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Krukenberg's tumor, three years after a colic carcinoma.

We report a case of left ovarian Krukenberg's tumor in a 65 year-old patient, three years after resection of a colonic carcinoma (pT3, G2, pN1, Stage 3, Dukes C). The case is briefly discussed with reference to the literature. Krukenberg's tumor usually occurs in younger patients, with a peak frequency before 40 years. Both ovaries are involved in 90% of cases. Pathogenetically the ovarian involvement arises either from hematogenous, lymphatic spreading or from contiguous extension from the primary colonic tumor. There may be some anatomic predispositions such as utero-ovarian vessel anastomosis in the ligamentum latum or by peritoneal adhesions.

Adenocarcinoma↗

Influence of misonidazole on the incidence of radiation-induced intestinal tumours in mice.

C57BL mice were given local irradiation to 2 cm2 of the lower abdomen in the dose range 16--24 Gy. There were some early deaths, but mice dying between 50--240 days predominantly developed invasive adenocarcinomas of the intestine. When the radiosensitizer misonidazole was given in a single dose shortly before irradiation the proportion of mice developing tumours was higher, but the difference was not statistically significant. However, there was a significant increase in the incidence of multiple tumours, largely attributable to tumours arising in the rectum.

Adenocarcinoma↗

Involvement of the ileocaecal region by non-Hodgkin's lymphoma in adults: clinical features and results of treatment.

Between January 1977 and January 1988, 19 patients with non-Hodgkin's lymphoma (NHL) involving the ileocaecal region were cared for by the CRC Wessex Medical Oncology Unit. Fifteen of these patients had primary ileocaecal NHL (stages IE or IIE) and four had secondary involvement of this region (stage IV). The commonest clinical presentation was with abdominal pain and a palpable mass in the right iliac fossa. Bulky (greater than 10 cm) disease was a particularly common feature, and complete surgical removal was possible in only seven patients. All patients had intermediate (18) or high grade (one) NHL using the Working Formulation. The commonest histological subtype was diffuse large cell. Seventeen patients received postoperative therapy, comprising local radiotherapy in one and combination chemotherapy in the remaining 16. Eleven of the 19 patients remain disease-free 6-60 months from diagnosis. Because of the high incidence of bulky disease at this site, postoperative therapy may be indicated, even for patients with apparently completely excised stage I disease.

Adult↗

The effects of pentoxifylline on the relative perfusion of tumours growing in three sites in the mouse.

The haemorheological agent pentoxifylline (PTX) has been shown to improve the relative perfusion and oxygenation of subcutaneous tumours in the mouse. In order to establish whether this effect is dependent on the site of tumour growth, we have looked at changes in the distribution of the cardiac output (COD) to the murine NT carcinoma grown either intradermally (i.d.), intramuscularly (i.m.), on the wall of the caecum, or in all three sites, following i.p. administration of 50 mg kg-1 PTX. In animals bearing a single tumour, PTX treatment significantly increases the COD to tumours located in the caecum, but has no significant effect on the COD to those located in the i.d. or i.m. sites. If all three tumours are present in a single animal, the COD to all three tumours is significantly enhanced by PTX. This appears to reflect the presence of the caecum tumour and does not appear to relate to changes in tumour size or to the haematocrit (HCT) of the blood. We propose that this site dependency implies that a significant increase in blood viscosity only occurs in animals with tumours located in specific sites. Therefore, the potential radiosensitising capability of PTX is highly dependent on tumour location.

Adenocarcinoma↗

Systematic heterogeneity and prognostic significance of cell proliferation in colorectal cancer.

The prognosis of colorectal cancer has not significantly changed during the last 30 years. While evaluation of tumour cell proliferation may provide prognostic information, results obtained so far have been contradictory Heterogeneity in tumour cell proliferation may explain these contradictions. With in vivo injection of iododeoxyuridine (IdUrd), estimation of labelling index (LI), S-phase transit time (Ts) and potential doubling time (Tpot) may be performed from a single sample. A total of 109 colorectal cancers were studied after in vivo injection of IdUrd before surgical removal. From each cancer, four to eight samples were processed for both flow cytometrical (FCM) and immunohistochemical (IHC) visualization of IdUrd incorporation. LI/IHC was morphometrically quantified at both the luminal border and the invasive margin of these tumours. LI was significantly higher at the luminal border compared with the invasive margin, although they were correlated with each other. Using combined IHC and FCM methods, rapidly growing colorectal cancers (high LI and/or low Tpot) showed an increased survival (significant for LI at the invasive margin and for Tpot at both the invasive margin and the luminal border) in the entire unselected material and for radically removed Dukes' B tumours. FCM data alone did not discriminate for survival, with the exception of Ts in diploid and radically removed Dukes' B tumours.

Cecal Neoplasms↗

Typhlitis complicating autologous blood stem cell transplantation for breast cancer.

Three cases of typhlitis occurring during autologous blood stem cell transplantation (ABSCT) for metastatic breast cancer are described. Typhlitis is a rare complication of neutropenia and has uncommonly been reported in the autologous transplant setting. Although it has been most commonly described in children with leukemia, typhlitis has increasingly been reported in adult leukemias and in association with neutropenia secondary to chemotherapy for a number of solid tumors. Only five previous cases of typhlitis in the setting of ABSCT have been described. Whereas diarrhea and fever are common toxicities associated with high-dose chemotherapy, it is likely that many cases of typhlitis go unrecognized. Bone Marrow Transplantation (2000) 25, 321-326.

Adult↗

Caecal carcinomas in the elderly: useful signs in minimal preparation CT.

OBJECTIVE: Frail, elderly and immobile patients frequently have difficulty in tolerating formal colonic investigations. Caecal tumours may account for up to 35% of colonic tumours. Barium enema and colonoscopy have limitations in assessing this region. The aims of this study were to evaluate the accuracy of a minimal preparation CT technique (merely with prolonged oral contrast medium) in identifying caecal carcinomas and to determine helpful radiological signs. MATERIALS AND METHODS: The CT technique involved helical acquisition following 2 days of preparation with oral contrast medium. The outcome of 4 years' experience (1995-1998) was reviewed. The gold-standards were pathological and cancer registration records, together with colonoscopy and barium enema where available, with a minimum of 15 months' follow-up. RESULTS: CT correctly identified 27 of 30 caecal carcinomas, and missed three, in a total of 1077 CT studies in 1031 patients (median age 80 years). There were also 21 false-positive cases in which CT incorrectly raised the possibility of a caecal tumour. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 90%, 98%, 99% and 56%, respectively. Serosal margin blurring, tumour length, presence of abnormal peri-colic fat and terminal ileal wall thickening were identified as useful radiological signs. CONCLUSIONS: Minimal preparation CT is able to identify caecal carcinomas with fair accuracy. Such evaluation may become important given the increasing population age and evidence of a 'proximal shift' in the site of colonic tumours in the elderly.

Aged↗