Diffuse Cutaneous Metastases as the Only Sign of Extranodal Tumor Spread in a Patient with Adenocarcinoma of the Colon

Cutaneous metastases from large bowel cancer are uncommon and are usually associated with organ involvement. Localization of lesions to the skin is mainly attributed to vascular and anatomical relationship, since most of them are seen in the abdominal wall or in a surgical scar. We report a 73-year-old woman in whom metastatic nodules from a poorly differentiated adenocarcinoma of the right colon developed throughout the skin (buttock, trunk, chest wall, arms, and neck) and remained the only sign of extranodal tumor spread until patient's death, seven months later. This unusual behaviour suggests that localization of neoplastic cells to the skin may be a site-specific process, determined by adhesion molecules and/or by growth factors found at that site

Transanal Resection of Rectal Lipoma Mimicking Rectal Prolapse: Description of a Case and Review of the Literature

Submucosal lipomas of the large bowel are uncommon. Occasionally, they occur in the rectum and may cause aspecific symptoms; presentation with rectal prolapse is very unusual and may lead to a misdiagnosis of simple mucosal prolapse. The paper describes an additional case of a prolapsing rectal mass that led to diagnosis and surgical treatment of a rectal lipoma under local anesthesia

Magnetic resonance imaging: Is there a role in clinical management for acute ischemic colitis?

AIM: To validate the utility of magnetic resonance imaging (MRI) for the clinical management of acute ischemic colitis (IC). METHODS: This is a magnetic resonance (MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical, endoscopic and computed tomography (CT) findings and who were imaged in our institution between February 2011 and July 2012. The mean age of the patients was 72.28 years. Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans, in the late arterial phase (start delay 45-50 s) and in the portal venous phase (start delay 70-80 s). The MR examinations were performed using a 1.5T superconducting magnet, using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane. CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings. RESULTS: Segmental involvement was seen in 6 patients (85.71%), with a mean length of involvement of 412 mm (range 145.5-1000 mm). Wall thickness varied between 6 mm and 17.5 mm (mean 10.52 mm) upon CT examinations and from 5 to 15 mm (mean 8.8 mm) upon MR examinations. The MRI appearance of the colonic wall varied over the time: Type I appearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations (41.66%), patients underwent MR within a mean of 36 h (ranging from 1 to 54 h) after the CT examination. Type II and III appearance with a 2 layer sign, was seen in 4 examinations (33.33%), patients underwent MR within a mean of 420.5 h (ranging from 121 to 720 h) after the CT examination. In the remaining three MRI examinations, performed within a mean of 410 h (ranging from 99.5 to 720 h) the colonic wall appeared normal. CONCLUSION: MRI, only using precontrast images, may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC

Update on epidemiology and risk factors of colorectal carcinoma

Etiology of colorectal cancer is not completely clear. Epidemiologic studies, especially those on migrant populations, demonstrate the importance of environmental factors, particularly dietary, in cancerogenesis. Anyway, familial aggregation within a given population shows that genetic factors play an important role. General risk factors are represented by age, sex, physical activity... while some pathologies increased the risk of developing KCR or are frankly precancerous (adenomas, ulcerative colitis, Crohn's disease...)

Heredity and colorectal cancer

Colorectal cancer is the second leading cause of death from malignancies in Western Countries. In spite of advances in treatment, little change in survival has been accomplished in last decades and this mandates greater importance to prevention and early detection. Although dietary factors have received primary attention familial clustering suggests that susceptibility to KCR is inherited. Hereditary colorectal cancer can arise on Familial Adenomatous Polyposis (HCC) or not on polyposis (HNPCC) and members of these families are at high risk of such neoplasias. Anyway, even in "sporadic" forms of KCR first-degree relatives have a 2 to 3-fold increased risk of the same cancer. The most desirable screening protocol would be a simple procedure involving only a blood test to identify gene defect by molecular biology techniques. Unfortunately, this is not practically possible, for lack of specific genetic alterations, out of FAP, and only the study of family history can enable targeted surveillance and cost-effective management strategies

Family anamnesis, cholecystectomy and gastric resection in patients with colorectal carcinoma: a case-control study

An increased risk of colorectal cancer has been reported in first-degree relatives of affected patients, and following cholecystectomy or partial gastrectomy for benign peptic ulcer disease. The aim of this study was to examine the incidence of these potential risk factors in 197 patients (127 males, 70 females, mean age 70 years +/- 10.9, range 22-94 years) with cancer of the large bowel and 202 controls (91 males, 111 females, mean age 68 years +/- 14.06, range 17-93 years) who underwent a total colonoscopy, that revealed no colorectal neoplasms. No significant differences were found between the case and control group for a past history of cholecystectomy or gastric surgery, respectively reported by 14 and 12 patients of group 1 and 18 and 8 patients of group 2. Patients with large bowel cancer show a significant excess of both colorectal (21.31% vs 11.9%) and extracolonic malignancies (46.19% vs 26.73) in first degree relatives (p < 0.05). In approximately 7% of them the aggregation of two or more colorectal cancers among relatives is suggestive for a hereditary form of large bowel cancer

Factors influencing women partecipation in colorectal cancer screening

Colorectal cancer(CRC) is the 2nd most common cancer in women worldwide. In Italy, only 50% of individuals invited touse Fecal occult blood test(FOBT) it attended. Women’s participation for breast and cervical screening is very high. More than 70% completed a mammography but the adhesion to FOBT is lower than the other two screening offered for free and the adhesion to colonoscopy is very low. The aim of the study is investigate the beliefs, feelings and psychological factors that could influence the behavior of women about participation in cancer screening(Colonoscopy and FOBT). Methods The survey was carried out in a center for cancer prevention in Siena, Tuscany, in 2011. A questionnaire, based on literature, was administered to 507 women attending mammography or clinical breast examination and it was administered to all age women but adherence to colorectal cancer screening was analyzed only for women age 50 years and older (207). We performed descriptive and bivariate analysis and we examined the association between participant characteristics, willingness and adherence to screening. Results Family history of colorectal cancer is associated with adherence to screening compliance (FOBT and colonoscopy) (p < 0.0087).The doctor’s advice is significantly associated with adherence to colorectal cancer screening (both) (p < 0.0001). Women who perceived colonoscopy as a painful examination are less likely to be compliant to screening for CRC (colonoscopy) (p < 0.0002).The embarrassment is another factor related to colonoscopy compliance (p < 0.0012). Conclusions Embarrassment, pain and doctor’s advice are the factors that correlated more strongly with adherence (or not) to screening. For the future is useful to implement information campaigns on colorectal cancer and refresher courses for general practitioners. A possible intervention for the future would be to hand before mammography or gynecological examination the kit for the collection of fecal occult blood

Microcystic adenoma of the pancreas (glycogen-rich cystadenoma) with stromal amyloid deposits

We report a case of a pancreatic glycogen-rich microcystic serous adenoma with stromal amyloid deposits, focusing on the significance of isolated amyloid deposits in tumours. The architectural pattern was characterized by thin-walled cysts lined by a single layer of flat or cuboidal epithelial cells intensely stained by the PAS-reaction only before diastase digestion, suggesting the presence of glycogen. Tumour stroma was composed of broad fibrocollagenous tissue with lamellar hyalinized areas which were positively stained by Congo red and showed green birefringence and dichroism with polarized light. For amyloid protein characterization, immunohistochemical studies were performed with anti-beta amyloid protein and anti-amyloid precursor pre-A4695. The former antibody diffusely stained tumour stroma, while the latter stained only scattered stroma cells. This is the first documented case of amyloid deposition in pancreatic serous adenoma. We indicate that the source of amyloid is an APP-like precursor secreted by stromal myofibroblasts