Cases reported "Rectal Neoplasms"

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1/85. Colorectal cancer complicating ulcerative colitis: an institutional series.

    Ulcerative colitis predisposes to colorectal cancer: the risk increases along with disease duration and extension. Also some subsets of patients are at increased risk, namely patients with early onset of colitis, and patients with primary sclerosing cholangitis. Cancer complicating ulcerative colitis affects evenly all the colon, and is not located more frequently in the rectum and in the sigmoid colon, as well as the sporadic counterpart. Multiple cancers and cancers associated with high grade dysplasia are not infrequent in ulcerative colitis; for this reason, and for controlling the colitis, the treatment of choice is total colectomy, with or without colostomy. The prognosis of cancer complicating ulcerative colitis is similar to the sporadic counterpart. The Authors present a colon cancers series as a complication of colitis occurred at Regina Elena Cancer Institute of rome, italy, over the period 1975-1998.
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2/85. radiation-associated rectal cancer: report of four cases.

    BACKGROUND/AIMS: radiation-associated rectal cancer is a remarkable clinical entity. We demonstrate 4 patients (mean age 68 years, range 63-74) who had undergone pelvic radiotherapy for cervical cancer. We indicate some characteristics of radiation-associated rectal cancer. RESULTS: Two patients had received intracavitary and external pelvic radiotherapy, while the remaining 2 had external pelvic radiotherapy following hysterectomy. The mean total radiation dose was 63 Gy, though radiation dose information was not available for 1 patient. Colorectal cancer developed at a mean time of 20.7 years (range 11-30) after radiation therapy. All patients presented with chronic radiation colitis, and 3 demonstrated abnormal tumor markers. colonoscopy revealed an ulcerative, localized well-differentiated adenocarcinoma of the rectosigmoid colon in 1 patient, and diffusely infiltrating cancers of the lower rectum, one signet-ring cell carcinoma and two mucinous carcinomas in the remaining 3. One case was stage I, 2 were stage IIIa, and the remaining case was stage IV. Three patients underwent abdominoperineal resection. The remaining patient was felt to be inoperable. The colorectal wall demonstrated the changes of chronic radiation injury. Two patients died within a short time because of their advanced cancers. CONCLUSION: radiation-associated rectal cancer has a tendency to be diagnosed in the advanced stage and to have a poor prognosis. A literature review and our case report suggest that since there are no reliable clinical or laboratory indicators of the presence of a curable colorectal cancer in the setting of chronic radiation proctocolitis, surveillance with a colonoscope should be done 10 years after irradiation in patients with previous pelvic radiotherapy.
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3/85. Anorectal melanoma metastatic to the breast.

    Anorectal melanoma is an extremely rare malignancy with poor prognosis. patients generally present with a sensation of mass and rectal bleeding, which is usually attributed to hemorrhoids or polyps. It can not be diagnosed early because of these benign symptoms, so it is bulky at the time of presentation. Despite aggressive surgery, 5-year survival is less than 10%. We present a case of inoperable anorectal melanoma which metastasized to the left breast and abdominal lymph nodes. We also briefly reviewed the appropriate literature, emphasizing the diagnostic and therapeutic approaches.
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4/85. Humoral hypercalcemia in patients with colorectal carcinoma: report of two cases and review of the literature.

    BACKGROUND: Humoral hypercalcemia rarely is associated with colorectal carcinoma; to the authors' knowledge only nine cases have been reported to date. methods: Two cases of advanced colorectal carcinoma with humoral hypercalcemia of malignancy (HHM) are presented. RESULTS: The two patients had severe hypercalcemia without bone metastases. The diagnosis of HHM was based on findings of hypercalcemia, hypophosphoremia, elevated serum parathyroid hormone-related peptide (PTHrP), and positive tumor immunoreactivity to monoclonal PTHrP antiserum. One patient had a colonic adenocarcinoma with a neuroendocrine component and the other patient had rectal adenocarcinoma. Immunoreactive PTHrP was found in both tumor components. Bisphosphonate treatment normalized the hypercalcemia within a few days but it recurred in the patients 2 weeks and 3 weeks later, respectively. The prognosis was extremely poor. CONCLUSIONS: To the authors' knowledge the two cases presented in the current study are the first to be reported with HHM-associated colorectal carcinoma with positive tumor immunoreactivity to PTHrP monoclonal antiserum.
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5/85. Rectal cancer in pregnancy: a new management based on blended anesthesia and monitoring of fetal well being.

    Colorectal carcinoma presenting during pregnancy is an extremely rare condition associated with a poor prognosis. In this report we studied a patient referred to our hospital at 26 weeks of gestation with the diagnosis of rectal adenocarcinoma. Tumor resection with a colostomy was planned in the attempt to preserve pregnancy until fetal viability could be reached. Blended anesthesia (general and epidural) was chosen to avoid surgical and anesthesiological risks; in fact this technique allows either an optimal block of neurohormonal response or a good control of surgical stress to be obtained. In order to monitor fetal well being during surgery, Doppler evaluations of fetal heart rate and umbilical artery flow velocity waveforms were performed. The patient was dismissed in good health and then rehospitalized at 32 weeks of gestation in order to perform an elective cesarean section. In conclusion we suggest that, with the choice of a good anesthesiological technique and monitoring of fetal well being, surgical treatment in case of rectal cancer could be performed without affecting the course of pregnancy.
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6/85. Primary linitis plastica of the rectosigmoid in a thirteen year old boy.

    Childhood malignant neoplasms of the gut are extremely rare. The reported incidence of colorectal cancers in patients under 20 years of age is 1 in 10 million. The low index of suspicion for this tumour in children results in advanced disease at diagnosis and subsequently a poor prognosis. A rare case of a primary linitis plastica of the rectum occurring in a 13 year old boy is reported with review of pertinent literature.
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7/85. Malignant melanoma of the anorectal area. Report of two cases.

    BACKGROUND/AIMS: Primary anorectal melanoma is a very rare malignant tumor with no more than 300 cases reported in the literature. methods: Two cases of anorectal melanoma are reported herein. RESULTS: Both patients, aged 44 and 74 years, presented at the outpatient department with anal bleeding, one after being treated for 3 months with antihemorrhoidal drugs. The diagnosis was established with proctoscopy and biopsy, and a palliative abdominoperineal resection in the presence of lymph node metastases was performed followed by chemotherapy with vindesine. Although the procedures were not curative, both patients had an uneventful postoperative recovery, and lived 4 years and 21 months, respectively, without bleeding problems albeit with the inconvenience of a colostomy. CONCLUSIONS: For the time being there is no convincing proof of the value of either types of proposed surgical management. We agree with those who believe that abdominal perineal resection has an advantage regarding the prognosis and quality of life.
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8/85. Complete remission of the liver metastases of anorectal malignant melanoma with regional chemotherapy: a case report.

    The prognosis of anorectal malignant melanoma is very poor. We present a 48-year-old male patient with anorectal malignant melanoma and multiple liver metastases who underwent abdominoperineal resection. A port system was implanted to the gastroduodenal artery for regional chemotherapy for liver metastases. Histopathological findings of tumor were 5 cm diameter and 2 cm depth, invading to the external sphincter. Both regional chemotherapy and immunotherapy were initiated 4 weeks postoperatively. The immunochemotherapy regimen included cisplatin (via port system) 50 mg/m2 once in 2 weeks, x 8 cycles, alpha-interferon 5 x 10(6) U subcutaneously on days 1-7 in 4 weeks, x 8 cycles, interleukin-2 9 x 10(6) U subcutaneously on days 5-9 in 4 weeks, x 8 cycles. Computed tomography scan was taken after the 2nd and 4th cycles of chemotherapy and the tumor had not responded to chemotherapy. dacarbazine 200 mg/m2 intravenously on days 1-5 in a month, x 4 cycles, was added to the previous immunochemotherapy regimen. Computed tomography and magnetic resonance imaging scans were taken on the 10th and 12th months after operation, respectively, no evidence of metastases in the liver was noted. No case of complete remission of liver metastases of anorectal malignant melanoma with regional intraarterial chemotherapy and systemic immunochemotherapy has been previously reported in the literature.
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9/85. Primary anorectal malignant melanoma: report of two cases.

    Primary anorectal malignant melanoma is a fairly uncommon but highly malignant disease. It is sometimes mistaken for benign conditions such as hemorrhoids or rectal polyps. Here we describe two cases of primary malignant melanoma of the rectum: in one patient a wide local excision (WLE) was performed and in the other an abdominoperineal resection (APR), both with curative intent. Both patients developed systemic recurrences and died of their disease at 24 and 10 months, respectively. In conclusion, the prognosis of anorectal melanoma is poor, irrespective of surgical treatment. WLE is the first choice for primary anorectal melanoma, while APR should be reserved for those cases where complete transrectal tumor resection is technically impossible.
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10/85. Primary yolk sac tumor of the rectum.

    Extragonadal germ cell tumors are well recognized in men but have rarely been reported in women. Reports have primarily focused on the pediatric population and have suggested a poor prognosis for extragonadal yolk sac tumors. A 23-year-old woman with a yolk sac tumor arising in the rectum is described. A review of the English-language literature (medline 1966-1998) regarding extragonadal germ cell tumors in females is provided. Treatment with four courses of cisplatin, etoposide, and bleomycin was followed by surgical resection of the involved area. No residual tumor was identified. She remains disease free 3.5 years later. Previous reports are limited by the small number of patients, focus on the pediatric population, and treatment before the availability of cisplatin. Extragonadal germ cell tumors in women are extremely rare but can be successfully treated with aggressive chemotherapy and surgery similar to testis cancer.
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