Humans ; Colon, Descending ; Dendritic Cell Sarcoma, Follicular

BACKGROUND: This study aimed to investigate the prognostic impact of intratumoral Fusobacterium nucleatum in colorectal cancer (CRC) treated with adjuvant chemotherapy. METHODS: F. nucleatum DNA was quantitatively measured in a total of 593 CRC tissues retrospectively collected from surgically resected specimens of stage III or high-risk stage II CRC patients who had received curative surgery and subsequent oxaliplatin-based adjuvant chemotherapy (either FOLFOXor CAPOX). Each case was classified into one of the three categories: F. nucleatum–high, –low, or –negative. RESULTS: No significant differences in survival were observed between the F.nucleatum–high and –low/negative groups in the 593 CRCs (p = .671). Subgroup analyses according to tumor location demonstrated that disease-free survival was significantly better in F.nucleatum–high than in –low/negative patients with non-sigmoid colon cancer (including cecal, ascending, transverse, and descending colon cancers; n = 219; log-rank p = .026). In multivariate analysis, F. nucleatum was determined to be an independent prognostic factor in non-sigmoid colon cancers (hazard ratio, 0.42; 95% confidence interval, 0.18 to 0.97; p = .043). Furthermore, the favorable prognostic effect of F. nucleatum–high was observed only in a non-microsatellite instability-high (non-MSI-high) subset of non-sigmoid colon cancers (log-rank p = 0.014), but not in a MSI-high subset (log-rank p = 0.844), suggesting that the combined status of tumor location and MSI may be a critical factor for different prognostic impacts of F. nucleatum in CRCs treated with adjuvant chemotherapy. CONCLUSIONS: Intratumoral F. nucleatum load is a potential prognostic factor in a non-MSI-high/non-sigmoid/non-rectal cancer subset of stage II/III CRCs treated with oxaliplatin-based adjuvant chemotherapy.
Chemotherapy, Adjuvant ; Colon, Descending ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; DNA ; Fusobacterium nucleatum ; Fusobacterium ; Gastrointestinal Microbiome ; Humans ; Microsatellite Instability ; Microsatellite Repeats ; Multivariate Analysis ; Prognosis ; Retrospective Studies

BACKGROUND/AIMS: The prevalence and severity of irritable bowel syndrome (IBS) declines with age, but the cause of this is unknown. This study tested 2 hypotheses: (1) autonomic nervous system responses to eating and bowel distention, measured by heart rate variability (HRV), differs by age in IBS patients and (2) HRV is correlated with colonic motility and IBS symptoms. METHODS: One hundred and fifty-six Rome III positive IBS patients and 31 healthy controls underwent colonic manometry with bag distention in the descending colon, followed by ingestion of an 810-kcal meal. HRV, evaluated by low frequency (%LF; 0.04–0.15 Hz) component, high frequency (%HF; 0.15–0.40 Hz) component, and the LF/HF ratio, was measured during colonic distention and after the meal. Motility index and subjective symptom scores were simultaneously quantified. RESULTS: Both colonic distention and eating decreased %HF and increased the LF/HF ratio, and both indices of autonomic nervous system correlated with age. In IBS patients, %HF negatively correlated with the postprandial motility index after adjusting for age. The %HF and LF/HF ratios also correlated with psychological symptoms but not bowel symptoms in IBS patients. CONCLUSION: Decreased vagal activity is associated with increase in age and greater postprandial colonic motility in patients with IBS, which may contribute to postprandial symptoms.
Autonomic Nervous System ; Colon ; Colon, Descending ; Eating ; Gastrointestinal Motility ; Heart Rate ; Humans ; Irritable Bowel Syndrome ; Manometry ; Meals ; Postprandial Period ; Prevalence ; Prospective Studies

BACKGROUND/AIMS: Although functional abdominal pain disorders (FAPDs) are common in children, the accurate pathogenesis of FAPDs is not known yet. Micro-inflammation, particularly tissue eosinophilia of gastrointestinal (GI) tract, has been suggested as the pathophysiology observed in several GI disorders. We aimed to evaluate eosinophilic infiltration throughout the entire GI tract in children with FAPDs, compared to those with inflammatory bowel diseases (IBD) and to normal reference values. METHODS: We included 56 children with FAPDs, 52 children with Crohn’s disease, and 23 children with ulcerative colitis. All subjects underwent esophagogastroduodenoscopic and colonoscopic examination with biopsies. Tissue eosinophil counts were assessed in 10 regions throughout the GI tract. RESULTS: Eosinophil counts of the gastric antrum, duodenum, terminal ileum, cecum, and ascending colon were significantly higher in children with FAPDs compared to normal reference values. Eosinophil counts of the stomach and the entire colon were observed to be significantly higher in children with IBD than in those with FAPDs. Even after selecting macroscopically uninvolved GI segments on endoscopy in children with IBD, eosinophil counts of the gastric body, cecum, descending colon, sigmoid colon, and the rectum were also significantly higher in children with IBD than those with FAPDs. CONCLUSIONS: Significantly high eosinophil counts of the stomach and colon were observed in the order of IBD, followed by FAPDs, and normal controls, regardless of endoscopically detected macroscopic IBD lesions in children. This suggests some contribution of GI tract eosinophils in the intrinsic pathogenesis of FAPDs in children.
Abdominal Pain ; Biopsy ; Cecum ; Child ; Colitis, Ulcerative ; Colon ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Duodenum ; Endoscopy ; Eosinophilia ; Eosinophils ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Humans ; Ileum ; Inflammatory Bowel Diseases ; Pyloric Antrum ; Rectum ; Reference Values ; Stomach

PURPOSE: Stage-IIIC colon cancer is an advanced disease; however, its oncologic outcomes and prognostic factors remain unclear. In this study, we aimed to determine the predictors of disease-free survival (DFS) in patients with stage-IIIC colon cancer. METHODS: From a multicenter database, we retrospectively enrolled 611 patients (355 men and 256 women) who had undergone a potentially curative resection for a stage-IIIC colon adenocarcinoma between 2003 and 2011. The primary end-point was the 5-year DFS. RESULTS: The median age was 62 years; 213 and 398 patients had right-sided colon cancer (RCC) and left-sided colon cancer (LCC), respectively. The 5-year DFS in all patients was 52.0%; median follow-up time was 35 months (range, 1–134 months). A multivariate Cox regression revealed that female sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.19–1.90; P < 0.01), right-sided tumor location (HR, 1.65; 95% CI, 1.29–2.11; P < 0.01), lymphatic invasion (HR, 1.52; 95% CI, 1.08–2.15; P < 0.01) and a high (≥0.4) metastatic lymph node ratio (HR, 3.72; 95% CI, 2.63–5.24; P < 0.01) were independent predictors of worse 5-year DFS. Female patients with RCC were 1.79 fold more likely to experience recurrence than male patients with LCC. CONCLUSION: Female sex and right-sided tumor location are associated with higher tumor recurrence rates in patients with stage-IIIC colon cancers. Aggressive treatment and close surveillance should be planned for patients in these groups.
Adenocarcinoma ; Colon* ; Colon, Ascending ; Colon, Descending ; Colonic Neoplasms* ; Disease-Free Survival ; Female* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Prognosis ; Recurrence ; Retrospective Studies

Simultaneous laparoscopic surgery for colorectal cancer and coexisting abdominal disease is shown to be feasible. However, simultaneous laparoscopic colorectal resection and nephrectomy is rarely documented, and its feasibility is unknown. We report two cases of simultaneous colorectal resection for colorectal cancer and nephrectomy. In the first case, a 71-year-old female underwent laparoscopic right hemicolectomy for an ascending colon cancer and left nephrectomy for a left non-functioning kidney. The second patient was a 77-year-old male with descending colon cancer and left renal cell carcinoma who underwent laparoscopic left hemicolectomy and left nephrectomy. The body mass indexes were 21.73 and 26.78 kg/m², respectively, and operation time was 275 and 395 minutes. Blood loss was 300 and 250 cc, and the postoperative hospital stay was 8 and 10 days. In both cases, there was no postoperative morbidity or mortality. Simultaneous laparoscopic resection for colorectal cancer and nephrectomy is a feasible and safe procedure.
Aged ; Body Mass Index ; Carcinoma, Renal Cell ; Colon, Ascending ; Colon, Descending ; Colorectal Neoplasms ; Female ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Male ; Mortality ; Nephrectomy*

We describe our initial experience with the use of biodegradable (BD) stents in benign ischemic colorectal strictures with two cases. The first case is of a 40-year-old male with a history of retroperitoneal sarcoma who developed a benign stricture in the descending colon postsurgical and radiotherapy treatment. Balloon dilation was required in order to pass the delivery system. The patient experienced significant pain postdeployment and post procedure computed tomography scan demonstrated a small perforation requiring an emergency laparotomy. The second case is a 61-year-old male with a history of retroperitoneal sarcoma who also developed an ischemic stricture in the descending colon after surgical excision. Using a combined fluoroscopic and endoscopic approach 3 separate BD stents were inserted over a 17-month period improving clinical symptoms of intermittent obstruction. These symptoms reoccurred after stent disintegration and the patient was definitively managed surgically with colostomy formation. The use of BD stents, although appealing, does not provide an adequate long term result. Additionally, more flexible, smaller calibre systems are required for deployment in tortuous environments.
Adult ; Colon, Descending ; Colostomy ; Constriction, Pathologic* ; Emergencies ; Humans ; Laparotomy ; Male ; Middle Aged ; Radiotherapy ; Sarcoma ; Stents* ; Tigers*

BACKGROUND/AIMS: Neuronal degeneration and changes in interstitial cells of Cajal (ICCs) are important mechanisms of age-related constipation. This study aims to compare the distribution of ICCs and neuronal nitric oxide synthase (nNOS) with regard to age-related changes between the ascending colon (AC) and descending colon (DC) in 6-, 31-, and 74-week old and 2-year old male Fischer-344 rats. METHODS: The amount of fecal pellet and the bead expulsion times were measured. Fat proportion in the muscle layer of the colon was analyzed by hematoxylin and eosin staining. Proto-oncogene receptor tyrosine kinase (KIT) and neuronal nitric oxide synthase (nNOS) expression were analyzed with Western blotting and immunohistochemistry. Isovolumetric contractile measurements and electrical field stimulation were used to assess smooth muscle contractility. RESULTS: Colon transit and bead expulsion slowed with senescence. Fat in the muscle layer accumulated with age in the AC, but not in the DC. The proportion of KIT-immunoreactive ICCs in the submucosal and myenteric plexus was higher in the DC than in the AC, and it declined with age, especially in the AC. In contrast, the proportion of NOS-immunoreactive neurons in the myenteric plexus was higher in the AC than in the DC, and both decreased in older rats. Nitric oxide levels declined with age in the DC. Muscle strip experiments showed that the inhibitory response mediated by nitric oxide in the circular direction of the DC was reduced in 2-year old rats. CONCLUSION: The AC and DC differ in their distribution of ICCs and nNOS, and age-related loss of nitrergic neurons more severely affects the DC than the AC.
Aging* ; Animals ; Blotting, Western ; Colon ; Colon, Ascending ; Colon, Descending* ; Constipation ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Immunohistochemistry ; Interstitial Cells of Cajal* ; Male ; Muscle, Smooth ; Myenteric Plexus ; Neurons* ; Nitrergic Neurons ; Nitric Oxide Synthase Type I ; Nitric Oxide* ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Rats ; Rats, Inbred F344*

Eosinophilic myenteric ganglionitis is a disorder characterized by infiltration of the Auerbach myenteric plexus by eosinophils. As a cause of chronic intestinal pseudo-obstruction (CIPO), eosinophilic myenteric ganglionitis has been rarely reported and the majority of the reported cases in the literature were children. We experienced a case of eosinophilic myenteric ganglionitis associated with CIPO in a 53-year-old female patient. Histologic examination of the resected descending colon showed moderate eosinophilic infiltrates with hypogangliosis in the myenteric plexus. Immunohistochemical study revealed increased number of CD4-positive lymphocytes and stronger but scantier glial fibillary acid protein expression in the inflamed myenteric plexus.
CD4-Positive T-Lymphocytes ; Child ; Colon, Descending ; Eosinophils* ; Female ; Ganglion Cysts* ; Humans ; Intestinal Pseudo-Obstruction ; Middle Aged ; Myenteric Plexus

Neurofibromas are benign, slow-growing nerve sheath tumors of the peripheral nervous system, arising from Schwann cells, and classically associated with neurofibromatosis type 1 (Nf1, von Recklinghausen's disease). They occur rarely in the gastrointestinal tract as isolated neoplasms, outside the classical clinical feature of neurofibromatosis. We herein present an isolated colonic neurofibroma without any systemic signs of neurofibromatosis. A 59-year-old female came to our hospital for constipation. On physical examination, general appearance showed no definite skin lesions. A subepithelial tumor measuring 0.8 cm was detected at the distal descending colon on colonoscopy. The lesion was removed completely by endoscopic resection. Microscopic examination showed proliferation of spindle cells in the mucosa and infiltration of inflammatory cells. Immunohistochemical staining was positive for S-100 protein. The above morphological and immunohistochemical characteristics were consistent with a diagnosis of a solitary neurofibroma of the sigmoid colon.
Colon ; Colon, Descending ; Colon, Sigmoid* ; Colonoscopy ; Constipation ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Middle Aged ; Mucous Membrane ; Nerve Sheath Neoplasms ; Neurofibroma* ; Neurofibromatoses ; Neurofibromatosis 1 ; Peripheral Nervous System ; Physical Examination ; S100 Proteins ; Schwann Cells ; Skin