection and pericardiectomy. To our knowledge, this is the first case reporting synchronous gastric and pulmonary inflammatory myofibroblastic tumors. The patient is alive without disease after 33 months.
•Inflammatory myofibroblastic tumor is a real intermediate-grade neoplasm.•Usually originates from lungs and the most common primary lung tumor in children.•Synchronous tumors should be kept in mind.•Radical surgery is the most effective treatment.
The murine sarcoma viral (V-Raf) oncogene homolog B (BRAF) V600E mutation, which increases protein kinase activity in BRAF-mitogen-activated protein kinase kinase (MEK) - extracellular ...signal-regulated kinases (ERK) (mitogen-activated protein kinase (MAPK)) signaling, is found in 5-40% of all colorectal carcinoma cases. Proteins with this mutation are reported to be 130-fold more active, which results in induced proliferation, differentiation, cellular survival, and angiogenesis. The aim of the present study was to investigate tumor tissues, together with the surrounding non-tumoral tissues, for BRAF mutation presence, which may be an indicator for possible recurrence or prognosis as in the 'field carcinogenesis' model.
The BRAF V600E genotype of 152 colorectal adenocarcinoma paraffin-embedded specimens were determined by mutant-allele-specific amplification-polymerase chain reaction.
According to our results, the presence of BRAF mutation increases risk of lymph node invasion by 1.55-fold χ(2)=3.83, p=0.05, odds ratio (OR)=1.55, 95% confidence interval (CI)=1.00-2.42, histologically medium or high-grade tumor by 1.60-fold (χ(2)=4.34, p=0.030, OR=1.60, 95% CI=1.03-2.48), vascular invasion by 1.55-fold (χ(2)=3.55, p=0.05, OR=1.55, 95% CI=0.99-2.42), perineural invasion by 1.50-fold (χ(2)=3.16, p=0.07, OR=1.5, 95% CI=0.96-2.33) and the combination of these poor prognostic features by 1.54-fold (χ(2)=2.47, p=0.11, OR=1.54, 95% CI=0.93-2.53). We also found that females are more prone to having the mutation and that being female increases the risk of having this mutation by 1.54-fold (χ(2)=3.58, p=0.05, OR=1.54, 95% CI=0.97-2.44).
BRAF V600E mutation in non-tumoral surrounding tissue in patients with colorectal cancer may be used as a valuable marker to foresee clinical outcome or a possible recurrence. To our knowledge, this was the first study to take into consideration the non-tumoral surrounding tissues in addition to the tumor tissue.
The aim of this retrospective survey is to determine the frequency of collagenous colitis among patients who presented with chronic diarrhea to our gastroenterology outpatient clinic and to evaluate ...the demographic, clinical and laboratory findings of these patients and the treatment modalities.
We reviewed the charts of the patients who had presented with chronic diarrhea to our outpatient clinic during four years. We identified the patients who were diagnosed to have collagenous colitis on histopathological examination.
Among the 93 patients who presented with chronic diarrhea, 7 (7.5%) were diagnosed as collagenous colitis. Six of these patients were female, the mean age was 64 ± 11.5 years. Celiac disease was diagnosed in 2 of these patients. Laboratory examination showed anemia in 2 patients, hypoalbuminemia in 4 patients and high C-reactive protein levels in 3 patients. Five patients were treated with mesalazine, 1 patient with salazopyrine and 1 with methylprednisolone. Remission was obtained in all of these patients except for one; in this case budesonide was started instead of mesalazine.
Collagenous colitis was detected in 7.5% of the patients who presented with chronic diarrhea to our gastroenterology outpatient clinic. They were usually middle aged female patients. Mesalazine was effective in most of these patients.
Background
Helicobacter pylori
infection leads to different clinical outcomes depending on both host and bacterial factors. In a recent study, we identified
H. pylori cagE
and
babA2
genotypes as ...independent predictors of duodenal ulcer (DU) and gastric cancer (GC) in dyspepsia patients, but no previous studies have examined the role of host-related genetic factors in Turkey. This time our aim was to evaluate whether polymorphisms of the interleukin 1B (
IL-1B
) and the interleukin 1 receptor antagonist (
IL-1RN
) genes are important factors in the differential expression of gastroduodenal diseases in
H. pylori
-positive dyspepsia patients.
Methods
Ninety-three
H. pylori
-positive patients, 30 with nonulcer dyspepsia (NUD), 30 with DU, and 33 with GC, were investigated. The
IL-1B-511
and
IL-1B-31
biallelic polymorphisms, and the
IL-1RN
intron 2 variable number tandem repeat were genotyped by polymerase chain reaction and single-strand confirmation polymorphism analysis.
Results
The
IL-1RN-1/1
genotype was significantly more prevalent among patients with NUD than among those with GC (χ
2
= 9.270;
P
= 0.002), and the
IL-1RN-1/2
genotype was significantly more common in patients with GC (χ
2
= 6.01;
P
= 0.014). Multivariate regression analysis showed that
cagE
,
babA2
, and
IL-1RN-1/2
genotypes were independent predictors of GC, but when patients with benign disorders were grouped together (NUD + DU) and compared with patients with GC, regression analysis disclosed that
babA2
(
P
= 0.000) and
IL-1B-31
gene polymorphisms (
CC
or
CT
) (
P
= 0.01) were the only independent markers of GC.
Conclusions
When analyzed together with host genetic factors, the wellestablished bacterial risk factor
babA2
seems to be the most important predictor of malignant disorders, and the presence of the
IL-1B-31TT
genotype emerges as a protective factor against them.
Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare. A 50-year-old female with SCLC who had limited ...disease and achieved full response after treatment presented with acute pancreatitis during her follow-up. The radiologic studies revealed a small area causing obliteration of the pancreatic duct without mass in the pancreatic neck, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the metastasis of SCLC. The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field. In SCLC, cases of MIAP can be encountered with conventional computed tomography with no mass image, and positron emission tomography and EUS-FNA can be useful for diagnosis of such cases. Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.
Selective observation method has started to replace routine laparotomy application for abdominal penetrating trauma patients after Shaftan's selective observation method applied in the 1960s. In this ...respect, there is a possibility of bowel perforations healing without operations. An experimental model was established in this study in order to clarify this possibility.
Fifty Wistar-Albino rats were divided into five groups, ten in each. While one group served as the control, distal part of the small bowel of the rats in the other four groups was perforated 1, 2, 3, and 4 mm in diameter with appropriate cutters. After a week of observation, test rats were sacrificed and relaparotomy was applied. The test material consisting of the perforated bowel, covering 1 cm of proximal and distal margins, and some peritoneal tissue was taken for histopathological examination.
Small bowel perforations with a diameter of 2 mm or below healed spontaneously without any operation. Peritonitis intensity increased in direct ratio with perforation diameters. Wall repair capacity of the bowel diminished with increasing perforation diameters.
It was observed that small perforations in the small bowel of rats could be limited by the organism itself without a necessity of any surgical intervention.
Gastric and colorectal cancers are prevalent and fatal cancers worldwide. Although mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRCC) are relatively uncommon, they are of critical ...importance because of poor prognosis. In Turkey, studies on MSI and other molecular characteristics in mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRCC) of stomach and colon have not been conducted. The present study aimed to investigate the similarities and differences between gastric/colorectal MACs and SRCCs. A total of 590 patients with gastric carcinoma and 1075 patients with colorectal carcinoma, in whom pathologic diagnosis was made within a period of 8 years in our hospital, were retrospectively evaluated. Tissue blocks and slides obtained from the pathology archive were used for immunohistochemical and genetic studies and for microscopic re-evaluation according to the WHO criteria. Data from a total of 135 patients, of whom 78 had been diagnosed with MAC and 57 had been diagnosed with SRCC, were analyzed. MAC patients were significantly older than those with SRCCs. While colorectal localization was more common among MACs, SRCC patients mostly showed gastric localization. Macroscopically, ulceroinfiltrative type was the most prevalent in both groups followed by fungating type in MAC and infiltrative type in SRCC. When compared with SRCC group, MAC group was associated with higher tumor invasion stage, lower rate of patients with infiltrative growth pattern and perineural invasion, and less frequent lymph node invasion. More effective approaches will be developed in the treatment and prevention of cancer along with more data about the incidence, pathogenesis, prognostic factors, and clinical course of cancers.
To assess the incidence of MLH1 (the human MutL homologue) and MSH2 (the human MutS homologue) protein expression in Turkish patients with sporadic colorectal cancers and to compare their survival ...and clinicopathological features.
We validated the tissue microarray technology in 77 colorectal carcinomas by analyzing the immunohistochemical expression of proteins involved in two main pathways of colorectal carcinogenesis: p53 protein for loss of heterozygosity tumors; MLH1 and MSH2 proteins for microsatellite instability (MSI).
Our analysis showed that 29 (39.2%) had loss of MLH1 expression, 5 (6.8%) had loss of MSH2 expression and 2 cases had loss of expression of both proteins. We found that 60% of MSH2-negative tumors were located in the right side of the colon; all MSH2-negative cases were women. In addition, the loss of MSH2 expression was correlated with low p53 expression. Neither MLH1 nor MSH2 expressions were associated with prognosis, although there seemed a tendency of longer survival (71.7 +/- 8.65 mo vs 47.08 +/- 5.26 mo) for the patients with MLH1-negative versus MLH1-positive carcinomas. There were not significant differences in overall and recurrence-free survival among MLH1/MSH2-positive and -negative cases.
Our data supports that Turkish patients with MLH1- and MSH2-defective tumors have some distinct features from each other. Although prognostic importance remains controversial, immunohistochemical analysis of mismatch repair genes may be used as a routine histopathological examination of sporadic colorectal carcinomas.
Acute rectal ischemia is a rare entity because the rectum has abundant blood supply from the inferior mesenteric, internal iliac, internal pudendal, and marginal artery with rich collaterals. We ...present a case of an acute ischemic proctosigmoiditis with a history of rectal cancer who completely recovered after total neoadjuvant treatment and was in the "watch-and-wait" protocol. Urgent laparoscopic low anterior resection and protective ileostomy were performed. Causes of acute rectosigmoid ischemia include old age, diabetes, atherosclerosis, previous aortic surgery due to aneurysm, vasculitis, and radiotherapy. Ischemia may be present as only involving the mucosa, which can be managed conservatively, but full-thickness necrosis requires urgent surgical intervention. Endoscopic examination is the gold standard in initial diagnosis. Ischemic gangrene of the rectosigmoid colon is a rare condition and can be life-threatening unless an urgent surgical intervention is performed.
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