The origin of myofibroblasts or myofibroblastic cells in the desmoplastic stroma associated with carcinoma invasion has been controversial. In the early invasive area of a rectal adenocarcinoma reported here, an obvio...The origin of myofibroblasts or myofibroblastic cells in the desmoplastic stroma associated with carcinoma invasion has been controversial. In the early invasive area of a rectal adenocarcinoma reported here, an obvious transition between the muscularis mucosa and the bundles of eosinophilic stromal cells observed in the carcinomatous stroma was demonstrated both in morphology and in their cytoskeletal phenotype, which conceivably suggests that the smooth muscle cells of the muscularis mucosa could convert to the eosinophilic stromal cells, namely myofibroblasts. Moreover, type I procollagen was demonstrated in both protein and mRNA levels in the areas of eosinophilic stromal cells with a lesser degree of differentiated smooth muscle phenotype that showed a transition from the muscularis mucosa, implying that the myofibroblastic cells converted from smooth muscle cells of the muscularis mucosa could be responsible for type I collagen production. These findings suggest that the muscularis mucosae may not be a passive barrier through which colorectal carcinomas infiltrate into the submucosa, but may play an active role in the formation and remodeling of tumor stroma.展开更多
BACKGROUND Nomograms for prognosis prediction in colorectal cancer patients are few,and prognostic indicators differ with age.AIM To construct a new nomogram survival prediction tool for middle-aged and elderly patien...BACKGROUND Nomograms for prognosis prediction in colorectal cancer patients are few,and prognostic indicators differ with age.AIM To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma.METHODS A total of 2773 eligible patients were divided into the training cohort(70%)and the validation cohort(30%).Optimal cutoff values were calculated using the X-tile software for continuous variables.Univariate and multivariate Cox proportional hazards regression analyses were used to determine overall survival(OS)and cancer-specific survival(CSS)-related prognostic factors.Two nomograms were successfully constructed.The discriminant and predictive ability and clinical usefulness of the model were also assessed by multiple methods of analysis.RESULTS The 95%CI in the training group was 0.719(0.690-0.749)and 0.733(0.702-0.74),while that in the validation group was 0.739(0.696-0.782)and 0.750(0.701-0.800)for the OS and CSS nomogram prediction models,respectively.In the validation group,the AUC of the three-year survival rate was 0.762 and 0.770,while the AUC of the five-year survival rate was 0.722 and 0.744 for the OS and CSS nomograms,respectively.The nomogram distinguishes all-cause mortality from cancer-specific mortality in patients with different risk grades.The time-dependent AUC and decision curve analysis showed that the nomogram had good clinical predictive ability and decision efficacy and was significantly better than the tumor-node-metastases staging system.CONCLUSION The survival prediction model constructed in this study is helpful in evaluating the prognosis of patients and can aid physicians in clinical diagnosis and treatment.展开更多
An intussusception due to colonic adenocarcinoma has sometimes been reported. However, to the best of our knowledge, reports of intussusception due to rectal adenocarcinoma are extremely rare. In this report, the case...An intussusception due to colonic adenocarcinoma has sometimes been reported. However, to the best of our knowledge, reports of intussusception due to rectal adenocarcinoma are extremely rare. In this report, the case of a young man with rectal adenocarcinoma causing intussusception is described. A 24-year-old man visited a hospital complaining of abdominal pain, and an upper rectal cancer was diagnosed by colonoscopy. Computed tomography showed intussusception caused by a large tumor in the pelvis and absence of distant metastases. Locally advanced rectal cancer causing intussusception was diagnosed, and a low anterior resection was performed. Intraoperatively, repair of the invagination could not be accomplished easily; therefore, the repair was abandoned. Instead, the tumor was removed en bloc to avoid dissemination of the cancer. Histopathologically, the tumor was diagnosed as a poorly differentiated adenocarcinoma, pStage IIA. The patient has no evidence of recurrence at 10 mo after the operation.展开更多
BACKGROUND Mantle cell lymphoma(MCL)of the gastrointestinal tract is a rare malignancy,accounting for about 0.2%of malignant colorectal tumors.MCL synchronous with rectal adenocarcinoma is extremely rare.We know of on...BACKGROUND Mantle cell lymphoma(MCL)of the gastrointestinal tract is a rare malignancy,accounting for about 0.2%of malignant colorectal tumors.MCL synchronous with rectal adenocarcinoma is extremely rare.We know of only a few cases reported in the literature.We describe the case of a patient with synchronous rectal adenocarcinoma and intestinal MCL.CASE SUMMARY A 63-year-old man was admitted to our hospital due to abdominal pain and hematochezia over the past month.The patient was diagnosed with middle rectal cancer cT2N0M0 and underwent surgery.However,we found a large tumor in the small intestine during surgery.The patient underwent total mesorectal excision for rectal cancer and resectioning of the ileal segment containing the large mass.Pathology and immunohistochemistry revealed the presence of both rectal adenocarcinoma and pathognomonic MCL stage IIE presenting as multiple lymphomatous polyposis.The patient subsequently underwent RDHAP/RCHOP chemotherapy and was maintained with rituximab.A Positron Emission Tomography and Computed Tomography(PET/CT)scan showed that the disease responded well to treatment without tumor-increased metabolism in the gastrointestinal tract.CONCLUSION Synchronous rectal adenocarcinoma and intestinal MCL presenting as multiple lymphomatous polyposis are extremely rare.MCL is often discovered fortuitously when rectal cancer is diagnosed.The coexistence of these tumors poses treatment challenges.展开更多
Objective This study aimed to construct a prognostic model for rectal adenocarcinomas based on immune-related long noncoding RNAs(lncRNAs)and verify its prediction efficiency.Methods Transcript data and clinical data ...Objective This study aimed to construct a prognostic model for rectal adenocarcinomas based on immune-related long noncoding RNAs(lncRNAs)and verify its prediction efficiency.Methods Transcript data and clinical data of rectal adenocarcinomas were downloaded from The Cancer Genome Atlas(TCGA)database.Perl software(strawberry version)and R language(version 3.6.1)were used to analyze the immune-related genes and immune-related lncRNAs of rectal adenocarcinomas,and the differentially expressed immune-related lncRNAs were screened according to the criteria|log2FC|>1 and P<0.05.The key immune-related lncRNAs were screened using single-factor Cox regression analysis and lasso regression analysis.Multivariate Cox regression analysis was performed to construct an immune-related lncRNA prognostic model using the risk scores.Next,we evaluated the effectiveness of the model through Kaplan-Meier(K-M)survival analysis,ROC curve analysis,and independent prognostic analysis of clinical features.In addition,prognostic biomarkers of immune-related lncRNAs in the model were analyzed by K-M survival analysis.Results In this study,we obtained gene expression profile matrices of 89 rectal adenocarcinomas and 2 paracancerous specimens from TCGA database and applied immunologic signatures to these transcripts.Through R and Perl software analysis,we obtained 847 immune-related lncRNAs and 331 protein-encoded immune-related genes in rectal adenocarcinomas.Eight important immune-related lncRNAs related to the prognosis of rectal adenocarcinomas were identified using univariate Cox regression and lasso regression analysis.Furthermore,four immune-related lncRNAs were identified as prognostic markers of rectal adenocarcinomas via multivariate Cox regression analysis.The prognostic risk model was as follows:risk score=(-4.084)*expression LINC01871+(3.112)*expression AL158152.2+(7.616)*expression PXN-AS1+(-0.867)*expression HCP5.The independent prognostic effect of the rectal adenocarcinoma risk score model was revealed through K-M analysis,ROC curve analysis,and univariate,and multivariate Cox regression analysis(P=0.035).LINC01871(P=0.006),PXN-AS1(P=0.008),and AL158152.2(P=0.0386)were closely correlated with the prognosis of rectal adenocarcinomas through the K-M survival analysis.Conclusion We constructed a prognostic model of rectal adenocarcinomas based on four immune-related lncRNAs by analyzing the data based on TCGA database,with high prediction accuracy.We also identified two biomarkers with poor prognosis(PXN-AS1 and AL158152.2)and one biomarker with good prognosis(LINC01871).展开更多
Activity of succinic dehydrogenase(SDH)and acid phosphatase(AcPase)of effector-target cells during the process of LAK cells killing HR8348 cells was estimated by enzyme cyto-chemistry technique.SHD positive granules a...Activity of succinic dehydrogenase(SDH)and acid phosphatase(AcPase)of effector-target cells during the process of LAK cells killing HR8348 cells was estimated by enzyme cyto-chemistry technique.SHD positive granules and AePase gray level were assayed with MIAS-300image analyser.The results showed:(1)After cocultivation of effector and target cells for vari-ous times,the activity of AcPase of HR8348 cells was apparently higher than that of the controlgroup,and it increased following prolonged coincubation.SDH activity of target cells increasedmarkedly within 30 and 60 rain cocultivation,but became low after 90 min treatment.(2)Ac-Pase content within LAK cells at 60,90,120,180 and 240 rain cocultivation was significantlyhigher than that of control group(P【0.01).The phenomenon of high AcPase and SDH activitywithin effector-target cells indicates that the function of the two types of cells was in an activestate.At the early stage of effector-target combining,the increase of SDH with HR8348 cellsmay be related to defensive function of the target cells.Higher AcPase activity of target cells in-dicates the activation of lysosomal enzyme which serves as the material basis for autolysis of thecells.展开更多
The human rectal adenocarcinoma cell line(HR8348)was treated withlympholdne activated killer(LAK)cells in vitro and the changes of the microtubulin inboth the effector and target cells were investigated with the aid o...The human rectal adenocarcinoma cell line(HR8348)was treated withlympholdne activated killer(LAK)cells in vitro and the changes of the microtubulin inboth the effector and target cells were investigated with the aid of immunofluorescencemicroscopy.It was revealed that after the attachment of LAK cells to the tumor cells,theeffector-target conjugates formed and distribution of the microtubulin in both the effectorand target cells changed.In the LAK cells,the microtubulin concentrated mainly in thecontact region,forming a crescent-like structure,while in the target cells,themicrotubulin condensed into patches and fused with the crescent-like structure of the LAKcells,Eventually,the target cells degenerated and died.It was suggested that the lysis ofthe target cells may be related to the redistribution of the microtubulin in both theeffector and target cells.展开更多
BACKGROUND Rectal mucinous adenocarcinoma(MAC)is a rare pathological type of rectal can-cer with unique pathological features and a poor prognosis.It is difficult to diag-nose and treat early because of the lack of sp...BACKGROUND Rectal mucinous adenocarcinoma(MAC)is a rare pathological type of rectal can-cer with unique pathological features and a poor prognosis.It is difficult to diag-nose and treat early because of the lack of specific manifestations in some aspects of the disease.The common metastatic organs of rectal cancer are the liver and lung;however,rectal carcinoma with metastasis to subcutaneous soft tissue is a rare finding.CASE SUMMARY In this report,the clinical data,diagnosis and treatment process,and postope-rative pathological features of a patient with left waist subcutaneous soft tissue masses were retrospectively analyzed.The patient underwent surgical treatment after admission and recovered well after surgery.The final pathological diagnosis was rectal MAC with left waist subcutaneous soft tissue metastasis.CONCLUSION Subcutaneous soft tissue metastasis of rectal MAC is rare,and it can suggest that the tumor is disseminated,and it can appear even earlier than the primary ma-lignant tumor,which is occult and leads to a missed diagnosis and misdiagnosis clinically.When a subcutaneous soft tissue mass of unknown origin appears in a patient with rectal cancer,a ma-lignant tumor should be considered.展开更多
Using the modified HABM (Human amniotic basement membrane) model,an invasive subline(HR-8348-Ⅰ)was selected frorn the human rectal adenocarcinoma cell line (HR-8348).The invasiveness,motility and other biological cha...Using the modified HABM (Human amniotic basement membrane) model,an invasive subline(HR-8348-Ⅰ)was selected frorn the human rectal adenocarcinoma cell line (HR-8348).The invasiveness,motility and other biological characteristics of the selected cells and the parent cells were assayed comparatively. Although no significant differences(P>0. 05) were found in the mitotic index,growth curve,doubling time and plate efficiency,the invasiveness,migrating ability and attachment of the subline cells increased significantly(P<0.01).The subline was nearly triploid,with wider chromosome distribution,and was characterized by possessing more surface projections (filiform pseudopods),thicker ruthenium red-positive coat,than the parent cells , which were hypertriploid.The results suggest that HR-8348-Ⅰis a highly invasive variant isolated from the subpopulation of HR-8348,and could be useful in defining the biochemical and genetic events mediating invasion.展开更多
Substructural changes during interaction between lymphokine activated killer (LAK) cells and HR8348 cells were observed under transmission electron microscope (TEM). The results showed that: (1)after binding,the membr...Substructural changes during interaction between lymphokine activated killer (LAK) cells and HR8348 cells were observed under transmission electron microscope (TEM). The results showed that: (1)after binding,the membranes of both LAK and HR8348 cells were thickened and condensed to various degrees,and their boundaries became unclear. Adherent plagues or junction-like strutures were formed,which were the morphological basis of effector-target stable binding; (2) some LAK cells inserted their protrusions into the depth of the target cells,and a few LAK cells penetrated into the taraet cells,which means LAK cells have the same'tumor-penetrating'function as natural killer (NK) and cytotoxic 1 lymphocytes (CTL) cells; (3) upon contact,the cytoplasmic organelles and granules of both cells were oriented toward the contact region,numerous microfilaments,microtubules,as well as lysosomes were aggregated at the site of contact,which plays some role in the lysis of the target cells; (4)upon binding,blebbing and ring punctures were apparent in the effector cells,whereas the target cells showed apoptotic or lytic necrosis. Apoptotic necrosis might be the result that non-perforin substances secreted by thet LAK cells triggered the action of endogeneous nucleotidase of the target cells by way of the receptors on the membrane, leading to the cleavage of DNA. The role of perforin,the entrance of calacium and magnesium ions,the edema of cells and the autolysis by lysosomes might be responsible for the lytic necrosis.展开更多
Morphological changes of lymphokine activated killer (LAK) cells and human rectal adenocarcinoma (HR8348) cells were observed under scanning electron microscope (SEM) during the interaction of the two kinds of the cel...Morphological changes of lymphokine activated killer (LAK) cells and human rectal adenocarcinoma (HR8348) cells were observed under scanning electron microscope (SEM) during the interaction of the two kinds of the cells in vitro. It was showed that the effector and target cells could actively and chemotactically move toward each other. LAK and HR8348 cells contacted with each other through cellular projections and microvilli. The LAK cells simply attached to the HR8348 cells at the early stagr, followed by jigsaw-like binding with them. After conjunction, the target cells' membrane appeared to blister and became perforated. The conjunction of microvilli and projection may act as a physical microbridge in the lysis of the target cells, and killing factors may mediate the lysis by the microbridge. 'Closed chamber' was formed between the conjunctive microvilli, which may play an important role in maintaining local concentration of the killing substances.展开更多
Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TE...Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.展开更多
Background: Fluorouracil-based preoperative chemoradiotherapy has become the standard treatment for stage Ⅱ/Ⅲ rectal cancer. In order to improve the overall survival (OS) and disease-flee survival (DFS), we add...Background: Fluorouracil-based preoperative chemoradiotherapy has become the standard treatment for stage Ⅱ/Ⅲ rectal cancer. In order to improve the overall survival (OS) and disease-flee survival (DFS), we added oxaliplatin to the standard treatment, and compared the effectiveness of these two treatment patterns. Methods: A total of 206 patients enrolled in the prospective study had histologically confirmed rectal cancer of clinical stage Ⅱ/Ⅲ during July 2007 to July 2010. They were randomized into the experimental group received oxaliplatin and capecitabine in combination with radiotherapy, and the control group received capecitabine in combination with radiotherapy. All patients received surgery in 6-10 weeks after chemoradiotherapy and adjuvant chemotherapy with mFOLFOX6. The primary endpoints were DFS and OS, and the secondary endpoints included toxicity, compliance, and histopathological response. Results: The 3-year OS in the experimental group and the control group was 90.29% vs. 86.41% (P〉0.05), and the 3-year DFS was 80.58% vs. 69.90% (P〉0.05). The pathological complete remission (pCR) rates were 23.30% and 19.42%, respectively (P=0.497). The 3-year local recurrence rates were 4.85% vs. 5.83% (P=0.694), and the 3-year distant metastasis rates were 16.50% and 28.16%, respectively (P=0.045). There were no significant differences in most grade 3-4 toxicities between two groups, however, grade 3-4 diarrhea occurred in 16.50% (17/103) of the experimental group, compared with 6.80% (7/103) of the control group (P=0.030). Also, the total grade 3-4 acute toxicity showed a significant difference (10.68% vs. 21.36%, P=0.037). Conclusions: The experimental treatment did not lead significantly improved OS and DFS, and thus longer follow-up is warranted for our patient cohort. Adding oxaliplatin to capecitabine-based preoperative chemoradiotherapy can significantly reduce metastasis, but has only minimal impact on local recurrence. Although grade 3-4 toxicity rate increased (primarily gastrointestinal toxicity), patients can stand to be followed up with allopathic treatment.展开更多
AIM: To study the feasibility and oncological outcomesfollowing laparoscopic total mesorectal excision(LTME) in patients who have received Neo-adjuvant long course chemo-radiotherapy(LCRT). METHODS: A protocol driven ...AIM: To study the feasibility and oncological outcomesfollowing laparoscopic total mesorectal excision(LTME) in patients who have received Neo-adjuvant long course chemo-radiotherapy(LCRT). METHODS: A protocol driven systematic review of published literature was undertaken to assess the feasibility and oncological outcomes following LTME in patients receiving LCRT. The feasibility was assessed using peri-operative outcomes and short term results. The oncological outcomes were assessed using local recurrence, disease free survival and overall survival.RESULTS: Only 8 studies-1 randomized controlled trial, 4 Case Matched/Controlled Studies and 3 Case Series were identified matching the search criteria. The conversion rate was low(1.2% to 28.1%), anastomotic leak rates were similar to open total mesorectal excision(0%-4.1% vs 0%-8.3%). Only 3 studies reported on local recurrence rates(5.2%-7.6%) at median 34 mo follow-up. A single study described disease free survival and overall survival at 3 years as 78.8% and 92.1% respectively. CONCLUSION: LTME following LCRT is feasible in experienced hands, with acceptable short term surgical outcomes and with the usual benefits associated with minimally invasive procedures. The long term oncological outcomes of LTME after LCRT appear to be comparable to open procedures but need further investigation.展开更多
Constipation is a common presenting complaint in children. Rectal duplication cysts are rare congenital malformations that need to be considered in patients with chronic constipation that has not responded to typical ...Constipation is a common presenting complaint in children. Rectal duplication cysts are rare congenital malformations that need to be considered in patients with chronic constipation that has not responded to typical therapy and in pa-tients presenting with rectal bleeding. It is important to maintain a high index of suspicion when diagnosing this condi-tion as other congenital malformations may be present and rectal duplication cysts have the potential for malignant transformation if they go unrecognized. This case report describes a 12 year old female with chronic constipation and rectal bleeding who was found to have a rectal duplication cyst. It discusses the pathophysiology of the disease and highlights the options available for treatment.展开更多
Colorectal cancer is a major cause of morbidity and mortality throughout the world. There is no study about colorectal cancer in our country. The aim of the study was to assess epidemiological, clinical, therapeutic a...Colorectal cancer is a major cause of morbidity and mortality throughout the world. There is no study about colorectal cancer in our country. The aim of the study was to assess epidemiological, clinical, therapeutic and histological aspects of colorectal cancer over a 10-year period (1999-2008) in Kamenge university hospital, Bujumbura, Burundi, by a descriptive retrospective study. A total of 37 cases of colorectal cancer, 22 males (59.5%) and 15 females (40.5%), mean age 50.8 years, were retrieved over the period of the study. The colorectal cancer was revealed by a rectal bleeding in 21 patients (56.8%) and an occlusive syndrome in 5 patients (13.5%). All patients underwent surgery. According to Dukes’ stages: 27% were A, 27% B, 19% C and 27% stage D. Histopathologically, 18 cases (46.7%) were differentiated adenocarcinoma, 14 cases (37.8%) undifferentiated adenocarcinoma, 2 cases of lymphoma and 2 cases of leiomyosarcoma. All patients underwent surgery. The hospitalization stay was a mean of 27 days. The prognosis was poor with a mortality rate of 13.5% in the hospital. In conclusion, colorectal cancer deserves awareness as a public health problem in our country.展开更多
目的探讨表观扩散系数(apparent diffusion coefficient,ADC)术前无创评估直肠腺瘤瘤体是否癌变的可行性。方法回顾性分析71例已经过手术病理证实的直肠病变患者(直肠腺瘤患者21例、直肠腺瘤并癌变患者14例及直肠腺癌患者36例)的MRI平扫...目的探讨表观扩散系数(apparent diffusion coefficient,ADC)术前无创评估直肠腺瘤瘤体是否癌变的可行性。方法回顾性分析71例已经过手术病理证实的直肠病变患者(直肠腺瘤患者21例、直肠腺瘤并癌变患者14例及直肠腺癌患者36例)的MRI平扫及DWI检查,ADC值由b值为0 s/mm^(2)和1000s/mm^(2)的DWI检查计算所得,测量肿瘤的平均ADC值及最小ADC值,根据直肠腺瘤、直肠腺瘤癌变及直肠腺癌进行分组,采用独立样本t检验分别比较分析。结果直肠腺瘤及腺瘤癌变分组的最小ADC值(1.126±0.134比1.015±0.107,P=0.015)、直肠腺瘤及腺癌分组的平均A D C值(1.277±0.099比1.026±0.096,P=0.000)及最小A D C值(1.126±0.134比0.995±0.087,P=0.000)、直肠腺瘤癌变及腺癌分组的平均ADC值(1.207±0.116比1.026±0.096,P=0.000)及最小ADC值(1.015±0.107比0.995±0.087,P=0.047)具有统计学学意义,仅直肠腺瘤及腺瘤癌变分组的平均ADC值(1.277±0.099比1.207±0.116,P=0.064)无统计学意义,最小ADC值在评估直肠腺瘤瘤体是否癌变中的作用优于平均ADC值。结论ADC值可在一定程度上对直肠腺瘤是否癌变做出较好预测。展开更多
文摘The origin of myofibroblasts or myofibroblastic cells in the desmoplastic stroma associated with carcinoma invasion has been controversial. In the early invasive area of a rectal adenocarcinoma reported here, an obvious transition between the muscularis mucosa and the bundles of eosinophilic stromal cells observed in the carcinomatous stroma was demonstrated both in morphology and in their cytoskeletal phenotype, which conceivably suggests that the smooth muscle cells of the muscularis mucosa could convert to the eosinophilic stromal cells, namely myofibroblasts. Moreover, type I procollagen was demonstrated in both protein and mRNA levels in the areas of eosinophilic stromal cells with a lesser degree of differentiated smooth muscle phenotype that showed a transition from the muscularis mucosa, implying that the myofibroblastic cells converted from smooth muscle cells of the muscularis mucosa could be responsible for type I collagen production. These findings suggest that the muscularis mucosae may not be a passive barrier through which colorectal carcinomas infiltrate into the submucosa, but may play an active role in the formation and remodeling of tumor stroma.
基金The National Natural Science Foundation of China,No.81770631.
文摘BACKGROUND Nomograms for prognosis prediction in colorectal cancer patients are few,and prognostic indicators differ with age.AIM To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma.METHODS A total of 2773 eligible patients were divided into the training cohort(70%)and the validation cohort(30%).Optimal cutoff values were calculated using the X-tile software for continuous variables.Univariate and multivariate Cox proportional hazards regression analyses were used to determine overall survival(OS)and cancer-specific survival(CSS)-related prognostic factors.Two nomograms were successfully constructed.The discriminant and predictive ability and clinical usefulness of the model were also assessed by multiple methods of analysis.RESULTS The 95%CI in the training group was 0.719(0.690-0.749)and 0.733(0.702-0.74),while that in the validation group was 0.739(0.696-0.782)and 0.750(0.701-0.800)for the OS and CSS nomogram prediction models,respectively.In the validation group,the AUC of the three-year survival rate was 0.762 and 0.770,while the AUC of the five-year survival rate was 0.722 and 0.744 for the OS and CSS nomograms,respectively.The nomogram distinguishes all-cause mortality from cancer-specific mortality in patients with different risk grades.The time-dependent AUC and decision curve analysis showed that the nomogram had good clinical predictive ability and decision efficacy and was significantly better than the tumor-node-metastases staging system.CONCLUSION The survival prediction model constructed in this study is helpful in evaluating the prognosis of patients and can aid physicians in clinical diagnosis and treatment.
文摘An intussusception due to colonic adenocarcinoma has sometimes been reported. However, to the best of our knowledge, reports of intussusception due to rectal adenocarcinoma are extremely rare. In this report, the case of a young man with rectal adenocarcinoma causing intussusception is described. A 24-year-old man visited a hospital complaining of abdominal pain, and an upper rectal cancer was diagnosed by colonoscopy. Computed tomography showed intussusception caused by a large tumor in the pelvis and absence of distant metastases. Locally advanced rectal cancer causing intussusception was diagnosed, and a low anterior resection was performed. Intraoperatively, repair of the invagination could not be accomplished easily; therefore, the repair was abandoned. Instead, the tumor was removed en bloc to avoid dissemination of the cancer. Histopathologically, the tumor was diagnosed as a poorly differentiated adenocarcinoma, pStage IIA. The patient has no evidence of recurrence at 10 mo after the operation.
文摘BACKGROUND Mantle cell lymphoma(MCL)of the gastrointestinal tract is a rare malignancy,accounting for about 0.2%of malignant colorectal tumors.MCL synchronous with rectal adenocarcinoma is extremely rare.We know of only a few cases reported in the literature.We describe the case of a patient with synchronous rectal adenocarcinoma and intestinal MCL.CASE SUMMARY A 63-year-old man was admitted to our hospital due to abdominal pain and hematochezia over the past month.The patient was diagnosed with middle rectal cancer cT2N0M0 and underwent surgery.However,we found a large tumor in the small intestine during surgery.The patient underwent total mesorectal excision for rectal cancer and resectioning of the ileal segment containing the large mass.Pathology and immunohistochemistry revealed the presence of both rectal adenocarcinoma and pathognomonic MCL stage IIE presenting as multiple lymphomatous polyposis.The patient subsequently underwent RDHAP/RCHOP chemotherapy and was maintained with rituximab.A Positron Emission Tomography and Computed Tomography(PET/CT)scan showed that the disease responded well to treatment without tumor-increased metabolism in the gastrointestinal tract.CONCLUSION Synchronous rectal adenocarcinoma and intestinal MCL presenting as multiple lymphomatous polyposis are extremely rare.MCL is often discovered fortuitously when rectal cancer is diagnosed.The coexistence of these tumors poses treatment challenges.
基金Supported by a grant from the Health Commission of Hubei Province Scientific Research Project(No.WJ2019M118)。
文摘Objective This study aimed to construct a prognostic model for rectal adenocarcinomas based on immune-related long noncoding RNAs(lncRNAs)and verify its prediction efficiency.Methods Transcript data and clinical data of rectal adenocarcinomas were downloaded from The Cancer Genome Atlas(TCGA)database.Perl software(strawberry version)and R language(version 3.6.1)were used to analyze the immune-related genes and immune-related lncRNAs of rectal adenocarcinomas,and the differentially expressed immune-related lncRNAs were screened according to the criteria|log2FC|>1 and P<0.05.The key immune-related lncRNAs were screened using single-factor Cox regression analysis and lasso regression analysis.Multivariate Cox regression analysis was performed to construct an immune-related lncRNA prognostic model using the risk scores.Next,we evaluated the effectiveness of the model through Kaplan-Meier(K-M)survival analysis,ROC curve analysis,and independent prognostic analysis of clinical features.In addition,prognostic biomarkers of immune-related lncRNAs in the model were analyzed by K-M survival analysis.Results In this study,we obtained gene expression profile matrices of 89 rectal adenocarcinomas and 2 paracancerous specimens from TCGA database and applied immunologic signatures to these transcripts.Through R and Perl software analysis,we obtained 847 immune-related lncRNAs and 331 protein-encoded immune-related genes in rectal adenocarcinomas.Eight important immune-related lncRNAs related to the prognosis of rectal adenocarcinomas were identified using univariate Cox regression and lasso regression analysis.Furthermore,four immune-related lncRNAs were identified as prognostic markers of rectal adenocarcinomas via multivariate Cox regression analysis.The prognostic risk model was as follows:risk score=(-4.084)*expression LINC01871+(3.112)*expression AL158152.2+(7.616)*expression PXN-AS1+(-0.867)*expression HCP5.The independent prognostic effect of the rectal adenocarcinoma risk score model was revealed through K-M analysis,ROC curve analysis,and univariate,and multivariate Cox regression analysis(P=0.035).LINC01871(P=0.006),PXN-AS1(P=0.008),and AL158152.2(P=0.0386)were closely correlated with the prognosis of rectal adenocarcinomas through the K-M survival analysis.Conclusion We constructed a prognostic model of rectal adenocarcinomas based on four immune-related lncRNAs by analyzing the data based on TCGA database,with high prediction accuracy.We also identified two biomarkers with poor prognosis(PXN-AS1 and AL158152.2)and one biomarker with good prognosis(LINC01871).
文摘Activity of succinic dehydrogenase(SDH)and acid phosphatase(AcPase)of effector-target cells during the process of LAK cells killing HR8348 cells was estimated by enzyme cyto-chemistry technique.SHD positive granules and AePase gray level were assayed with MIAS-300image analyser.The results showed:(1)After cocultivation of effector and target cells for vari-ous times,the activity of AcPase of HR8348 cells was apparently higher than that of the controlgroup,and it increased following prolonged coincubation.SDH activity of target cells increasedmarkedly within 30 and 60 rain cocultivation,but became low after 90 min treatment.(2)Ac-Pase content within LAK cells at 60,90,120,180 and 240 rain cocultivation was significantlyhigher than that of control group(P【0.01).The phenomenon of high AcPase and SDH activitywithin effector-target cells indicates that the function of the two types of cells was in an activestate.At the early stage of effector-target combining,the increase of SDH with HR8348 cellsmay be related to defensive function of the target cells.Higher AcPase activity of target cells in-dicates the activation of lysosomal enzyme which serves as the material basis for autolysis of thecells.
文摘The human rectal adenocarcinoma cell line(HR8348)was treated withlympholdne activated killer(LAK)cells in vitro and the changes of the microtubulin inboth the effector and target cells were investigated with the aid of immunofluorescencemicroscopy.It was revealed that after the attachment of LAK cells to the tumor cells,theeffector-target conjugates formed and distribution of the microtubulin in both the effectorand target cells changed.In the LAK cells,the microtubulin concentrated mainly in thecontact region,forming a crescent-like structure,while in the target cells,themicrotubulin condensed into patches and fused with the crescent-like structure of the LAKcells,Eventually,the target cells degenerated and died.It was suggested that the lysis ofthe target cells may be related to the redistribution of the microtubulin in both theeffector and target cells.
文摘BACKGROUND Rectal mucinous adenocarcinoma(MAC)is a rare pathological type of rectal can-cer with unique pathological features and a poor prognosis.It is difficult to diag-nose and treat early because of the lack of specific manifestations in some aspects of the disease.The common metastatic organs of rectal cancer are the liver and lung;however,rectal carcinoma with metastasis to subcutaneous soft tissue is a rare finding.CASE SUMMARY In this report,the clinical data,diagnosis and treatment process,and postope-rative pathological features of a patient with left waist subcutaneous soft tissue masses were retrospectively analyzed.The patient underwent surgical treatment after admission and recovered well after surgery.The final pathological diagnosis was rectal MAC with left waist subcutaneous soft tissue metastasis.CONCLUSION Subcutaneous soft tissue metastasis of rectal MAC is rare,and it can suggest that the tumor is disseminated,and it can appear even earlier than the primary ma-lignant tumor,which is occult and leads to a missed diagnosis and misdiagnosis clinically.When a subcutaneous soft tissue mass of unknown origin appears in a patient with rectal cancer,a ma-lignant tumor should be considered.
文摘Using the modified HABM (Human amniotic basement membrane) model,an invasive subline(HR-8348-Ⅰ)was selected frorn the human rectal adenocarcinoma cell line (HR-8348).The invasiveness,motility and other biological characteristics of the selected cells and the parent cells were assayed comparatively. Although no significant differences(P>0. 05) were found in the mitotic index,growth curve,doubling time and plate efficiency,the invasiveness,migrating ability and attachment of the subline cells increased significantly(P<0.01).The subline was nearly triploid,with wider chromosome distribution,and was characterized by possessing more surface projections (filiform pseudopods),thicker ruthenium red-positive coat,than the parent cells , which were hypertriploid.The results suggest that HR-8348-Ⅰis a highly invasive variant isolated from the subpopulation of HR-8348,and could be useful in defining the biochemical and genetic events mediating invasion.
文摘Substructural changes during interaction between lymphokine activated killer (LAK) cells and HR8348 cells were observed under transmission electron microscope (TEM). The results showed that: (1)after binding,the membranes of both LAK and HR8348 cells were thickened and condensed to various degrees,and their boundaries became unclear. Adherent plagues or junction-like strutures were formed,which were the morphological basis of effector-target stable binding; (2) some LAK cells inserted their protrusions into the depth of the target cells,and a few LAK cells penetrated into the taraet cells,which means LAK cells have the same'tumor-penetrating'function as natural killer (NK) and cytotoxic 1 lymphocytes (CTL) cells; (3) upon contact,the cytoplasmic organelles and granules of both cells were oriented toward the contact region,numerous microfilaments,microtubules,as well as lysosomes were aggregated at the site of contact,which plays some role in the lysis of the target cells; (4)upon binding,blebbing and ring punctures were apparent in the effector cells,whereas the target cells showed apoptotic or lytic necrosis. Apoptotic necrosis might be the result that non-perforin substances secreted by thet LAK cells triggered the action of endogeneous nucleotidase of the target cells by way of the receptors on the membrane, leading to the cleavage of DNA. The role of perforin,the entrance of calacium and magnesium ions,the edema of cells and the autolysis by lysosomes might be responsible for the lytic necrosis.
文摘Morphological changes of lymphokine activated killer (LAK) cells and human rectal adenocarcinoma (HR8348) cells were observed under scanning electron microscope (SEM) during the interaction of the two kinds of the cells in vitro. It was showed that the effector and target cells could actively and chemotactically move toward each other. LAK and HR8348 cells contacted with each other through cellular projections and microvilli. The LAK cells simply attached to the HR8348 cells at the early stagr, followed by jigsaw-like binding with them. After conjunction, the target cells' membrane appeared to blister and became perforated. The conjunction of microvilli and projection may act as a physical microbridge in the lysis of the target cells, and killing factors may mediate the lysis by the microbridge. 'Closed chamber' was formed between the conjunctive microvilli, which may play an important role in maintaining local concentration of the killing substances.
文摘Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.
文摘Background: Fluorouracil-based preoperative chemoradiotherapy has become the standard treatment for stage Ⅱ/Ⅲ rectal cancer. In order to improve the overall survival (OS) and disease-flee survival (DFS), we added oxaliplatin to the standard treatment, and compared the effectiveness of these two treatment patterns. Methods: A total of 206 patients enrolled in the prospective study had histologically confirmed rectal cancer of clinical stage Ⅱ/Ⅲ during July 2007 to July 2010. They were randomized into the experimental group received oxaliplatin and capecitabine in combination with radiotherapy, and the control group received capecitabine in combination with radiotherapy. All patients received surgery in 6-10 weeks after chemoradiotherapy and adjuvant chemotherapy with mFOLFOX6. The primary endpoints were DFS and OS, and the secondary endpoints included toxicity, compliance, and histopathological response. Results: The 3-year OS in the experimental group and the control group was 90.29% vs. 86.41% (P〉0.05), and the 3-year DFS was 80.58% vs. 69.90% (P〉0.05). The pathological complete remission (pCR) rates were 23.30% and 19.42%, respectively (P=0.497). The 3-year local recurrence rates were 4.85% vs. 5.83% (P=0.694), and the 3-year distant metastasis rates were 16.50% and 28.16%, respectively (P=0.045). There were no significant differences in most grade 3-4 toxicities between two groups, however, grade 3-4 diarrhea occurred in 16.50% (17/103) of the experimental group, compared with 6.80% (7/103) of the control group (P=0.030). Also, the total grade 3-4 acute toxicity showed a significant difference (10.68% vs. 21.36%, P=0.037). Conclusions: The experimental treatment did not lead significantly improved OS and DFS, and thus longer follow-up is warranted for our patient cohort. Adding oxaliplatin to capecitabine-based preoperative chemoradiotherapy can significantly reduce metastasis, but has only minimal impact on local recurrence. Although grade 3-4 toxicity rate increased (primarily gastrointestinal toxicity), patients can stand to be followed up with allopathic treatment.
文摘AIM: To study the feasibility and oncological outcomesfollowing laparoscopic total mesorectal excision(LTME) in patients who have received Neo-adjuvant long course chemo-radiotherapy(LCRT). METHODS: A protocol driven systematic review of published literature was undertaken to assess the feasibility and oncological outcomes following LTME in patients receiving LCRT. The feasibility was assessed using peri-operative outcomes and short term results. The oncological outcomes were assessed using local recurrence, disease free survival and overall survival.RESULTS: Only 8 studies-1 randomized controlled trial, 4 Case Matched/Controlled Studies and 3 Case Series were identified matching the search criteria. The conversion rate was low(1.2% to 28.1%), anastomotic leak rates were similar to open total mesorectal excision(0%-4.1% vs 0%-8.3%). Only 3 studies reported on local recurrence rates(5.2%-7.6%) at median 34 mo follow-up. A single study described disease free survival and overall survival at 3 years as 78.8% and 92.1% respectively. CONCLUSION: LTME following LCRT is feasible in experienced hands, with acceptable short term surgical outcomes and with the usual benefits associated with minimally invasive procedures. The long term oncological outcomes of LTME after LCRT appear to be comparable to open procedures but need further investigation.
文摘Constipation is a common presenting complaint in children. Rectal duplication cysts are rare congenital malformations that need to be considered in patients with chronic constipation that has not responded to typical therapy and in pa-tients presenting with rectal bleeding. It is important to maintain a high index of suspicion when diagnosing this condi-tion as other congenital malformations may be present and rectal duplication cysts have the potential for malignant transformation if they go unrecognized. This case report describes a 12 year old female with chronic constipation and rectal bleeding who was found to have a rectal duplication cyst. It discusses the pathophysiology of the disease and highlights the options available for treatment.
文摘Colorectal cancer is a major cause of morbidity and mortality throughout the world. There is no study about colorectal cancer in our country. The aim of the study was to assess epidemiological, clinical, therapeutic and histological aspects of colorectal cancer over a 10-year period (1999-2008) in Kamenge university hospital, Bujumbura, Burundi, by a descriptive retrospective study. A total of 37 cases of colorectal cancer, 22 males (59.5%) and 15 females (40.5%), mean age 50.8 years, were retrieved over the period of the study. The colorectal cancer was revealed by a rectal bleeding in 21 patients (56.8%) and an occlusive syndrome in 5 patients (13.5%). All patients underwent surgery. According to Dukes’ stages: 27% were A, 27% B, 19% C and 27% stage D. Histopathologically, 18 cases (46.7%) were differentiated adenocarcinoma, 14 cases (37.8%) undifferentiated adenocarcinoma, 2 cases of lymphoma and 2 cases of leiomyosarcoma. All patients underwent surgery. The hospitalization stay was a mean of 27 days. The prognosis was poor with a mortality rate of 13.5% in the hospital. In conclusion, colorectal cancer deserves awareness as a public health problem in our country.
文摘目的探讨表观扩散系数(apparent diffusion coefficient,ADC)术前无创评估直肠腺瘤瘤体是否癌变的可行性。方法回顾性分析71例已经过手术病理证实的直肠病变患者(直肠腺瘤患者21例、直肠腺瘤并癌变患者14例及直肠腺癌患者36例)的MRI平扫及DWI检查,ADC值由b值为0 s/mm^(2)和1000s/mm^(2)的DWI检查计算所得,测量肿瘤的平均ADC值及最小ADC值,根据直肠腺瘤、直肠腺瘤癌变及直肠腺癌进行分组,采用独立样本t检验分别比较分析。结果直肠腺瘤及腺瘤癌变分组的最小ADC值(1.126±0.134比1.015±0.107,P=0.015)、直肠腺瘤及腺癌分组的平均A D C值(1.277±0.099比1.026±0.096,P=0.000)及最小A D C值(1.126±0.134比0.995±0.087,P=0.000)、直肠腺瘤癌变及腺癌分组的平均ADC值(1.207±0.116比1.026±0.096,P=0.000)及最小ADC值(1.015±0.107比0.995±0.087,P=0.047)具有统计学学意义,仅直肠腺瘤及腺瘤癌变分组的平均ADC值(1.277±0.099比1.207±0.116,P=0.064)无统计学意义,最小ADC值在评估直肠腺瘤瘤体是否癌变中的作用优于平均ADC值。结论ADC值可在一定程度上对直肠腺瘤是否癌变做出较好预测。