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Importance of epidermal growth factor receptor signaling in establishment of adenomas and maintenance of carcinomas during intestinal tumorigenesis.

We used the hypomorphic Egfr(wa2) allele to genetically examine the impact of impaired epidermal growth factor receptor (Egfr) signaling on the Apc(Min) mouse model of familial adenomatous polyposis. Transfer of the Apc(Min) allele onto a homozygous Egfr(wa2) background results in a 90% reduction in intestinal polyp number relative to Apc(Min) mice carrying a wild-type Egfr allele. This Egfr effect is potentially synergistic with the actions of the modifier-of-min (Mom1) locus. Surprisingly, the size, expansion, and pathological progression of the polyps appear Egfr-independent. Histological examination of the ilea of younger animals revealed no differences in the number of microadenomas, the presumptive precursor lesions to gross intestinal polyps. Pharmacological inhibition with EKI-785, an Egfr tyrosine kinase inhibitor, produced similar results in the Apc(Min) model. These data suggest that normal Egfr activity is required for establishment of intestinal tumors in the Apc(Min) model between initiation and subsequent expansion of initiated tumors. The role of Egfr signaling during later stages of tumorigenesis was examined by using nude mice xenografts of two human colorectal cancer cell lines. Treatment with EKI-785 produced a dose-dependent reduction in tumor growth, suggesting that Egfr inhibitors may be useful for advanced colorectal cancer treatment.

Adenoma↗

Peutz-Jeghers syndrome: case report.

A case of Peutz-Jeghers syndrome (PJS) in an African girl is presented to document the clinical presentation, management and follow up of this condition. The patient who presented with black buccal mucosal hyperpigmentation and clinical features of jejuno-jejunal intussusception was successfully managed by operative reduction of the intussusception and polypectomy. She is being followed up for evidence of malignant transformation in associated intestinal polyps and development of extra-intestinal malignancies at other sites. The management of PJS in light of recent trends is discussed, especially with reference to suggested protocols for screening and surveillance of sites at supposed risk of tumour development.

Abdominal Pain↗

Fibrofolliculomas, tricodiscomas and acrochordons (Birt-Hogg-Dubé) associated with intestinal polyposis.

We describe a patient with multiple fibrofolliculomas (FF), tricodiscomas (TD) and acrochordons (Birt-Hogg-Dubé) associated with intestinal polyps. One of the polyps presented histological features of marked dysplasia. This association may not be fortuitous and suggests that patients with multiple hamartomas of the perifollicular connective tissue should be examined periodically for intestinal polyps before malignancy develops.

Adenoma↗

Acceleration of intestinal polyposis through prostaglandin receptor EP2 in Apc(Delta 716) knockout mice.

Arachidonic acid is metabolized to prostaglandin H(2) (PGH(2)) by cyclooxygenase (COX). COX-2, the inducible COX isozyme, has a key role in intestinal polyposis. Among the metabolites of PGH(2), PGE(2) is implicated in tumorigenesis because its level is markedly elevated in tissues of intestinal adenoma and colon cancer. Here we show that homozygous deletion of the gene encoding a cell-surface receptor of PGE(2), EP2, causes decreases in number and size of intestinal polyps in Apc(Delta 716) mice (a mouse model for human familial adenomatous polyposis). This effect is similar to that of COX-2 gene disruption. We also show that COX-2 expression is boosted by PGE(2) through the EP2 receptor via a positive feedback loop. Homozygous gene knockout for other PGE(2) receptors, EP1 or EP3, did not affect intestinal polyp formation in Apc(Delta 716) mice. We conclude that EP2 is the major receptor mediating the PGE2 signal generated by COX-2 upregulation in intestinal polyposis, and that increased cellular cAMP stimulates expression of more COX-2 and vascular endothelial growth factor in the polyp stroma.

Adenoma↗

[Clinical analysis of Peutz-Jeghers syndrome:a report of 6 cases].

OBJECTIVE: To investigate the diagnostic methods and reasonable treatment of Peutz-Jeghers syndrome (PJS). METHODS: Clinical data of six patients with PJS were reviewed. RESULTS: Repeated abdominal pain, intussusception and intestinal polyp with bleeding were main manifestations. Four patients father,three patients grandfather and one patients mother were diagnosed with PJS. Three patients had family history of cancer. Case 4 and case 5 underwent laparotomy for many times because of intussusceptions caused by polyps or recurrent abdominal pain. Case 1 and case 4 had polyps synchronous with adenoma, and case 2 had polyp with gastric cancer. Main treatment included polyp resection and partial small intestinal and colon resection. CONCLUSIONS: Patients with PJS have family history of cancer and a high incidence of polyp recurrence of small intestine. Surgical intervention is the first choice regimen. Surveillance should be emphasized on gastrointestinal tract and other potential malignant organs in PJS patients.

Adolescent↗

[Morphostatistical characteristics of adenomas of the large intestine based on the data from 1915 autopsies].

Large intestine polyps have been revealed in 1372 cases of 1915 autopsies. 4.1% of these have been hyperplastic polyps, 86.2% tubular adenomas, 11.1% tubular-villous and 2.7% villous adenomas. Solitary adenomas have been less frequent than multiple one (42 vs. 58%). The adenomas have been equally incident in the right and left portions of the large intestine, but they have been larger and characterized by a higher degree of epithelial dysplasia in the sigmoid and rectum. Malignant adenomas made up 0.8% of the total number of tumors. Adenomas have been revealed twice more frequently in the patients who died in hospital than in the group of forensic medical autopsies. Multifactorial analysis has demonstrated a correlation between adenoma detection rate and some chronic diseases.

Adenoma↗

Inflammatory fibroid polyp of small intestine in a child.

Inflammatory fibroid polyps are rare lesions that are usually solitary and affect adults. We report an inflammatory fibroid polyp in a 7-year-old boy who presented with intestinal obstruction. He recovered after excision of the affected segment of ileum.

Child↗

COX-2 and iNOS, good targets for chemoprevention of colon cancer.

Cyclooxygenase (COX)-2 has been suggested to play an important role in colon carcinogenesis. We found that the COX-2 selective inhibitor, nimesulide, reduces azoxymethane (AOM)-induced aberrant crypt foci (ACF) in rats and colon carcinogenesis in mice, as well as formation of intestinal polyps in Min mice. Thus, selective inhibitors of COX-2, which catalyzes the synthesis of prostanoids, could be good candidates as chemopreventive agents against colon cancer. Examination of the effect of prostanoid receptor deficiency and a selective antagonist of prostanoid receptor on the development of AOM-induced ACF in mice revealed the involvement of the EP1 receptor. Moreover, a selective EP1 antagonist reduced the number of intestinal polyps in Min mice. These results suggest that PGE2 contributes to colon carcinogenesis through binding to the EP1 receptor. Nitric oxide synthase (NOS) is known to be overexpressed in colon cancers of humans and rats, and a NOS inhibitor, L-NG-nitroarginine methyl ester, was found to inhibit the development of AOM-induced ACF in rats. Thus, NOS including iNOS could also be a good target for chemoprevention of colon cancer, as in the COX-2 case.

Animals↗

EGF genetic polymorphism is associated with clinical features but not malignant phenotype in neurofibromatosis type 1 patients.

Neurofibromatosis type 1 (NF1) is characterized by a wide variation in clinical presentation and in some cases progression to malignant tumor. Epidermal growth factor (EGF) is an important mitogen for Schwann cells and is involved in the development of malignant tumors in NF1 patients. We hypothesized that EGF +61 G/A functional polymorphism, which represents constitutional all-life exposure to higher EGF expression and circulating levels, may predispose for precocious and more aggressive manifestations of disease. We found that clinical findings of intestinal polyps are significantly more frequent in patients with G homozygous genotype (P = 0.023). Those carriers of GG genotype have earlier onset of café-au-lait spots and Lisch nodules appearance (P = 0.030 and P = 0.017, respectively). Nevertheless, the EGF overexpressing genotype-GG, is not associated with higher risk for malignant progression or severity of disease. EGF polymorphism may play a role in the earlier onset of NF1 pigment cell-related manifestations and in intestinal polyps' development. Further studies in larger samples should confirm the absence of risk for having higher severity grade or malignant phenotype in NF1 patients.

Adult↗

Intestinal polyposis associated with oxyurid parasites in a chimpanzee (Pan troglodytes).

A 40-year-old male chimpanzee had multiple intestinal polyps associated with immature male oxyurid parasites. The gross and histologic characteristics of these lesions were identical to those produced by Nochtia nochti in the stomach and esophagus of Old World primates. It was theorized that the lesions resulted from hypersensitivity to oxyurid infection in an aberrant host.

Animals↗

PKA independent and cell type specific activation of the expression of caudal homeobox gene Cdx-2 by cyclic AMP.

Cdx-2 is a transactivator for the proglucagon gene in pancreatic and intestinal endocrine cells. Cdx-2 is also expressed in differentiated intestinal epithelia of nonendocrine origin. Cdx-2-/- mice are embryonic lethal, while Cdx-2+/- mutants show multiple malfunctions including the formation of intestinal polyps. Within the polyps, the remaining wild type Cdx-2 allele ceases its expression, while the expression of both Cdx-2 and proglucagon in the endocrine cells remains unaltered, indicating that Cdx-2 could be haplo-insufficient for nonendocrine cells, but not for proglucagon producing endocrine cells. We propose that mechanisms underlying Cdx-2 expression and auto-regulation [Xu F, Li H & Jin T (1999), J Biol Chem274, 34310-34316] differ in these two types of cells. We show here that forskolin and cAMP upregulate Cdx-2 expression in proglucagon producing cells, but not in colon cancer cells and primary intestinal cell cultures. It is unlikely that the activation is mainly mediated by PKA, because the activation was observed in a PKA deficient cell line. Co-transfecting a dominant negative Ras expression plasmid substantially repressed the Cdx-2 promoter, in contrast to a previous finding that Ras is a negative factor for Cdx-2 expression in colon cancer cells. Furthermore, forskolin activated ERK1/2 phosphorylation in the endocrine cells, and attenuation of ERK1/2 phosphorylation by its inhibitor is associated with attenuated Cdx-2 expression. Finally, an Epac pathway specific cAMP analogue stimulated both ERK1/2 phosphorylation and Cdx-2 expression. Taken together, our observations suggest that Cdx-2 expression is regulated by the second messenger cAMP, cell-type specifically, via the Epac pathway.

Animals↗

Clinico-pathological study of juvenile polyp of large intestine.

Although the difference of juvenile polyps between the childhood and adult groups was investigated, no significant difference could be pointed out both clinically and histologically. Since the polyps showing similar pathological findings were examined in the present investigation, it should be considered as a matter of course that no significant difference by age was pointed out. In a sense, these facts revealed the existence of a juvenile polyp which occurs in adult patients. In fact, the incidence of juvenile polyp which occurs in adult patients beyond the age of 20 has been estimated as 0 to 44% in the literature. If the term of juvenile polyp is not preferable in the adult cases, the term adult juvenile type polyp may be useful. Although several theories like as hamartoma, inflammation, allergy, etc. have been discussed for its histogenesis, it may be difficult to understand the histogenesis of juvenile polyps by a single theory.

Adolescent↗

Intestinal tumorigenesis in compound mutant mice of both Dpc4 (Smad4) and Apc genes.

The DPC4 (SMAD4) gene plays a key role in the TGFbeta signaling pathway. We inactivated its mouse homolog Dpc4 (Smad4). The homozygous mutants were embryonic lethal, whereas the heterozygotes showed no abnormality. We then introduced the Dpc4 mutation into the Apc(delta716) knockout mice, a model for human familial adenomatous polyposis. Because both Apc and Dpc4 are located on chromosome 18, we constructed compound heterozygotes carrying both mutations on the same chromosome by meiotic recombination. In such mice, intestinal polyps developed into more malignant tumors than those in the simple Apc(delta716) heterozygotes, showing an extensive stromal cell proliferation, submucosal invasion, cell type heterogeneity, and in vivo transplantability. These results indicate that mutations in DPC4 (SMAD4) play a significant role in the malignant progression of colorectal tumors.

Adenocarcinoma↗

Incidence of colorectal cancer following adenomatous polyps of the large intestine.

An association between adenomatous polyps of the large bowel and colorectal cancer has been reported, in the absence, however, of population-based estimates of risk. Subjects with histologically confirmed first diagnosis of large-bowel polyps notified to the population-based Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) during the calendar period 1979-1990 were actively followed up to the end of 1990 for the subsequent occurrence of malignant neoplasms. Among 2,496 individuals with intestinal polyps, followed for a total of 10,310 person-years at risk (6,201 among males and 4,109 among females), 150 malignant neoplasms were registered versus 152 expected. Thus, the standardized incidence ratio (SIR) for all cancers combined was 0.99. A significant excess was observed for colorectal cancer, with 35 cases observed (19 males, 16 females) versus 17.0 expected (SIR = 2.1; 95% CI: 1.5-3.0). There was also an excess, although not significant, for small-bowel cancer (2 cases observed vs. 0.4 expected; SIR = 5.4). In none of the other cancer sites was SIR significantly or appreciably elevated: in subjects with colorectal polyps the SIR was 1.6 for stomach, 1.0 for lung, 0.9 for breast and 1.2 for prostate. The SIR of colorectal cancer was 3.1 in the first year since polyp registration, and declined thereafter to 1.8, in the absence, however, of any further trend with time since diagnosis. The cumulative risk of colorectal cancer in subjects with colorectal polyps was 2% at 5 years and 3% at 10 years. The quantitative estimates of this study are of interest for their population-based nature, and are potentially useful for defining and targeting screening colonoscopy programmes.

Adult↗

Inflammatory pseudotumors (inflammatory fibrous polyps) of the small intestine: A clinicopathologic study.

The clinical and pathologic features of 25 inflammatory pseudotumors of the small intestine are reported. These rare lesions, which clinically may simulate neoplasms, consist of localized, frequently polypoid masses composed of inflamed fibrous and granulation tissue. Inflammatory pseudotumors may produce intussusception and small-bowel obstruction. Some are found at laparotomy performed for other reasons. The diagnosis of inflammatory pseudotumor usually can not be made until the lesion is examined histogically. Their etiology remains unknown, but their relationship to intestinal ulceration is discussed. Problems in differential histologic diagnosis are considered.

Adult↗

Epithelial polyps of the large intestine. A classification based on biologic behavior.

Classifications of colonic polypoid lesions are often based on their pathogenesis. Little attention is paid to the biologic behavior (or predicted behavior, based on experience) of these lesions. Classification based on biologic behavior separates these lesions, regardless of histogenesis, according to possible malignant potential. This helps the clinician to explain the implications of the histopathologic diagnosis to the patient and to understand when aggressive or prophylactic therapy should be pursued.

Adenoma↗