Core curriculum illustration: colonic intussusception due to pedunculated lipoma

This is the 48th installment of a series that will highlight one case per publication issue from the bank of cases available online as a part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at

Cytoreductive approach to peritoneal carcinomatosis

Purpose: To present our clinical experience on the combined (surgicochemotherapeutic) treatment of peritoneal carcinomatosis. Patients and methods: Thirteen patients (six men and 7 women) with a mean age of 53 years (range 23-75) with peritoneal carcinomatosis (11 colorectal carcinoma, 1 ovarian carcinoma, and 1 malignant peritoneal mesothelioma) were treated with a cytoreductive approach (CRA) that consisted of cytoreductive surgery (CRS), early postoperative intraperitoneal chemotherapy (IPCT), and late systemic chemotherapy. CRS aimed at removing all visible disease. Patients with colorectal and ovarian cancer received IPCT with mitomycin-C 10 mg/m2 (postop. day 1). On postop, days 2-5, 5-fluorouracil (5-FU) 15 mg/kg/day was administered. The patient with mesothelioma received IPCT with adriamycin 0.1 mg/kg/day on postop, days 1-5. Late systemic chemotherapy with 5-FU 450 mg/m2/day and leucovorin 20 mg/m2/day for 5 consecutive days every 3 weeks and for a total of 6 cycles, was administered to all patients. Results: No major complications were encountered in 9 (69%) patients. In 10 (77%) patients complete removal of all visible disease was achieved. The mean survival of all patients was 17 months. Four patients are still alive with no evidence of disease for a mean survival time of 27+ months. Conclusion: The results in our small series indicate that the CRA seems to have some noticeable beneficial effects for patients with peritoneal carcinomatosis

Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients

Deterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined. We conducted a prospective study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients

Transanal Single-port Access Microsurgery (TSPAM)

Transanal single-port access microsurgery (TSPAM) is an emerging and feasible minimally invasive method for the transanal excision of large sessile adenomas and early-stage carcinomas of the rectum. Here we present our TSPAM experience on rectal adenomas (high-grade rectal adenomas in 5 cases and carcinoma in situ in 1 case). TSPAM is an innovative method that can be an affordable and disseminated alternative to transanal endoscopic microsurgery for the local excision of the rectal lesions

Matrix metalloproteinase-9,-3 and tissue inhibitor of matrix metalloproteinase-1 in colorectal cancer: relationship to clinicopathological variables

The balance between matrix metalloproteinases (MMPs) and their physiological tissue inhibitors of matrix metalloproteinases (TIMPs) is crucial in tumour invasion and progression. The aim of this study was to investigate the levels of MMP-9, MMP-3 and TIMP-1 in colorectal cancer (CRC) and to evaluate these proteinases and their inhibitor with respect to clinicopathological variables. Activities of pro- and active MMP-9 were measured in paired turnout and distant normal tissue specimens from 43 patients with CRC using gelatin zymography. ELISA was employed for the determination of MMP-9, MMP-3 and TIMP-1 protein expressions. The activity levels of pro- and active MMP-9 and protein expression levels of MMP-9, MMP-3 and TIMP-1 were higher in tumour tissues than in the corresponding normal tissues; the differences being significant for all (p < 0.05), except TIMP-1. Similarly, active MMP-9/proMMP-9 and the ratio of protein expression level of MMP-9-TIMP-1 were found to be significantly higher in tumour tissues (p < 0.0 1). Among all the clinicopathological variables investigated, significant correlations were found between MMP-9 and presence of perineural invasion, MMP-3 and lymph node status, TIMP-1 and tumour differentiation, MMP-9/TIMP- I ratio and histological types (p < 0.05). In conclusion, MMP-3 was not as notably increased as MMP-9 in tumour tissues. However, different roles may be attributed to MMP-9 and MMP-3 in CRC development and progression. Additionally, assessment of TIMP-1 in relation to MMPs appeared to be crucial in CRC studies to provide a basis for the re-evaluation of the clinical usefulness of TIMP-1 in colorectal cancer. Copyright (C) 2006 John Wiley & Sons, Ltd

Survival Outcomes of Liver Metastasectomy in Colorectal Cancer Cases: A Single-Center Analysis in Turkey

Background: The purpose of this study was to analyze our series of liver resections for metastatic colorectal carcinoma (mCRC) to determine prognostic factors affecting survival and to evaluate the potential roles of neoadjuvant or adjuvant chemotherapy. Materials and Methods: Ninety-nine patients who underwent metastasectomy for liver metastases due to colorectal cancer at the Department of Medical Oncology, 9 Eylul University Hospital between 1996 and 2010 were evaluated in this study. The patients were followed through July 2013. Demographic, perioperative, laboratory, radiological and chemotherapy as well as survival data were obtained by retrospective chart review. Results: In 47 (47.5%) patients, liver metastases were unresectable at initial evaluation; the remaining 52 (52.5%) patients exhibited resectable liver metastases. Simultaneous hepatic resection was applied to 52 (35.4%) patients with synchronous metastasis, whereas 5 (64.5%) patients underwent hepatic resection after neoadjuvant chemotherapy. Forty-two patients with metachronous metastasis underwent hepatic resection following neoadjuvant chemotherapy. R0 resection was obtained in 79 (79.8%) patients. A second hepatectomy was performed in 22 (23.2%) patients. Adjuvant chemotherapy was given to 85 (85.9%) patients after metastasectomy. The median disease-free and overall survivals after initial metastasectomy were 12 and 37 months, respectively, the 1-year, 3-year and 5-year disease-free survival (DFS) and overall survival (OS) rates being 46.5%, 24.3% and 17.9% and 92.3%, 59.0% and 39.0%, respectively. On multivariate analysis, the primary tumor site, tumor differentiation, resection margin and DFS were independent factors predicting better overall survival. Conclusions: In selected cases, hepatic metastasectomy for mCRC to the liver can result in long-term survival. Neoadjuvant chemotherapy did not exert a positive effect on DFS or OS. Adjuvant chemotherapy also did not appear to impact DFS and OS

A patient with nonfunctional pancreatic neuroendocrine tumor and incidental metachronous colon carcinoma detected by positron emission tomography: Case report

Pancreatic neuroendocrine tumors constitute about 2% of all gastrointestinal neoplasms. Approximately half of the pancreatic neuroendocrine tumors are nonfunctional. Due to lack of specific symptoms, most patients with nonfunctional pancreatic neuroendocrine tumors present with locally advanced or metastatic disease. Second primary malignancies are seen very rarely in these patients. Colon carcinoma ranks third in frequency among primary sites of cancer in both men and women in western countries. Presence of a metachronous colon adenocarcinoma in a patient with nonfunctional pancreatic neuroendocrine tumor has not been reported before. We present a patient who had an asymptomatic mass in the head of the pancreas, detected by ultrasonography in 1996. The patient did not consent to operation. In 2002, after the diagnosis of an unresectable, nonfunctional pancreatic neuroendocrine tumor, interferon alpha-2b and octreotide were started. A year after biological treatment, he refused further treatment. In 2004, during the evaluation of dissemination of the asymptomatic disease, positron emission tomography revealed a high uptake by the descending colon despite the failure of other imaging methods. After surgery for operable colon carcinoma, the patient received chemotherapy and biological therapy for both tumors. Since 2005, he has been doing well without any further treatment thus far. In conclusion, computerized tomography/magnetic resonance imaging and octreotide scintigraphy may be insufficient to show disseminated disease and asymptomatic second primary malignancies. Therefore, positron emission tomography is a valuable promising option for the evaluation of gastroenteropancreatic neuroendocrine tumors and concomitant or metachronous malignancies. Lifelong follow-up by a multidisciplinary oncology team is needed so that a long-term survival can be achieved with integrated multimodal systemic treatment approaches

Infectious Complications after Cytoreductive Surgery and Hyperthermic Intra-Peritoneal Chemotherapy

Background: The aim of this study was to review the post-operative and infectious complications and determine the risk factors associated with infections in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)