AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence. METHODS: Two cases are presented: a 65-year-old female receiving t...AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence. METHODS: Two cases are presented: a 65-year-old female receiving two colonic resections for primary anastomotic recurrences within 21 mo, and a 57-year-old female undergoing two local excisions of recurrent anastomotic adenomas within 26 mo. A loss of heterozygosity (LOH) study of 25 microsatellite markers and a mutational analysis of genes BRAF , K-RAS and APC were performed in samples of neoplastic and normal colonic mucosa collected over the years. RESULTS: A diffuse genetic instability was present in all samples, including neoplastic and normal colonic mucosa. Two different patterns of genetic alterations (LOH at 5q21 and 18p11.23 in the first case, and LOH at 1p34 and 3p14 in the second) were found to be associated with carcinogenesis over the years. A role for the genes MYC-L (mapping at 1p34) and FIHT (mapping at 3p14.2) is suggested, whereas a role for APC (mapping at 5q21) is not shown. CONCLUSION: The study challenges the most credited intraluminal implantation and metachronous carcinogenesis theories, and suggests a persistent, patient-specific alteration as the trigger of colorectal cancer anastomotic recurrence.展开更多
Repeated anastomotic recurrence(AR)of colonic cancer is uncommon.We report a case of a double-isolated AR after sigmoidectomy.In 2003,a 60-year-old woman underwent stapled sigmoid resection for a moderately differenti...Repeated anastomotic recurrence(AR)of colonic cancer is uncommon.We report a case of a double-isolated AR after sigmoidectomy.In 2003,a 60-year-old woman underwent stapled sigmoid resection for a moderately differentiated adenocarcinoma.Further rectal bleeding occurred after six months,and colonoscopy detected an AR.Thus,an additional stapled colorectal anastomosis was performed.Ten months later,a colonoscopy detected a circumferential AR that prompted the completion of a second colorectal resection,with a doublestapled colorectal anastomosis.Twenty-four hours after surgery,a massive pulmonary embolism occurred,and the patient died within a few hours.At present,onlysix cases of repeated isolated AR have been described.Repeated segmental colorectal resections are generally associated with a favourable prognosis,with a median survival rate of 45 mo(range,13-132 mo).Repeated isolated ARs are rare,and segmental colorectal resections are generally associated with long-term diseasefree survival.展开更多
文摘AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence. METHODS: Two cases are presented: a 65-year-old female receiving two colonic resections for primary anastomotic recurrences within 21 mo, and a 57-year-old female undergoing two local excisions of recurrent anastomotic adenomas within 26 mo. A loss of heterozygosity (LOH) study of 25 microsatellite markers and a mutational analysis of genes BRAF , K-RAS and APC were performed in samples of neoplastic and normal colonic mucosa collected over the years. RESULTS: A diffuse genetic instability was present in all samples, including neoplastic and normal colonic mucosa. Two different patterns of genetic alterations (LOH at 5q21 and 18p11.23 in the first case, and LOH at 1p34 and 3p14 in the second) were found to be associated with carcinogenesis over the years. A role for the genes MYC-L (mapping at 1p34) and FIHT (mapping at 3p14.2) is suggested, whereas a role for APC (mapping at 5q21) is not shown. CONCLUSION: The study challenges the most credited intraluminal implantation and metachronous carcinogenesis theories, and suggests a persistent, patient-specific alteration as the trigger of colorectal cancer anastomotic recurrence.
文摘Repeated anastomotic recurrence(AR)of colonic cancer is uncommon.We report a case of a double-isolated AR after sigmoidectomy.In 2003,a 60-year-old woman underwent stapled sigmoid resection for a moderately differentiated adenocarcinoma.Further rectal bleeding occurred after six months,and colonoscopy detected an AR.Thus,an additional stapled colorectal anastomosis was performed.Ten months later,a colonoscopy detected a circumferential AR that prompted the completion of a second colorectal resection,with a doublestapled colorectal anastomosis.Twenty-four hours after surgery,a massive pulmonary embolism occurred,and the patient died within a few hours.At present,onlysix cases of repeated isolated AR have been described.Repeated segmental colorectal resections are generally associated with a favourable prognosis,with a median survival rate of 45 mo(range,13-132 mo).Repeated isolated ARs are rare,and segmental colorectal resections are generally associated with long-term diseasefree survival.
