Synchronous rectal adenocarcinoma and intestinal mantle cell lymphoma:A case report

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.

Construction of a clinical survival prognostic model for middle-aged and elderly patients with stage III rectal adenocarcinoma

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.

Construction and validation of an immune-related lncRNA prognostic model for rectal adenocarcinomas

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).

Muscularis mucosae in desmoplastic stroma formation of early invasive rectal adenocarcinoma

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,typeⅠprocollagen 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 typeⅠcollagen 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.

Tumor-stroma ratio as prognostic factor for survival in rectal adenocarcinoma: A retrospective cohort study

AIM To evaluate the prognostic value of the tumor-stroma ratio(TSR) in rectal cancer.METHODS TSR was determined on hematoxylin and eosin stained histological sections of 154 patients treated for rectal adenocarcinoma without prior neoadjuvant treatment in the period 1996-2006 by two observers to assessreproducibility. Patients were categorized into three categories: TSR-high [carcinoma percentage(CP) ≥ 70%], TSR-intermediate(CP 40%, 50% and 60%) and TSR-low(CP ≤ 30%). The relation between categorized TSR and survival was analyzed using Cox proportional hazards model.RESULTS Thirty-six(23.4%) patients were scored as TSR-low, 70(45.4%) as TSR-intermediate and 48(31.2%) as TSRhigh. TSR had a good interobserver agreement(κ = 0.724, concordance 82.5%). Overall survival(OS) and disease free survival(DFS) were significantly better for patients with a high TSR(P = 0.01 and P = 0.02, respectively). A similar association existed for disease specific survival(P = 0.06). In multivariate analysis, patients without lymph node metastasis and an intermediate TSR had a higher risk of dying from rectal cancer(HR = 5.27, 95%CI: 1.54-18.10), compared to lymph node metastasis negative patients with a high TSR. This group also had a worse DFS(HR = 6.41, 95%CI: 1.84-22.28). An identical association was seen for OS. These relations were not seen in lymph node metastasis positive patients. CONCLUSION The TSR has potential as a prognostic factor for survival in surgically treated rectal cancer patients, especially in lymph node negative cases.

Intussusception due to rectal adenocarcinoma in a young adult:A case report

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,pStageⅡA.The patient has no evidence of recurrence at 10 mo after the operation.

Quantitative observation by enzyme cytochemistry of human rectal adenocarcinoma cells killed by LAK cells

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.

An immunofluorescence study on the changes of microtubulin in human rectal adenocarcinoma cells killed by LAK cells in vitro

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.

Waist subcutaneous soft tissue metastasis of rectal mucinous adenocarcinoma: A case report

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.

Characterization of the highly invasive subline of the human rectal adenocarcinoma in vitro

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TEM observation on LAK cells killing the human rectal adenocarcinoma cells in vitro

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SEM observation on LAK cells killing the human rectal adenocarcinoma cells in vitro

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Fluorouracil-based preoperative chemoradiotherapy with or without oxaliplatin for stage Ⅱ/Ⅲ rectal cancer:a 3-year follow-up study

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.

Transanal endoscopic surgery in rectal cancer

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.

Usefulness of two independent hist classifications of tumor regression iUsefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy

AIM: To assess the usefulness of two independent histopathological classifications of rectal cancer regression following neo-adjuvant therapy. METHODS: Forty patients at the initial stage cT3NxM0 submitted to preoperative radiotherapy (42 Gy during 18 d) and then to radical surgical treatment. The relationship between “T-downstaging” versus regressive changes expressed by tumor regression grade (TRG 1-5) and Nasierowska-Guttmejer classification (NG 1-3) was studied as well as the relationship between TRG and NG versus local tumor stage ypT and lymph nodes status, ypN. RESULTS: Complete regression (ypT0, TRG 1) was found in one patient. “T-downstaging” was observed in 11 (27.5%) patients. There was a weak statistical significance of the relationship between “T-downstaging” and TRG staging and NG stage. Patients with ypT1 were diagnosed as TRG 2-3 while those with ypT3 as TRG5. No lymph node metastases were found in patients with TRG 1-2. None of the patients without lymph node metastases were diagnosed as TRG 5. Patients in the ypT1 stage were NG 1-2. No lymph node metastases were found in NG 1. There was a significant correlation between TRG and NG. CONCLUSION: Histopathological classifications may be useful in the monitoring of the effects of hyperfractionated preoperative radiotherapy in patientswith rectal cancer at the stage of cT3NxM0. There is no unequivocal relationship between “T-downstaging” and TRG and NG. There is some concordance in the assessment of lymph node status with ypT, TRG and NG. TRG and NG are of limited value for the risk assessment of the lymph node involvement.

The predictive value of vascular endothelial growth factor and Ki-67 expression on neoadjuvant therapy in rectal cancer

调查脉管的内皮生长因素(VEGF ) 和增殖的房间的表情的目的在有直肠的腺癌的病人和他们有 neoadjuvant 的协会的原子抗原(Ki-67 ) 治疗。方法包括两预告的处理肿瘤活体检视和手术后的标本，在直肠的腺癌的 32 种情况中的 Ki-67 和 VEGF 的表情被免疫组织化学用特定的抗体检测，并且与 clinicopathological 因素被相关。结果染色的 VEGF 的紧张显著地与淋巴被相关节的转移( P = 0.033 )，肿瘤侵略的深度( P = 0.007 )并且肿瘤舞台( P = 0.016 )，然而并非与组织学的类型，肿瘤尺寸，病人的年龄和性( P 】 0.05 )。VEGF 表示的底层与对 neoadjuvant 治疗的反应的高敏感有重要关联(P = 0.016 ) 。VEGF 表示的短暂增加能在 neoadjuvant 治疗以后被看见(P = 0.035 ) 。把索引(Ki-67-LI ) 标记的 Ki-67 显著地与淋巴节点转移被相关(P = 0.028 ) ，然而并非相关到肿瘤尺寸，病人的年龄和性(P 】 0.05 ) 。有更低的 Ki-67-LI 的肿瘤对 neoadjuvant 治疗更敏感(P = 0.032 ) 。Ki-67 水平在 neoadjuvant 治疗以后减少了，但是没有统计意义被发现 P 】 0.05 ) 。我们的结果表明的结论在预告的处理的 VEGF 和 Ki-67 的表示直肠的腺癌活体检视可能对 neoadjuvant 的肿瘤反应是预兆的治疗。

Feasibility and oncological outcomes of laparoscopic rectal resection following neo-adjuvant chemo-radiotherapy: A systematic review

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.

双层探测器光谱CT对直肠腺癌转移淋巴结的诊断价值

目的 探讨双层探测器光谱CT(DLSCT)在评估直肠腺癌淋巴结转移中的价值。方法 前瞻性分析78例术前接受DLSCT平扫及双期增强扫描的直肠腺癌患者资料,根据术后病理结果将108枚淋巴结分为转移组(n=52)及非转移组(n=56)。两名影像医生在不知病理结果的情况下独立测量淋巴结短径(SD),评估其边缘、形状及强化均匀度,测量平扫期有效原子序数(Eff-Z),动脉期(AP)及静脉期(VP)的碘浓度(IC),计算双期增强标准化碘浓度(NIC)值。采用两独立样本Mann-Whitney检验及χ^(2)检验比较两组间形态学指标及光谱CT参数的差异,应用受试者工作特征曲线(ROC)分析各指标的诊断效能。结果 转移组与非转移组间的淋巴结SD、边缘,形状及强化均匀度均差异有统计学意义(P<0.05);转移组的NIC_(AP)及NIC_(VP)均显著高于非转移组(P<0.05),而Eff-Z值在两组间差异无统计学意义(P>0.05)。淋巴结的SD、边缘、形状、强化均匀度,NIC_(AP)及NIC_(VP)在评估转移淋巴结的曲线下面积(AUC)分别为0.810、0.648、0.630、0.637、0.806及0.722;将AUC值相对较高的3个参数(NIC_(AP),NIC_(VP)及SD)联合评估淋巴结转移,AUC值最大,达0.911,敏感度80.77%,特异度85.71%。结论 DLSCT标准化碘浓度值有助于提高直肠腺癌淋巴结转移的诊断准确性,光谱CT多参数联合SD可提高诊断效能。

Rectal Duplication Cyst in a 12 year old Female Presenting with Chronic Constipation and Rectal Bleeding: A Case Report

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.

MRI动态增强和弥散加权成像在直肠腺癌术前壁外血管侵犯中的评估价值

目的探讨动态增强(DCE)和弥散加权磁共振成像(DWI-MRI)在直肠腺癌术前壁外血管侵犯(EMVI)中的评估价值。方法选取经病理确诊直肠腺癌患者52例,其中病理诊断EMVI阳性27例、阴性25例。所有患者术前接受MRI常规序列、DCE和DWI-MRI检查,获得平均定量灌注参数[体积转移常数(K^(trans))、细胞外血管外体积分数(V e)和反流速率常数(K_(ep))]和标准表观扩散系数(ADC)值,根据MRI表现将52例患者分为MRI-EMVI阳性组23例和阴性组29例。结果MRI-EMVI阳性组癌胚抗原(CEA)、肿瘤浸润深度、环周浸润率和Ki67阳性表达率均显著高于阴性组,组织分化程度降低,T分期增加,N阳性率升高,差异有统计学意义(P<0.05)。与病理EMVI诊断结果比较,MRI-EMVI具有较好的一致性(Kappa=0.789,P<0.001)。MRI-EMVI阳性组K^(trans)和K_(ep)值显著高于阴性组,而ADC值显著降低,差异有统计学意义(P<0.05)。Spearman检验显示ADC值与K^(trans)和K_(ep)值呈现明显负相关(r=-0.755和-0.669,P<0.001)。受试者工作特征曲线(ROC)显示,K^(trans)值、K_(ep)值、ADC值以及联合诊断MRI-EMVI阳性的曲线下面积(AUC)分别为0.781、0.732、0.704和0.879。结论DCE和DWI-MRI术前评估直肠腺癌EMVI与病理结果有较好的一致性,能够反映肿瘤的恶性侵袭程度,获得K^(trans)值、K_(ep)值和ADC值定量参数联合诊断EMVI效能较高,有重要的临床应用潜力。