The introduction of total mesorectal excision and the use of neoadjuvant therapy has led to improved prognosis of rectal cancer. Circumferential resection margin(CRM) is one of the main prognostic factors. Positive CRM is associated with adverse prognosis. It is of clinical significance to clarify different patterns of CRM involvement, the exact definitions, and associated factors. TME quality assessment and accurate determination of CRM involvement are crucial in the pathologic examination of rectal cancer. Extended abdominoperineal resection during which the levator muscles are resected en bloc with the anus and lower rectum may be superior than conventional abdominoperineal resection (APR) in terms of obtaining a negative CRM.
Humans ; Perineum ; pathology ; surgery ; Prognosis ; Rectal Neoplasms ; diagnosis ; pathology ; surgery ; Rectum ; pathology ; surgery

Anal Canal ; surgery ; Early Diagnosis ; Follow-Up Studies ; Humans ; Neoplasm Staging ; Rectal Neoplasms ; diagnosis ; pathology ; surgery

Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.
Adult ; Carcinoma/*diagnosis ; Diagnosis, Differential ; Endometriosis/*diagnosis/pathology/surgery ; Female ; Humans ; Middle Aged ; Rectal Neoplasms/*diagnosis ; Sigmoid Neoplasms/*diagnosis

OBJECTIVETo summarize the clinicopathological characteristics of primary anorectal malignant melanoma (AMM).

METHODSClinical data of nine patients with AMM were reviewed retrospectively from January 1999 to March 2005.

RESULTSAnorectal malignant melanoma had a female predominance. The average age was 56 years old and average course of disease was 5.8 months. The onset of symptom was hematochezia, then anus prolapses. 94.7% of patients had AMM within 5 cm from anus margin; the average tumor size was (3.3+/- 2.1) cm. The polyp and ulcer were most common types. More than a half (54.5%) of the tumor was movable, 19.1% smooth surfaced, 6.6% soft textured. Synchronous metastasis was found in 14.0% of the patients, the first common metastasis was found in liver, the secondary was superficial inguinal lymph node metastasis. Half of the patients were misdiagnosed,and over 50% of patients were misdiagnosed as benign disease. Mile's operation was performed in most of patients (63%), while anal resection was performed in 30% of the patients.

CONCLUSIONSAnorectal malignant melanoma is often misdiagnosed,surgical procedure is the first choice for patients with AMM.

Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Melanoma ; diagnosis ; pathology ; surgery ; Middle Aged ; Rectal Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies

Multiple primary malignancy was reported firstly by Billroth in 1889. Recently, multiple primary malignancies are considered to increase due to improved survival rate of cancer patients, advanced diagnostic tools, and increased use of chemotherapy and radiotherapy. In Korea, several cases of triple primary malignancies were reported. However, four primary malignancies in gastro-intestinal tract was rarely reported. Recently, we experienced a 70 year-old male who was diagnosed with metachronous four primary malignancies in rectum, ascending colon, stomach, and ampulla of Vater. We report this rare case of metachronous four primary malignancies with a review of literature.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Ampulla of Vater/*pathology ; Colonic Neoplasms/diagnosis/surgery ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Gastrointestinal Neoplasms/*diagnosis/pathology/radiography ; Humans ; Male ; Neoplasms, Second Primary/*diagnosis/pathology ; Rectal Neoplasms/diagnosis/surgery ; Stomach Neoplasms/diagnosis/pathology/surgery ; Tomography, X-Ray Computed

No abstract available.
Diagnosis, Differential ; Endosonography ; Female ; Humans ; Incidental Findings ; *Intestinal Mucosa/pathology/radiography/surgery ; Intestinal Polyps/*diagnosis/pathology/radiography/surgery ; Middle Aged ; Neoplasms, Fibroepithelial/*diagnosis/pathology/radiography/surgery ; Predictive Value of Tests ; Rectal Neoplasms/*diagnosis/pathology/radiography/surgery ; Tomography, X-Ray Computed

Rectal schwannoma is a rare mesenchymal tumor originating from Schwann's cell. We experienced a 61- year-old female patient who complained of blood tinged and narrow calibered stool for several years, and found a 4 cm sized submucosal tumor with a central ulcer on the rectal wall during colonoscopy. She underwent transanal excision. Microscopically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. Tumor cells showed a diffuse strong immunoreactivity to S-100 protein, but not stain for CD 34, desmin and smooth muscle actin. This is the first case report of rectal schwannoma in Korea.
Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Middle Aged ; Neurilemmoma/*diagnosis/pathology/surgery ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Rectum ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
Adult ; Aged ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical diagnosis, treatment and immunohistochemical characteristics of rectal stromal tumors.

METHODSImmunohistochemical expression of CD117 was retrieved in 20 cases of mesenchymal tumors of the rectum. And we analyzed the immunohistochemical characteristics, clinical data of rectal stromal tumors, and the results retrospectively.

RESULTSSixteen cases of rectal stromal tumors, 3 cases of leiomyosarcomas and 1 case of schwannoma were diagnosed. Histologically, 2 cases of GISTs were classified as benign, 1 as borderline and 13 as malignant. All of rectal stromal tumors (100%) were strongly positive for CD117, and 14 cases (88%) positive for CD34. The demographic profile of rectal stromal tumors showed a male predominance with average age of 60 years old. The main symptoms were urinary retention, constipation and abdominal pain. 14 cases were positive in digital rectal examination. The recurrence rate of local and radical resection in malignant stromal tumors was 4/4 and 3/6. 1, 3, 5-year survival rates were 89%, 64%, 48%, respectively. After operation mean survival time of was 47 months.

CONCLUSIONSThe specific GIST constituted the majority of mesenchymal tumors in rectum. It usually showed malignant biological behavior. Invasion and recurrence were common. Earlier diagnosis and radical resection had better prognosis. Periodically following up can help to detect the recurrence timely.

Adult ; Aged ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; pathology ; surgery ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Rectal Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies

Lateral lymph node metastasis represents a major cause of local pelvic recurrence after curative resection for mid-low rectal cancer. Considerable controversies over issues remain among eastern and western countries, with respect to the diagnosis of lateral lymph node metastasis, the multidisciplinary management regime, indication for lateral pelvic lymph node dissection, and the prognosis of surgical dissection. The purpose of this expert consensus is to improve the understanding of this condition among Chinese specialists, and to help standardizing the diagnosis and therapeutic strategies for lateral lymph node metastasis. Each statement and recommendation in this consensus were generated based on suggestions from at least three experts, agreed by a majority of experts from the Chinese expert panel. The evaluation criteria by U.S. Preventive Services Task Force was adopted for the grading of recommendations. In respect to the aforementioned controversies, the present consensus produced 21 statements on diagnosis and treatment for lateral lymph node metastasis. The pending issues in this consensus need further high-quality clinical practice and research.
China ; Consensus ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Neoplasm Recurrence, Local ; pathology ; Prognosis ; Rectal Neoplasms ; diagnosis ; pathology ; surgery