Inhibitory effect of sulindac against chemically induced primary colonic tumours by N methyl N nitrosourea in mice

AIM To investigate the chemopreventive effect of sulindac, one of the nonstroidal anti inflammatory drugs (NSAIDs), on the growth of N methyl N nitrosourea (MNU) induced mouse colonic tumors.

Laparoscopic segmental colectomy for colonic lymphangiomas: A definitive, minimally invasive surgical option

Colonic lymphangioma is an unusual benign malformation.We herein describe two cases.A 36-year-old woman was admitted with one year of intermittent abdominal pain;colonoscopy,abdominopelvic computed tomography and endoscopic ultrasonography(EUS)revealed enlarged cystic masses at the ascending colon.In another 40-year-old man,colonoscopy and EUS revealed an asymptomatic lobulated cystic mass with four small sessile polyps at the sigmoid colon.Both patients underwent laparoscopic segmental colectomy.Both masses were histologically confirmed as cystic lymphangiomas,and the patients were discharged without complications.The management of colonic lymphangioma depends on the individual situation;close surveillance or endoscopic therapy may be appropriate for asymptomatic lesions smaller than 2.5 cm in diameter.Surgical intervention can be considered for larger lesions or in patients who develop complication risks.Laparoscopic segmental colon resection may be recommended to excise relatively large submucosal lesions because it is a definitive,minimally invasive intervention with a fast postoperative recovery.

Is colonic lavage a suitable alternative for left-sided colonic emergencies?

BACKGROUND The use of intra-operative colonic lavage(IOCL)with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies,with alternatives including Hartmann’s procedure,manual decompression and subtotal colectomy.AIM To compare the peri-operative outcomes of IOCL to other procedures.METHODS Electronic databases were searched for articles employing IOCL from inception till July 13,2020.Odds ratio and weighted mean differences(WMD)were estimated for dichotomous and continuous outcomes respectively.Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.RESULTS Of 28 studies were included in this meta-analysis,involving 1142 undergoing IOCL,and 634 other interventions.IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure,and anastomotic leak and wound infection when compared to manual decompression.There was a decreased length of hospital stay(WMD=-7.750;95%CI:-13.504 to-1.996;P=0.008)compared to manual decompression and an increased operating time.Single-arm meta-analysis found that overall mortality rates with IOCL was 4%(CI:0.03-0.05).Rates of anastomotic leak and wound infection were 3%(CI:0.02-0.04)and 12%(CI:0.09-0.16)respectively.CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures.More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.

Malignant myopericytoma originating from the colon: A case report

BACKGROUND Myopericytoma is a benign tumor that typically occurs within subcutaneous tissue and most often involves the distal extremities,followed by the proximal extremities,neck,thoracic vertebrae and oral cavity.Complete resection is often curative.Malignant myopericytoma is extremely rare and has a poor prognosis.Here,we report for the first time a case of malignant myopericytoma originating from the colon.CASE SUMMARY A 69-year-old male was admitted to our hospital with right upper quadrant pain for five days.Imaging suggested a liver mass with hemorrhage.A malignant hepatic tumor was the initial diagnosis.Surgical resection was performed after a complete preoperative work up.Initial postoperative pathology suggested that the mass was a malignant myoblastoma unrelated to the liver.Four months after the first surgery,an enhanced computed tomography(CT)scan revealed a recurrence of the tumor.The diagnosis of malignant myopericytoma derived from the colon was confirmed on histopathological examination of the specimen from the second surgery.The patient did not return to the hospital regularly for surveillance.The first postoperative abdominal CT examination six months after the second surgery demonstrated multiple liver metastases.Survival time between the diagnosis of the tumor to death was approximately one year.CONCLUSION Malignant myopericytoma is a rare cancer.Preoperative diagnosis may be difficult.Due to a lack of treatment options,prognosis is poor.

Prevention of metastasis to liver by using 5-FU intraperitoneal chemotherapy in nude mice inoculated with human colonic cancer cells

AIMS Using a new approach of regional adjuvant chemotherapy to prevent cancer cells hepatic metasta- sis after radical surgery of large bowel cancer. METHODS A model of liver with metastasis of hu- man colonic cancer (HCC) cells in nude mice was used to observe the effect in prevention of metastasis of HCC cells inoculated via spleen applied with early postoper- ative intraperitoneal (IP) chemotherapy using large dose of 5-FU. RESULTS The incidence of metastasis to liver was decreased by 40%,the mean number of metastatic liv- er nodules in each animal was reduced by 50.89% and the mean survival times of each animal was prolonged by 48.21% by using 5-FU 40 mg/NS 40 ml/kg IP for two consecutive days as compared with the controls. CONCLUSIONS IP is a new and more effective re- gional adjuvant chemotheraputic approach in the pre- vention of liver metastasis HCC cells after radical surgery of large bowel cancer.

Effect of gastrin on protein kinase C and its subtype in human colon cancer cell line SW480

INTRODUCTIONGastrin is atrophic gastrointestinal hormone whichis secreted by G cell.Gastrin has long beenconsidered a growth stimulatory hormone formucosa of the gastrointestinal tract.The growthresponses of certain colorectal cancer cells,andxenografts,can be stimulated by endogenousgastrin.Protein kinase C (PKC) is a family ofisozymes that plays a crucial role in transducingsignals of many hormones,growth peptides,

Analysis of 72 patients with colorectal high-grade neuroendocrine neoplasms from three Chinese hospitals

BACKGROUND Colorectal high-grade neuroendocrine neoplasms(HGNENs)are rare and constitute less than 1%of all colorectal malignancies.Based on their morphological differentiation and proliferation identity,these neoplasms present heterogeneous clinicopathologic features.Opinions regarding treatment strategies for and improvement of the clinical outcomes of these patients remain controversial.AIM To delineate the clinicopathologic features of and explore the prognostic factors for this rare malignancy.METHODS This observational study reviewed the data of 72 consecutive patients with colorectal HGNENs from three Chinese hospitals between 2000 and 2019.The clinicopathologic characteristics and follow-up data were carefully collected from their medical records,outpatient reexaminations,and telephone interviews.A survival analysis was conducted to evaluate their outcomes and to identify the prognostic factors for this disease.RESULTS According to the latest recommendations for the classification and nomenclature of colorectal HGNENs,61(84.7%)patients in our cohort had poorly differentiated neoplasms,which were categorized as high-grade neuroendocrine carcinomas(HGNECs),and the remaining 11(15.3%)patients had well differentiated neoplasms,which were categorized as high-grade neuroendocrine tumors(HGNETs).Most of the neoplasms(63.9%)were located at the rectum.More than half of the patients(51.4%)presented with distant metastasis at the date of diagnosis.All patients were followed for a median duration of 15.5 mo.In the entire cohort,the median survival time was 31 mo,and the 3-year and 5-year survival rates were 44.3%and 36.3%,respectively.Both the univariate and multivariate analyses demonstrated that increasing age,HGNEC type,and distant metastasis were risk factors for poor clinical outcomes.CONCLUSION Colorectal HGNENs are rare and aggressive malignancies with poor clinical outcomes.However,patients with younger age,good morphological differentiation,and without metastatic disease can have a relatively favorable prognosis.

Colonic metastasis after resection of primary squamous cell carcinoma of the lung:A case report and literature review

Lung cancer is a common malignancy in the world; however symptomatic colonic metastasis from primary lung cancer is rare. A 64-year-old man was originally found poorly differentiated squamous cell carcinoma of right lung and received right lower lobectomy and lymph node dissection. Three years later, the patient presented to our emergency room with the symptom of upper abdominal pain and weight loss. Abdominal palpation and computed tomography scan of the abdomen revealed a large mass measuring 7.6 cm × 8.5 cm in the ascending colon. Colonoscopy and biopsy revealed poorly differentiated squamous cell carcinoma with similar morphological pattern to that of the previous lung cancer. Chemotherapy was given and the patient died 5 mo later. Lung cancer metastatic to the colon confers a poor prognosis: overall survival ranged from 5 wk to 1 year, with a median survival of 3 mo after the diagnosis of the colonic metastasis.

Comparison of hydrocolonic sonograpy accuracy in preoperative staging between colon and rectal cancer

AIM:To compare the accuracy of hydrocolonic sonography (HUS) in determining the depth of invasion (T stage) in colon and rectal cancer. METHODS:A total of 1000-2000 mL of saline was instilled per rectum using a system for barium enemas,and then ultrasonography was conducted by a SSA-270A (Toshiba Co,Japan) sonolayer unit with a 3.75 MHz for 17 patients with colon cancer and 13 patients with rectal cancer before operation.After operation,T stage in HUS was compared with postoperative histological findings. RESULTS:Overall,the accuracy of T stage was 70%.It was 88% in colon cancer and 46% in rectal cancer.In evaluating nodal state,the accuracy of HUS was low in both colon (71%) and rectal cancers (46%) compared with conventional CT or MRI.The overall accuracy of N staging was 60%. CONCLUSION:HUS is valuable to evaluate the depth of invasion in colon cancer,but is less valuable in rectal cancer.Because HUS is low-cost,noninvasive,and readily available at any place,this technique seems to be useful to determine the preoperative staging in colon cancer,but not in rectal cancer.

Primary early-stage intestinal and colonic non-Hodgkin's lymphoma: Clinical features, management, and outcome of 37 patients

AIM： To analyze the clinical features, management, and outcome of treatment of patients with primary intestinal and colonic non-Hodgkin＇s lymphoma （PICL）. METHODS： A retrospective study was performed in 37 patients with early-stage PICL who were treated in our hospital from 1958 to 1998. Their clinical features, management, and outcome were assessed. Prognostic factors for survival were analyzed by univariate analysis using the Kaplan-Meier product-limit method and log-rank test. RESULTS： Twenty-five patients presented with Ann Arbor stage Ⅰ PICL and 12 with Ann Arbor stage Ⅱ PICL. Thirty-five patients underwent surgery （including 31 with complete resection）, 22 received postoperative chemotherapy or radiotherapy or both. Two patients with rectal tumors underwent biopsy and chemotherapy with or without radiotherapy. The 5- and 10-year overall survival （OS） rates were 51.9% and 44.5%. The corresponding diseasefree survival （DIS） rates were 42.4% and 37.7%. In univariate analysis, multiple-modality treatment was associated with a better DFS rate compared to single treatment （P= 0.001）. While age, tumor size, tumor site, stage, histology, or extent of surgery were not associated with OS and DFS, use of adjuvant chemotherapy significantly improved DFS （P = 0.031） for the 31 patients who underwent complete resection. Additional radiotherapy combined with chemotherapy led to a longer survival than chemotherapy alone in six patients with gross residual disease after surgery or biopsy.CONCLUSION： Combined surgery and chemotherapy is recommended for treatment of patients with PICL, Additional radiotherapy is needed to improve the outcome of patients who have gross residual disease after surgery.

Effect of Octreotide on cell-cycle kinetics and serum CEA level in hepatic metastases of colonic adenocarcinoma

AIM To study the inhibitory effect of somatostatin analogue (Octreotide) in tumor growth. METHODS The influence of cell cycle kinetics on hepatic metastases of BALB/c mice colonic adenocarcinoma (CT26) with Octreotide treatment in vivo was investigated by flow cytometry. The serum CEA levels were also determined. RESULTS The results showed that the proliferative index (PI) and the S phase fraction in hepatic tumors of mice treated with Octreotide decreased markedly and the G 0/G 1 phase fraction increased significantly in comparison with the control ( P <0 01). After administration of Octreotide, the serum CEA level were also lower than that of control group. The incidence of liver metastases in the treated group were lower than that of control. The mice body weight loss was slow and the survival was long in the treated group. Furthermore, the changes of PI and the fraction distribution of S phase or G 0/G 1 phase in cell cycle were closely related to the serum CEA levels. CONCLUSION Octreotide may be useful for inhibiting the hepatic metastases of colonic carcinoma.

Ischemic colitis masquerading as colonic tumor:Case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulcerated or submucosal mass or as a narrowed segment of colon with ulcerated mucosa on colonoscopy. Awareness and early recognition of such varied presentations of a common condition is necessary to differentiate from a colonic carcinoma, and to avoid unnecessary surgery and related complications.

Definitive palliation for neoplastic colonic obstruction using enteral stents:Personal case-series with literature review

Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment.Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases.This“manoeuvre” leads the patient to a percentage of moRality/morbidity and to a bad quality of life due to acceptance of stoma.The introduction of enteral metal stent inserted endoscopically has,in our opinion,provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method.We reported our case-series and we analyzed the current literature and costs of treatments.

Integrin αvβ6 sustains and promotes tumor invasive growth in colon cancer progression

AIM: To detect the mechanism by which colon tumor escapes the growth constraints imposed on normal cells by cell crowding and dense pericellular matrices.METHODS: An immunohistochemical study of integrin αvβ6 and matrix metalloproteinase-9(MMP-9) was performed on tissue microarrays of 200 spots, including 100 cases of colon tumors. RESULTS: High immunoreactivity for αvβ6(73.7%; 28/38) and MMP-9(76.5%; 52/68) was observed in invasive tumor portions. Furthermore, the effects of integrin αvβ6 on tumor invasive growth in nude mice were detected. Tumor invasive growth and high expression of both αvβ6 and MMP-9 were only seen in tumors resulting from Wi Dr cells expressing αvβ6 in the tumorigenicity assay. Flow cytometry was applied to analyze αvβ6 expression in colon cancer Wi Dr and SW480 cells. The effects of cell density on αvβ6 expression and MMP-9 secretion were also detected by Biotrak MMP-9 activity assay and gelatin zymography assay. High cell density evidently enhanced αvβ6 expression and promoted MMP-9 secretion compared with low density. CONCLUSION: Integrin αvβ6 sustains and promotes tumor invasive growth in tumor progression via a selfperpetuating mechanism. Integrin ανβ6-mediated MMP-9 secretion facilitates pericellular matrix degradation at high cell density, which provides the basis of invasive growth.

Association between colonic polyps and diverticular disease

AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7). CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.

Perivascular epithelioid cell neoplasm of the colon

A 17-year-old female presented with rectal bleeding from an ulcerated sigmoid mass in 1994.Initial pathological evaluation revealed a rare clear cell neoplasm of the colon,possibly originating from kidneys,adrenals,lung or a gynecologic source as a metastatic lesion.Extensive imaging studies were negative,and over the next 15 years,she remained well with no recurrence.The original resected neoplasm was reviewed and reclassified as a perivascular epithelioid cell neoplasm (PEComa).Although the long-term natural history of PEComas requires definition,increased clinical and pathological awareness should lead to increased recognition of an apparently rare type of colonic neoplasm that likely occurs more often than is currently appreciated.

Effects of endostatin on expression of vascular endothelial growth factor and its receptors and neovascularization in colonic carcinoma implanted in nude mice

AIM:To investigate the antiangiogenic effects of endostatin on colonic carcinoma cell line implanted in nude mice and its mechanism. METHODS:Nude mice underwent subcutaneous injection with LS-174t colonic carcinoma cell line to generate carcinoma and were randomly separated into two groups.Mice received injection of vehicle or endostatin every day for two weeks. After the tumor was harvested,the tumor volumes were determined,and the expressions of CD34,VEGF and FIk-1 were examined by immunohistochemical method. RESULTS:Tumor volume was significantly inhibited in the endostatin group(84.17%)and tumor weight was significantly inhibited in the endostatin group(0.197±0.049) compared to the control group(1.198±0.105)(F=22.56, P=0.001),microvessel density(MVD)was significantly decreased in the treated group(31.857±3.515)compared to the control group(100.143±4.290)(F=151.62,P<0.001). Furthermore,the expression of FIk-1 was significantly inhibited in the treated group(34.29%) ompared to the control group(8.57%)(X^2=13.745,P=0.001).However no significant decrease was observed in the expression of vascular endothelial growth factor(VEGF)between these two groups(X^2=0.119,P=0.730). CONCLUSION:Endostatin can inhibit tumor growth and angiogenesis by blocking Vegf/FIk-1 pathway.This experiment provides the theory basis for developing a new anti-carcinoma drug through studying the properties of anti-angiogenesis inhibitors.

Surgical treatment and prognosis of cancers of hepatic flexure of colon invading the duodenum in 65 patients

Objective： The aim of the study was to discuss surgical treatment of right colon carcinoma of hepatic flexure invading the duodenum. Methods： The 65 patients with right colon carcinoma of hepatic flexure invading the duodenum, treated in our department from 1987 to 2007, were included in this study. Their clinicopathological data were retrospectively reviewed and analyzed. All the cases were divided into three types （local invasion, regional invasion, and cancer with internal fistula） according to duodenal defect, including local invasion （ 2.0 cm）, wide invasion （ 2.0 cm） and the presence of internal fistula. Results： The 25 patients with local invasion underwent en bloc resection of the duodenal wall. Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0–3.0 cm in 5 patients. Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients. Conservative resection of right-sided colon was performed in 18 patients with wide invasion. Four patients underwent pancreaticoduodenectomy combined with right hemicolectomy for colon cancer involving the pancreatic head. Ten cases underwent duodenal diverticularization. One patient with anastomotic leakage healed within 3 weeks. Other patients were cured without postoperative complications. The total 3-and 5-year survival rates after surgery were 53.8% and 9.2%, respectively. Conclusion： The surgical procedure to be performed is usually decided according to the cancer location, extent, and duodenal defect and invasion, which are important for prolonging life time, improving of quality of life and prognosis in these patients.

Patients with multiple synchronous colonic cancer hepatic metastases benefit from enrolment in a “liver first” approach protocol

AIM: To assess a protocol for treating patients with multiple synchronous colonic cancer liver metastases, which are unresectable in one stage. METHODS: Patients enrolled in the "liver first" protocol presented with colon-only(not rectal) cancer and multiple synchronous hepatic metastases(type Ⅱ or Ⅲ). All patients showed good performance status(ECOG PS 0-1) and were treated with curative intent. Complete oncologic staging including positron emission tomography-computed tomography was performed in order to rule out extrahepatic disease. If bowel obstruction was imminent, an intraluminal colonic stent was placed endoscopically. Subsequently, all patients received standardised neo-adjuvant chemotherapy, that is, FOLFOX or XELOX regimens combined with an antiangiogenic agent(bevacizumab or cetuximab). Provided that a response to chemotherapy was observed, patients underwent either one or two hepatectomies with or without portal vein embolization followed by the indicated colectomy. Further chemotherapy was administered after each procedure. Re-staging was performed after each chemotherapeutic treatment. Disease progression at any stage resulted in discontinuation of the protocol and conversion to palliative disease management.RESULTS: Prospectively recorded data from 11 consecutive patients(8 men) were analysed for this study. Their mean age at the time of their first assessment was 65.7(SD ± 15.3) years. Six(54.6%) patients presented with type Ⅲ metastatic disease. The minimum and maximum follow-up periods were 7.3 and 39.6 mo, respectively. The mean overall survival of all patients was 16.5(95%CI: 10.0-23.2) mo. A colonic stent had to be placed in 5(45.5%) patients due to the onset of an intraluminal obstruction. Four(36.4%) patients succeeded in completing all planned surgical operations. Their mean overall survival was 27.2(95%CI: 15.1-39.3) mo and the mean disease-free survival was 7.7(95%CI: 3.0-12.5) mo. Patients, who were obliged to shift to palliative treatment due to dis-ease progression, had a mean overall survival of 10.5(95%CI: 8.6-12.4) mo. None of these patients underwent palliative colectomy. No postoperative mortality was recorded.CONCLUSION: The implementation of a structured "liver first" approach protocol for the treatment of patients with extensive, liver-limited colon cancer metastatic disease may be beneficial.