Chronic lymphocytic leukemia and subsequent cancer in the same patient.
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A case of solitary cecal plasmacytoma is described with strong evidence of IgGk paraprotein production demonstrated by immunofluorescence and electromicroscopy. This is the ninth case of colonic plasmacytoma reported in the English literature and the first to show positive immunofluorescence.
Two hundred and eighty patients with previously untreated large bowel adenocarcinoma were retrospectively evaluated following complete primary resection to determine patterns of recurrence. One hundred and five patients (37%) subsequently developed recurrent disease. Sixty percent (63/105) presented with local recurrence alone, 14% (15/105) with concomitant local recurrence and distant metastases, and 26% (27/105) with distant metastases alone. Ninety-two percent of local recurrences developed in structures contiguous to the operative area of the incision. The degree of tumor anaplasia and depth of tumor penetration into the bowel wall influenced the rate of local recurrence. Through 5 years, local recurrence without clinical evidence of distant metastases was the most common cause of death. Plans for adjuvant radiation therapy are discussed.
Squamous cell carcinoma of the colon is a distinctly rare entity. Squamous cell carcinoma and adenoacanthoma occur in the colon and upper rectum 0.05% as frequently as adenocarcinoma. Squamous cell carcinoma of the cecum is an even rarer entity, this case appearing to be the seventh recorded case. A review of the literature concerning this topic is included in this report.
Two unusual presentations of carcinoma of the right colon are described. One of the two patients presented with a right gluteal abscess and the other presented with a colocutaneous fistula to the anterior abdominal wall at the site of a previous appendectomy scar. Despite extensive local tumor invasion of adjacent structures in both cases, all the regional lymph nodes were free of cancer and the tumors were of low-grade malignancy. A review of the literature indicates that bulky colonic tumors with extensive local invasion and negative mesenteric lymph nodes have a relatively good prognosis if adequate resection is performed.
The colon and rectum were removed from 445 consecutive autopsies and examined for the presence of polypoid lesions under an illuminating magnifying lens. There were seven clinically undiagnosed carcinomas, 329 adenomas, 174 hyperplastic polyps, 59 mucosal tags, 34 other polypoid lesions, and 54 polyps in which no histologic diagnosis could be made. Adenomas were present in 34% of the men and 32% of the women. The adenoma prevalence rate increased smoothly with age in men, whereas the rate in women showed a biphasic variation with a peak at 50--59 years followed by a second increase after 70 years of age. The distribution of adenomas within the bowel showed a marked change with age, from a moderate left-sided predominance before 60 years of age to a marked right-sided predominance in patients over 80 years of age, particularly in men. Hyperplastic polyps were present in 27% of the men and 18% of the women. In men, their frequency and distribution within the bowel showed similar changes with age as were seen for the adenomas. In women, no such age-dependency was observed for hyperplastic polyps. Multiplicity of polyps increased with age and was more pronounced in men than in women. Adenomas in women tended to be larger, more atypical, and more villous than in men. A comparison with a similar study from Northern Norway showed no difference in the prevalence of adenomas in spite of a 70% higher incidence rate for colorectal cancer in Oslo.
A mother and son were found to have multiple juvenile polyps of the colon; later a metastatic adenocarcinoma of the large bowel developed in the mother. In both patients, histologic examination of the polyps did not reveal adenomas, but some of the juvenile polyps contained adenomatous-like elements. Because of the mother's history of colon cancer and the adenomatous features in some of the son's juvenile polyps, he underwent an elective subtotal colectomy. This family may represent a phenotype variation with features of both the juvenile and adenomatous polyposis syndromes and the presence of dysplasia of the glandular epithelium could be a marker of potential malignancy in patients with juvenile polyposis coli.
A young man presented with intestinal obstruction. Laparotomy revealed a large mass encircling the cecum and terminal ileum which histologically proved to be a granulocytic sarcoma. No evidence of leukemia was present in peripheral blood or bone marrow. Initial therapy consisted of abdominal irradiation. Two months following completion of irradiation, widespread systemic involvement without leukemia was evident. Systemic chemotherapy with doxorubicin, cytosine arabinoside, vincristine, and prednisone was initiated. Chemotherapy was continued for 18 months. The patient has remained without evidence of disease for 49 months following discontinuation of treatment, and 67 months after initial diagnosis. Systemic therapy for granulocytic sarcoma presenting without evidence of leukemia is reviewed.
Twenty-one patients with adenocarcinoma of the cecum were treated in a pilot study between October, 1972 and June, 1982 by right hemicolectomy and received adjuvant postoperative irradiation (40-45 Gy/4-5 weeks) and 5-Fluorouracil (5-FU). There were 15, 4, and 2 patients with Stages (Astler-Coller) B2, C2, and D, respectively. There was no major morbidity nor mortality attributable to the adjuvant therapy. Patients were followed for a minimum of 15 months. Fifteen patients are alive and disease-free, with a median survival of 34 months (range, 17-79). There were no significant differences in the median survival or incidence of distant metastases when the adjuvant therapy group was matched by sex, age, and stage of disease with a group of patients treated by right hemicolectomy alone. There was a lower local failure rate in the adjuvant group compared with the surgery-alone group (5% versus 19%) (P less than 0.2). These data suggest that adjuvant therapy for cecal carcinoma is feasible, safe, and may reduce local failures and possibly improve survival in high-risk patients. It deserves further investigation so that a definite conclusion may be drawn.
The anatomic site distribution of large bowel cancer was studied in 2079 patients between 1967 and 1980. To measure the trend in the localization of the carcinomas, the slope of the regression line of the proportions at each site over the years was computed. The large bowel was divided into five segments: cecum, ascending colon and hepatic flexure, transverse and descending colon, sigmoid and rectosigmoid junction, and rectum. A significant decrease in the proportions of cancer in the sigmoid for both sexes (slope parallel b = -0.89; P less than 0.001) and an increase of cecal cancer (b = 0.54; P less than 0.004) was observed. Sex-specific results indicated the diminishing proportion of sigmoid cancer in men (b = -1.04; P less than 0.004) with an increase in transverse and descending colon cancer proportions (b = 0.52; P = 0.012). In women, a negative slope of -0.74 was not significant for sigmoid cancer, but cancer of the cecum showed an increase in proportions (b = 0.80; P = 0.01). The age distribution indicated a significant decrease in proportion of men older than 80 years and of women in the age group of 40 to 49 years and an increase in women older than 80 years. However, age adjustment did not change any of the previous conclusions. The observed sex differences in the changing distribution within the large bowel over a 14-year period cannot be explained by the improvement of diagnostic tools in the last years. In view of these findings, it is important to evaluate the possible sex-related bias in the application of screening and preventive measures as well as the changes in the ecologic features of the large intestine.
The natural history of surgically treated adenocarcinoma of the cecum has not been well defined. This report is a retrospective study of 106 patients followed for a median time of 25 months after hemicolectomy. The overall median survival rate was 73 months and the median disease-free survival rate was 37 months; 22 of 106 patients failed locally (21%). In addition, 7 of these 22 patients had distal failure. Thus, there appears to exist a group of patients likely to benefit from adjuvant radiotherapy. Whether total abdominal irradiation or locoregional radiotherapy is the method of choice needs to be further defined.
We examined 217 tissue samples of various human malignancies for the presence of human papillomavirus (HPV) DNA using low-stringency filter hybridization techniques. These techniques were sufficiently sensitive for crosshybridization of the HPV DNA probes to all the known types of papillomavirus DNAs, both human and animal. Approximately 2% of the cancers analyzed contained HPV DNA. These included carcinomas of the lung, cecum, tongue, and neck. Three of four cancers contained HPV-16-related nucleotide sequences. Thus, in addition to previous data demonstrating the association of HPV DNA with certain cancers of the skin and genital tract, data is presented that indicates that several additional human cancers also contain HPV-related nucleotide sequences.