Mixed epithelial endocrine neoplasms of the colon and rectum–An evolution over time:A systematic review

BACKGROUND Mixed tumors of the colon and rectum,composed of a combination of epithelial and endocrine elements of benign and malignant potential are rare neoplasms.These can occur anywhere in the gastrointestinal tract and are often diagnosed incidentally.Though they have been a well-documented entity in the pancreas,where the exocrine-endocrine mixed tumors have been known for a while,recognition and accurate diagnosis of these tumors in the colon and rectum,to date,remains a challenge.This is further compounded by the different terminologies that have been attributed to these lesions over the years adding to increased confusion and misclassification.Therefore,dedicated literature reviews of these lesions in the colon and rectum are inconsistent and are predominantly limited to case reports and case series of limited case numbers.Though,most of these tumors are high grade and of advanced stage,intermediate and low grade lesions of these mixed tumors are also increasingly been reported.There are no established independent consensus based guidelines for the therapeutic patient management of these unique lesions.AIM To provide a comprehensive targeted literature review of these complex mixed tumors in the colon and rectum that chronicles the evolution over time with summarization of historical perspectives of terminology and to further our understanding regarding their pathogenesis including genomic landscape,clinicoradiological features,pathology,treatment,prognosis,the current status of the management of the primary lesions,their recurrences and metastases.METHODS A comprehensive review of the published English literature was conducted using the search engines PubMed,MEDLINE and GOOGLE scholar.The following search terms[“mixed tumors colon”OR mixed endocrine/neuroendocrine tumor/neoplasm/lesion colon OR adenocarcinoma and endocrine/neuroendocrine tumor colon OR mixed adenocarcinoma and endocrine/neuroendocrine carcinoma colon OR Amphicrine tumors OR Collision tumors]were used.Eligibility criteria were defined and all potential relevant items,including full articles and/or abstracts were independently reviewed,assessed and agreed upon items were selected for in-depth analysis.RESULTS In total 237 full articles/abstracts documents were considered for eligibility of which 45 articles were illegible resulting in a total of 192 articles that were assessed for eligibility of which 139 have been selected for reference in this current review.This seminal manuscript is a one stop article that provides a detailed outlook on the evolution over time with summarization of historical perspectives,nomenclature,clinicoradiological features,pathology,treatment,prognosis and the current status of the management of both the primary lesions,their recurrences and metastases.Gaps in knowledge have also been identified and discussed.An important outcome of this manuscript is the justified proposal for a new,simple,clinically relevant,non-ambiguous terminology for these lesions to be referred to as mixed epithelial endocrine neoplasms(MEENs).CONCLUSION MEEN of the colon and rectum are poorly understood rare entities that encompass an extensive range of heterogeneous tumors with a wide variety of combinations leading to tumors of high,intermediate or low grade malignant potential.This proposed new revised terminology of MEEN will solve the biggest hurdle of confusion and misclassification that plagues these rare unique colorectal neoplasms thus facilitating the future design of multi institutional prospective randomized controlled clinical trials to develop and evaluate newer therapeutic strategies that are recommended for continued improved understanding and personal optimization of clinical management of these unique colorectal neoplasms.

Critical considerations for the management of gastrointestinal mixed neuroendocrine non-neuroendocrine neoplasms and pure neuroendocrine carcinomas

Mixed neuroendocrine non-neuroendocrine neoplasms constitute rare tumors that are located mainly in the gastrointestinal(GI)tract and have high degrees of malignancy,and the frequency of these tumors has been increasing.They consist of a neuroendocrine neoplastic component with another component of adenocarcinoma usually and have a dismal prognosis.The rare GI pure neuroendocrine carcinoma is highly aggressive and requires complex and extensive management since a genetic distinction exists between it and GI non-neuroendocrine neoplasms,which are generally slow-growing lesions.The most common GI-mixed neuroendocrine non-neuroendocrine neoplasms are colorectal,followed by gastric,mainly in the gastroesophageal junction.Current imaging modalities of nuclear medicine and radiology play important roles in the accuracy of diagnosis.Liquid biopsy may contribute to early detection and timely diagnosis.Ultrasonography,either endoscopic or abdominal,is a technique that contributes to a diagnosis;additionally,contrast-enhanced ultrasonography is very helpful in followup appointments.Histopathology establishes a definite diagnosis and stage by evaluating the cell differentiation grade and the cell proliferation index Ki67.The genetic profile can be valuable in diagnosis and gene therapy.Surgical resection with wide lymphadenectomy,whenever possible,and adjuvant chemotherapy constitute the main therapeutic management strategies.Targeted therapy and immunotherapy achieve encouraging results.

Colonoscopy plays an important role in detecting colorectal neoplasms in patients with gastric neoplasms

BACKGROUND Gastric cancer(GC)and colorectal cancer(CRC)are the fifth and third most common cancer worldwide,respectively.Nowadays,GC is reported to have a potential predictive value for CRC,especially for advanced CRC.AIM To evaluate the necessity of colonoscopy for gastric neoplasm(GN)patients.METHODS Four databases,including PubMed,EMBASE,the Cochrane Library,and Ovid,were used to perform the search strategy on May 2,2023.The prevalence of colorectal neoplasms(CRN)and baseline characteristics were compared between the neoplasm group and the control group.Continuous variables are expressed as the mean difference and standard deviation.Relationships of categorical variables in the two groups are expressed as odds ratios(OR)and 95%confidence intervals(95%CIs).Subgroup analysis according to different kinds of GNs was conducted for more in-depth analysis.The results of this study are represented by forest plots.Publication bias was evaluated by a funnel plot.All data analyses were performed by STATA SE 16.0 software.RESULTS A total of 3018 patients with GNs and 3905 healthy controls(age and sex matched)were enrolled for analysis.After comparing the prevalence of CRNs between the two groups,CRNs were detected significantly more frequently in GN patients than in controls(OR=1.69,95%CI=1.28 to 2.23,I^(2)=85.12%,P=0.00),especially in patients with GC(OR=1.80,95%CI=1.49 to 2.18,I^(2)=25.55%,P<0.1).Moreover,other risk factors including age(OR=1.08,95%CI=1.00 to 1.17,I^(2)=90.13%,P=0.00)and male sex(OR=2.31,95%CI=1.26 to 4.22,I^(2)=87.35%,P=0.00),were related to the prevalence of CRNs.For patients in the GN group,body mass index(BMI,OR=0.88,95%CI=0.80 to 0.98,I^(2)=0.00%,P=0.92)and smoking(OR=1.03,95%CI=1.01 to 1.05,I^(2)=0.00%,P=0.57)were protective and risk factors for CRNs,respectively.CONCLUSION Patients are recommended to undergo colonoscopy when diagnosed with GNs,especially GC patients with a low BMI and a history of smoking.

Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience

Background: Biliary mucinous cystic neoplasms(BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Afflliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female(75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients(44.9%) had no symptoms. Serum carbohydrate antigen(CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34(70.8%) had low-grade intraepithelial neoplasms(LGINs), and 14(29.2%) had high-grade intraepithelial neoplasms(HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin(CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival(OS) of BMCNs was not reached. The longest survival time was 137 months.The 5-and 10-year OS rates were 100% and 85.4%, respectively. The 5-and 10-year recurrence-free survival(RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.

Helicobacter pylori-related chronic gastritis as a risk factor for colonic neoplasms

To summarize the current views and insights on associations between Helicobacter pylori(H. pylori)-related chronic gastritis and colorectal neoplasm, we reviewed recent studies to clarify whether H. pylori infection/H. pylori-related chronic gastritis is associated with an elevated risk of colorectal neoplasm. Recent studies based on large databases with careful control for confounding variables have clearly demonstrated an increased risk of colorectal neoplasm associated with H. pylori infection. The correlation between H. pylori-related chronic atrophic gastritis(CAG) and colorectal neoplasm has only been examined in a limited number of studies. A recent large study using a national histopathological database, and our study based on the stage of H. pylori-related chronic gastritis as determined by serum levels of H. pylori antibody titer and pepsinogen, indicatedthat H. pylori-related CAG confers an increased risk of colorectal neoplasm, and more extensive atrophic gastritis will probably be associated with even higher risk of neoplasm. In addition, our study suggested that the activity of H. pylori-related chronic gastritis is correlated with colorectal neoplasm risk. H. pylori-related chronic gastritis could be involved in an increased risk of colorectal neoplasm that appears to be enhanced by the progression of gastric atrophy and the presence of active inflammation.

Capsule endoscopy compared with conventional colonoscopy for detection of colorectal neoplasms

Colon capsule endoscopy(CCE) may be a means to overcome the low adherence to colorectal cancer screening. The device is an ingestible capsule with a video camera at both ends that can take photographs as it progresses through the gastrointestinal tract.PillCam colon(PCC1) may be used for structural evaluation of the large bowel following an adequate cleaning procedure.PCC1 measures 11 mm×31 mm and has dual cameras that enable the device to acquire video images from both ends with a wide coverage area,automatic light control and a frame rate of four frames per second.The system includes a sensor array and data recorder connected to the patient during the procedure.The recorded data are downloaded to the Given Imaging Rapid workstation for review of the colon video.The second generation of PillCam Colon(PCC2) is similar to PCC1 and incorporates new developments.The angle of view has been increased to 172 degrees.It has an adaptive frame rate,alternating from 35 frames per second while in motion to 4 images when virtually stationary.The new RAPIDsoftware now includes a simple graphic interface tool for polyp size estimation.The procedure of bowel cleansing until capsule ingestion is similar to that used for traditional colonoscopy.However it is more rigorous as the bowel cleanliness for capsule colonoscopy has to be excellent or at least good to result in an adequate sensi-tivity of the method.Briefly,it consists of 3.5-4 L of split dose polyethylene glycol.Oral NaP boosters are administered after 1-2 h if the capsule has entered the small bowel.Sodium phosphate(NaP) seems to be a necessary adjunct to the regimen because the total transit time is doubled without NaP.The cleansing level was considered to be good to excellent in 72%-88%in studies with PCC1.The sensitivity for significant polyps(>6 mm or more than 3 polyps>3 mm) ranged from 63%-88% with specificities between 64%-94%.PCC2 showed an improved sensitivity of 89%and a specificity of 76%. CCE seems to be a safe and effective method of visualizing the colonic mucosa through colon fluids without the need for sedation or insufflation of air.The sensitivity of CCE to detect polyps,advanced adenomas and cancer is lower compared to optical colonoscopy but improvements will be made in the near future.With an increased recording duration,even a panenteric examination of the whole gastrointestinal tract may be possible.

Association between white opaque substance under magnifying colonoscopy and lipid droplets in colorectal epithelial neoplasms

AIM To examine the association between white opaque substance(WOS) and histologically verified lipiddroplets in colorectal epithelial neoplasms.METHODS We reviewed colonoscopy records at our institution from 2014 to 2016 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms observed by magnifying narrow-band imaging(M-NBI) colonoscopy. Immunohistochemistry was used to stain tumors with a monoclonal antibody specific to adipophilin as a marker of lipids. The expression and distribution of adipophilin were compared between WOS-positive and WOS-negative lesions and among tumors classified by histologic type and depth of invasion.RESULTS Under M-NBI colonoscopy, 81 lesions were positive for WOS and 48 lesions were negative for WOS. The rate of adipophilin expression was significantly higher in WOS-positive lesions(95.1%) than in WOS-negative lesions(68.7%)(P = 0.0001). The incidence of deep adipophilin expression was higher in WOS-positive lesions(24.7%) than in WOS-negative lesions(4.2%)(P = 0.001). The incidence of deep expression was predominant among cancers with massive submucosal invasion(62.5%) compared to adenoma(7.2%) and high-grade dysplasia or cancers with slight submucosal invasion(12.7%)(P = 0.0001).CONCLUSION The distribution of lipid droplets may be closely associated with the visibility of WOS under M-NBI colonoscopy, and with histologic grade and depth of tumor invasion.

Pan-immune-inflammation value as a prognostic biomarker for colon cancer and its variation by primary tumor location

BACKGROUND A growing body of research indicates significant differences between left-sided colon cancers(LCC)and right-sided colon cancers(RCC).Pan-immune-inflammation value(PIV)is a systemic immune response marker that can predict the prognosis of patients with colon cancer.However,the specific distinction between PIV of LCC and RCC remains unclear.AIM To investigate the prognostic and clinical significance of PIV in LCC and RCC patients.METHODS This multicenter retrospective cohort study included 1510 patients with colon cancer,comprising 801 with LCC and 709 with RCC.We used generalized lifting regression analysis to evaluate the relative impact of PIV on disease-free survival(DFS)in these patients.Kaplan-Meier analysis,as well as univariate and multivariate analyses,were used to examine the risk factors for DFS.The correlation between PIV and the clinical characteristics was statistically analyzed in these patients.RESULTS A total of 1510 patients{872 female patients(58%);median age 63 years[interquartile ranges(IQR):54-71];patients with LCC 801(53%);median follow-up 44.17 months(IQR 29.67-62.32)}were identified.PIV was significantly higher in patients with RCC[median(IQR):214.34(121.78-386.72)vs 175.87(111.92-286.84),P<0.001].After propensity score matching,no difference in PIV was observed between patients with LCC and RCC[median(IQR):182.42(111.88-297.65)vs 189.45(109.44-316.02);P=0.987].PIV thresholds for DFS were 227.84 in LCC and 145.99 in RCC.High PIV(>227.84)was associated with worse DFS in LCC[PIV-high:Adjusted hazard ratio(aHR)=2.39;95%confidence interval:1.70-3.38;P<0.001]but not in RCC(PIV-high:aHR=0.72;95%confidence interval:0.48-1.08;P=0.114).CONCLUSION These findings suggest that PIV may predict recurrence in patients with LCC but not RCC,underscoring the importance of tumor location when using PIV as a colon cancer biomarker.

Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

Pancreatobiliary intraductal papillary neoplasms(IPNs)represent precursors of pancreatic cancer or bile duct cholangiocarcinoma that can be detected and treated.Despite advances in diagnostic methods,identifying these premalignant lesions is still challenging for treatment providers.Modern imaging,biomarkers and molecular tests for genomic alterations can be used for diagnosis and follow-up.Surgical intervention in combination with new chemotherapeutic agents is considered the optimal treatment for malignant cases.The balance between the risk of malignancy and any risk of resection guides management policy;therefore,treatment should be individualized based on a meticulous preoperative assessment of high-risk stigmata.IPN of the bile duct is more aggressive;thus,early diagnosis and surgery are crucial.The conservative management of low-risk pancreatic branch-duct lesions is safe and effective.

Clinical outcome and prognostic factors of T4N0M0 colon cancer after R0 resection:A retrospective study

BACKGROUND Paradoxically,patients with T4N0M0(stage II,no lymph node metastasis)colon cancer have a worse prognosis than those with T2N1-2M0(stage III).However,no previous report has addressed this issue.AIM To screen prognostic risk factors for T4N0M0 colon cancer and construct a prognostic nomogram model for these patients.METHODS Two hundred patients with T4N0M0 colon cancer were treated at Tianjin Medical University General Hospital between January 2017 and December 2021,of which 112 patients were assigned to the training cohort,and the remaining 88 patients were assigned to the validation cohort.Differences between the training and validation groups were analyzed.The training cohort was subjected to multi-variate analysis to select prognostic risk factors for T4N0M0 colon cancer,followed by the construction of a nomogram model.RESULTS The 3-year overall survival(OS)rates were 86.2%and 74.4%for the training and validation cohorts,respectively.Enterostomy(P=0.000),T stage(P=0.001),right hemicolon(P=0.025),irregular review(P=0.040),and carbohydrate antigen 199(CA199)(P=0.011)were independent risk factors of OS in patients with T4N0M0 colon cancer.A nomogram model with good concordance and accuracy was constructed.CONCLUSION Enterostomy,T stage,right hemicolon,irregular review,and CA199 were independent risk factors for OS in patients with T4N0M0 colon cancer.The nomogram model exhibited good agreement and accuracy.

Mixed neuroendocrine non-neuroendocrine neoplasms in gastroenteropancreatic tract

Mixed neuroendocrine non-neuroendocrine neoplasms(MiNENs)are a hetero-geneous group of malignant neoplasms that can settle in the gastroenteropan-creatic tract.They are composed of a neuroendocrine(NE)and a non-NE compo-nent in at least 30%of each tumour.The non-NE component can include different histological combinations of glandular,squamous,mucinous and sarcomatoid phenotypes,and one or both of the components can be low-or high grade malignant.Recent changes in the nomenclature of these neoplasms might lead to great deal of confusion,and the lack of specific clinical trials is the main reason why their management is difficult.The review aims to clarify the definition of MiNEN and analyze available evidence about their diagnosis and treatment options according to their location and extension through careful analysis of the available data.It would be important to reach a general consensus on their diagnosis in order to construct a classification that remains stable over time and facilitates the design of clinical trials that,due to their low incidence,will require long recruitment periods.

Application value of dexmedetomidine in anesthesia for elderly patients undergoing radical colon cancer surgery

BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.

Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Expression of cyclin-dependent kinase 9 is positively correlated with the autophagy level in colon cancer

BACKGROUND Cyclin-dependent kinase 9(CDK9)expression and autophagy in colorectal cancer(CRC)tissues has not been widely studied.CDK9,a key regulator of transcription,may influence the occurrence and progression of CRC.The expression of auto-phagy-related genes BECN1 and drug resistance factor ABCG2 may also play a role in CRC.Under normal physiological conditions,autophagy can inhibit tumorigenesis,but once a tumor forms,autophagy may promote tumor growth.Therefore,understanding the relationship between autophagy and cancer,partic-ularly how autophagy promotes tumor growth after its formation,is a key motivation for this research.AIM To investigate the relationship between CDK9 expression and autophagy in CRC,assess differences in autophagy between left and right colon cancer,and analyze the associations of autophagy-related genes with clinical features and prognosis.METHODS We collected tumor tissues and paracarcinoma tissues from colon cancer patients with liver metastasis to observe the level of autophagy in tissues with high levels of CDK9 and low levels of CDK9.We also collected primary tissue from left and right colon cancer patients with liver metastasis to compare the autophagy levels and the expression of BECN1 and ABCG2 in the tumor and paracarcinoma tissues.RESULTS The incidence of autophagy and the expression of BECN1 and ABCG2 were different in left and right colon cancer,and autophagy might be involved in the occurrence of chemotherapy resistance.Further analysis of the rela-tionship between the expression of autophagy-related genes CDK9,ABCG2,and BECN1 and the clinical features and prognosis of colorectal cancer showed that the high expression of CDK9 indicated a poor prognosis in colorectal cancer.CONCLUSION This study laid the foundation for further research on the combination of CDK9 inhibitors and autophagy inhibitors in the treatment of patients with CRC.

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.

A Review of Type 1 and Type 2 Intraductal Papillary Neoplasms of the Bile Duct

Intraductal papillary neoplasm of the bile duct(IPNB)is a heterogeneous disease similar to intraductal papillary mucinous neoplasm of the pancreas.These lesions have been recognized as one of the three major precancerous lesions in the biliary tract since 2010.In 2018,Japanese and Korean pathologists reached a consensus,classifying IPNBs into type l and type 2 IPNBs.IPNBs are more prevalent in male patients in East Asia and are closely related to diseases such as cholelithiasis and schistosomiasis.From a molecular genetic perspective,IPNBs exhibit early genetic variations,and different molecular pathways may be involved in the tumorigenesis of type 1 and type 2 IPNBs.The histological subtypes of IPNBs include gastric,intestinal,pancreaticobiliary,or oncocytic subtypes,but type 1 IPNBs typically exhibit more regular and well-organized histological features than type 2 IPNBs and are more commonly found in the intrahepatic bile ducts with abundant mucin.Due to the rarity of these lesions and the absence of specific clinical and laboratory features,imaging is crucial for the preoperative diagnosis of IPNB,with local bile duct dilation and growth along the bile ducts being the main imaging features.Surgical resection remains the optimal treatment for IPNBs,but negative bile duct margins and the removal of lymph nodes in the hepatic hilum significantly improve the postoperative survival rates for patients with IPNBs.

Surgical Management of Perforated Colon Tumours in Yaoundé: A Multicentre Retrospective Review of 30-Day Postoperative Outcome

Introduction: Colon cancer is often diagnosed late in our context and there is a high prevalence of complicated forms, this including perforation. The optimal surgical treatment remains controversial. The aim of this study was to improve the short-term postoperative outcomes of patients operated upon for perforated colon cancer, by identifying factors associated with complications occurring within 30 days after surgery. Patients and methods: We carried out an analytical observational study, with a retrospective collection of data from the files of patients operated upon for an in situ tumoral colon perforation. This was done in four referral hospitals in the city of Yaoundé. The period was from the 1st of January, 2012 to the 31st of December, 2021. Cox regression identified the factors associated with postoperative morbidity and mortality. Results: We collected files of 46 patients. The mean age was 54.7 ± 19.9 years with a sex ratio of 1.4. The clinical presentation on admission was dominated by the presence of signs of peritoneal irritation (91.3%) and bowel obstruction (28.3%). The diagnosis was made preoperatively in 16 cases (34.8%). The surgical procedures consisted of colectomy with anastomosis in 28 cases (60.9%) and without anastomosis in 14 cases (30.4%). Postoperative morbidity was 60.9% dominated by surgical site infection (37%). Postoperative mortality was 39.1%. The existence of generalized peritonitis was associated with the occurrence of postoperative complications (p = 0.019). The main factors associated with postoperative mortality were resection with primary anastomosis (p = 0.027), enterocutaneous fistula (p = 0.005). Conclusion: Colic resection with primary anastomosis or ideal colectomy is associated with an increased risk of mortality and should therefore not be performed in this setting.

Alteration of ascending colon mucosal microbiota in patients after cholecystectomy

BACKGROUND Cholecystectomy is a successful treatment option for gallstones,although the inci-dence of colorectal cancer(CRC)has notably increased in post-cholecystectomy(PC)patients.However,it remains uncertain whether the altered mucosal micro-biota in the ascending colon is related.In total,30 PC patients and 28 healthy controls underwent colonoscopies to collect mucosal biopsy samples.PC patients were divided based on their clinical features.Then,16S-rRNA gene sequencing was used to analyze the amplicon,alpha diversity,beta diversity,and composition of the bacterial communities.Addi-tionally,the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)database,sourced from the Kyoto Encyclopedia of Genes and Genomes,was used to predict the functional capabilities of the bac-teria.RESULTS PC patients were comparable with healthy controls.However,PC patients older than 60 years had a distinct composition compared to those under 60 years old.Bacteroidetes richness was considerably higher at the phylum level in PC patients.Bacteroides,Parabacteroides,and Bilophila were more abundant in the PC group than in the control group.Furthermore,PC patients exhibited greater enrichment in metabolic pathways,specifically those related to lipopolysaccharide biosynthesis and vancomycin group antibiotic production,than controls.CONCLUSION This study indicated that the mucosal microbiota in PC patients was altered,perhaps offering new perspectives on the treatment possibilities for CRC and diarrhea following cholecystectomy.

Evaluation of the GATIS score for predicting prognosis in rectal neuroendocrine neoplasms

The GATIS score,developed by Zeng et al,represents a significant advancement in predicting the prognosis of patients with rectal neuroendocrine neoplasms(RNENs).This study,which included 1408 patients from 17 major medical centres in China over 12 years,introduces a novel prognostic model based on the tumour grade,T stage,tumour size,age,and the prognostic nutritional index.Compared with traditional methods such as the World Health Organization classification and TNM staging systems,the GATIS score has superior predictive power for overall survival and progression-free survival.With a C-index of 0.915 in the training set and 0.812 in the external validation set,the GATIS score’s robustness and reliability are evident.The study’s use of a large,multi-centre cohort and rigorous validation processes underscore its significance.The GATIS score offers clinicians a powerful tool to accurately predict patient outcomes,guide treatment decisions,and improve follow-up strategies.This development represents a crucial step forwards in the management of R-NENs,addressing the complexity and variability of these tumours and setting a new benchmark for future research and clinical practice.

Advances in the Diagnosis and Treatment of Appendiceal Mucinous Neoplasms

Primary appendiceal neoplasms represent a relatively low percentage of all gastrointestinal cancers. A subset of these neoplasms, those of epithelial origin, are characterised by the production of a considerable amount of mucus, which is referred to as appendiceal mucinous neoplasms (AMN). Appendiceal mucinous neoplasms (AMN) have a low incidence, are easily misdiagnosed, depend on postoperative examination for confirmation of the diagnosis, are prone to form a “diagnosis”, and have a high incidence of the disease. Furthermore, they are prone to form peritoneal pseudomyxoma peritonei (PMP), are controversial in surgical decision-making, are prone to recurring after surgery alone, and are tricky to manage clinically. In this paper, we review the pathological characteristics, diagnosis and treatment of appendiceal mucinous tumours in the light of recent literature reports, with a view to providing certain references for the clinical diagnosis and treatment of this disease. .