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Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation.

Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation. [ABSTRACT FROM AUTHOR]

Background: Colorectal carcinoma is a malignant epithelial tumor originating in the large bowel. More than 90% of colorectal carcinomas (CRC) are adenocarcinomas. This being graded morphologically at H&E stain in histopathology as well-differentiated, moderately differentiated, and poorly differentiated. Aims and Objectives: The aim of this study is to assess any association with different histopathological types and extent of differentiation of CRC with change in expression of CK 7 and Cytokeratin 20 (CK20). Materials and Methods: In the present study, total 59 patients has been selected by the predetermined sampling techniques. The specimen was collected and the necessary processing was done for H&E stain and for immunohistochemistry for CK 20 and CK 7 profile. Results: This study showed that most of the well-differentiated colorectal carcinoma are CK20 (+ve)/Cytokeratin 7 (CK7) (-ve) and poorly differentiated CRC are CK20 (+) and/CK7 (+) and also CK20 (−ve)/CK7 (+ve). Conclusion: Hence, from this study, it is evident that the expression of CK 20 positivity decreasing and CK7 positivity increasing in respect of progression of well differentiated to poorly differentiated colorectal carcinoma, that is, there is a relationship of expression of CK20 and CK7 profile with the histological grading of colorectal carcinoma. Furthermore, the expression profile of CK20 and CK 7 may be of helpful while searching for unknown primary in cases of metastatic deposit.

Background: Preoperatively, reliable diagnosis of the amount of dissemination of a colorectal cancer not only reveals the probable outcome but also aids care. There have been few studies on the use of spiral computed tomography (CT) pneumocolon for pre-operative staging of colorectal cancer. Aims and Objectives: Therefore, the present study was undertaken to evaluate colonic masses and determine the accuracy of spiral CT pneumocolon in staging colonic carcinomas. Materials and Methods: This prospective and hospital-based study was conducted for 2 years of period at the Department of Radiodiagnosis and comprised 75 patients who were sent for CT abdomen. All patients of all ages referred for CT examination with symptoms and/or clinical suspicion of colonic cancer, suspected colonic tumor, blockage, or stricture on barium studies or colonoscopies, or worrisome sonographic abnormalities, including colonic wall thickening and other features indicative of colon cancer were included in the study. Results: The predominated gender is male (63%) than female (37%). The observations reveal that, in malignant diseases, bleeding per rectum was the most prevalent symptom, while discomfort in the abdomen was the most common symptom in benign pathologies. CT pneumocolon correctly diagnosed cancer in all 57 patients, although three benign lesions were incorrectly categorized as malignant. The sensitivity and specificity for differentiating benign from malignant lesions were both 100% (57/57) and 83.3% (15/18). Conclusion: CT pneumocolon looks to be a non-invasive and quick inquiry that clearly displays the lumen of the colon, wall of the colon, surrounding structures, extraluminal component of colonic lesions, and metastases and gives useful information preoperatively.

Introduction: Colorectal Carcinoma (CRC) is the third most common type of cancer worldwide and is one of the leading causes of cancer-related death. Adenocarcinoma is the most common type. Histopathological examination is necessary to determine the type and extent of the tumour, which is essential for patient management and prognosis. Molecular markers play a major role in CRC, among which Epidermal Growth Factor Receptor (EGFR) has prognostic significance. Aim: The aim of this study was to evaluate the immunohistochemical expression of EGFR in cases of colonic carcinoma and analyse its relationship with various histological and clinical parameters. Materials and Methods: An observational (cross-sectional) study was conducted in the Department of Pathology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari district, Tamil Nadu, India. Data from colonic carcinoma patients confirmed by Haematoxylin and Eosin (H&E) staining were collected over a three-year period from January 2019 to December 2021. A total of 58 cases were included. The characteristics studied included age, sex, Carcinoembryonic Antigen (CEA) levels, tumour site, size, degree of histological differentiation (well, moderate, poor), TNM staging, and lymph node status. The EGFR score was obtained by multiplying the grade (% positive cells) by the intensity, and a composite score ranging from 0 to 9 was obtained. This score was used to define low EGFR expression (6). Analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the 58 patients included in the study, the most common age group affected by CRC was 61 to 70 years (28 cases; 48.3%), with a mean age of 63.32±14.36 years. The most common histological variant was low-grade adenocarcinoma (47 cases; 81.03%). EGFR reactivity was positive in 50 patients (86.20%). EGFR overexpression was significantly associated with histopathological type (low-grade adenocarcinoma) and tumour stage, with p-values of 0.03 and 0.001, respectively. Conclusion: Immunohistochemical overexpression of EGFR in CRC is associated with histopathological type and tumour staging in this study. This overexpression is associated with poor prognosis and can be used as a predictive marker for patients who yield positive results with chemotherapy.

Background: Colorectal carcinoma is a malignant epithelial tumor originating in the large bowel. More than 90% of colorectal carcinomas (CRC) are adenocarcinomas. This being graded morphologically at H&E stain in histopathology as well-differentiated, moderately differentiated, and poorly differentiated. Aims and Objectives: The aim of this study is to assess any association with different histopathological types and extent of differentiation of CRC with change in expression of CK 7 and Cytokeratin 20 (CK20). Materials and Methods: In the present study, total 59 patients has been selected by the predetermined sampling techniques. The specimen was collected and the necessary processing was done for H&E stain and for immunohistochemistry for CK 20 and CK 7 profile. Results: This study showed that most of the well-differentiated colorectal carcinoma are CK20 (+ve)/Cytokeratin 7 (CK7) (-ve) and poorly differentiated CRC are CK20 (+) and/CK7 (+) and also CK20 (-ve)/CK7 (+ve). Conclusion: Hence, from this study, it is evident that the expression of CK 20 positivity decreasing and CK7 positivity increasing in respect of progression of well differentiated to poorly differentiated colorectal carcinoma, that is, there is a relationship of expression of CK20 and CK7 profile with the histological grading of colorectal carcinoma. Furthermore, the expression profile of CK20 and CK 7 may be of helpful while searching for unknown primary in cases of metastatic deposit. [ABSTRACT FROM AUTHOR]

Background: Preoperatively, reliable diagnosis of the amount of dissemination of a colorectal cancer not only reveals the probable outcome but also aids care. There have been few studies on the use of spiral computed tomography (CT) pneumocolon for pre-operative staging of colorectal cancer. Aims and Objectives: Therefore, the present study was undertaken to evaluate colonic masses and determine the accuracy of spiral CT pneumocolon in staging colonic carcinomas. Materials and Methods: This prospective and hospital-based study was conducted for 2 years of period at the Department of Radiodiagnosis and comprised 75 patients who were sent for CT abdomen. All patients of all ages referred for CT examination with symptoms and/or clinical suspicion of colonic cancer, suspected colonic tumor, blockage, or stricture on barium studies or colonoscopies, or worrisome sonographic abnormalities, including colonic wall thickening and other features indicative of colon cancer were included in the study. Results: The predominated gender is male (63%) than female (37%). The observations reveal that, in malignant diseases, bleeding per rectum was the most prevalent symptom, while discomfort in the abdomen was the most common symptom in benign pathologies. CT pneumocolon correctly diagnosed cancer in all 57 patients, although three benign lesions were incorrectly categorized as malignant. The sensitivity and specificity for differentiating benign from malignant lesions were both 100% (57/57) and 83.3% (15/18). Conclusion: CT pneumocolon looks to be a non-invasive and quick inquiry that clearly displays the lumen of the colon, wall of the colon, surrounding structures, extraluminal component of colonic lesions, and metastases and gives useful information preoperatively. [ABSTRACT FROM AUTHOR]

Large cell neuroendocrine carcinomas of the colon (LCNECC) are exceptionally rare, comprising only 0.2 % of all colonic carcinomas. Their diagnosis poses a significant challenge due to their propensity to mimic colonic adenocarcinomas. Typically diagnosed at advanced stages, LCNECCs carry a grim prognosis. Herein, we present a rare case of LCNECC and aim to elucidate its clinico-pathological characteristics. A 56-year-old female patient presented with complaints of constipation, abdominal pain, and weight loss. On physical examination, a sizable mass was palpable in the right flank. Colonoscopy revealed a polyp in the descending colon and a friable multinodular stenosing mass in the ascending colon. Microscopic examination of the biopsy from the ascending colon mass exhibited a poorly differentiated large cell carcinomatous proliferation with positivity for synaptophysin and CD56, along with a Ki-67 proliferation index of 50 %. The polyp in the descending colon was consistent with a low-grade dysplastic tubular adenoma. A diagnosis of LCNECC with synchronous low-grade dysplastic tubular adenoma was established. A right hemicoloctomy was performed. Final pathological examination confirmed LCNECC invading the muscularis propria, with lymph node metastases. The tumor was classified as pT2N1M0 (Stage III). LCNECCs often mimic adenocarcinomas clinically, endoscopically, and radiologically. Pathological examination is the key for diagnosis. An immunohistochemical study using neuroendocrine markers is imperative to prevent overlooking the diagnosis of LCNECC. LCNECCs represent rare aggressive carcinomas. Their diagnosis might be challenging. A better knowledge of this rare entities would enable early diagnosis. • Large cell neuroendocrine carcinomas of the colon (LCNECC) are exceedingly rare, comprising only 0.2% of all colonic carcinomas. • Their diagnosis poses a significant challenge due to their propensity to mimic colonic adenocarcinomas. • Pathological examination is the key for diagnosis. • An immunohistochemical study using neuroendocrine markers is imperative. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the colonic carcinoma in patients with acute intestinal obstruction Methods: The study was cross sectional study was done in the department of surgery from January 2018 to September 2021, after taking the permission of ethical committee. 150 Patients presented with acute onset of vomiting, constipation and abdominal distension were included in this study. Diagnosis of intestinal obstruction was made based on clinical examination, history, image evidence in X ray and ultrasonogram. Results: The most common diagnosis was obstructive hernia (35.3), followed by adhesion obstruction (27.3%) and Carcinoma colon (13.3%). There was higher prevalence of Carcinoma Colon among males compared to females (70% vs 30%) which was statistically significant with chi square of 4.13 and p value 0.041. Conclusion: We concluded that the rise in the number of cases of colon cancer presenting as acute intestinal obstruction. Small bowel obstructions were much more common mainly due to adhesions and obstructed herniae. [ABSTRACT FROM AUTHOR]

Zixuan Ye,1,* Yue Zhang,1,* Yuanfen Liu,2,* Yanyan Liu,1 Jiasheng Tu,1 Yan Shen1 1Department of Pharmaceutics, State Key Laboratory of Nature Medicines, China Pharmaceutical University, Nanjing, People’s Republic of China; 2Jiangsu Health Vocational College, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Shen; Jiasheng TuDepartment of Pharmaceutics, State Key Laboratory of Nature Medicines, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, People’s Republic of ChinaTel +86 25 83271305Email shenyan@cpu.edu.cn; jiashengtu@aliyun.comBackground: Specific modifications to carriers to achieve targeted delivery of chemotherapeutics into malignant tissues are a critical point for efficient diagnosis and therapy. In this case, bovine serum albumin (BSA) was conjugated with cetuximab–valine–citrulline (vc)–doxorubicin (DOX) to target epidermal growth factor receptor (EGFR) and enable the release of drug in EGFR-overexpressed tumor cells.Methods: Maleimidocaproyl–valine–citrulline–p-aminobenzylcarbonyl-p-nitrophenol (MC-Val-Cit-PAB-PNP) and DOX were used to synthesize MC-Val-Cit-PAB-DOX, which was further linked with cetuximab to prepare antibody–drug conjugates (ADCs). Then, the ADCs were adsorbed to the surface of the BSA nanoparticles (NPs), which were prepared by a desolvation method to obtain cetuximab-vc-DOX-BSA-NPs. The cetuximab-vc-DOX conjugates adsorbed on the surface of the BSA nanoparticles were determined and optimized by size exclusion chromatography. An in vitro cytotoxicity study was conducted using a colon carcinoma cell line with different EGFR-expression levels to test the selectivity of cetuximab-vc-DOX-NPs.Results: The vc-DOX and cetuximab-vc-DOX conjugates were both synthesized successfully and their structural characteristics confirmed by 1H-NMR and SDS-PAGE. The MTT assay showed stronger cytotoxicity of cetuximab-vc-DOX-NPs versus control IgG-vc-DOX-NPs in EGFR–overexpressing RKO cells. Cellular binding and intracellular accumulation determined by flow cytometry and confocal laser scanning microscopy revealed the strong binding ability of cetuximab-vc-DOX-NPs to RKO cells. The in vivo imaging study demonstrated that cetuximab-vc-DOX-NPs exhibited higher fluorescent intensity in tumor tissues than non-decorated nanoparticles (IgG-vc-DOX-NPs). In vivo tumor inhibition and survival tests showed that cetuximab-vc-DOX-NPs revealed higher tumor inhibition efficacy and lower systemic toxicity than control IgG-vc-DOX- NPsConclusion: The obtained results emphasize that cetuximab-vc-DOX-NPs, with good tumor-targeting ability and low systemic toxicity, are a promising targeting system for drug delivery.Keywords: bovine serum albumin, antibody–drug conjugate, cetuximab, doxorubicin, colonic carcinoma, epidermal growth factor receptor

Non‐islet cell tumor hypoglycemia (NICTH) is a very rare symptom of severe hypoglycemia associated with extrapancreatic tumors. It is considered to be caused by insulin‐like growth factor (IGF)‐II. There have been no autopsy cases of colorectal carcinoma with NICTH confirmed with both serum high molecular weight and tumoral IGF‐II. We report the case of a 46‐year‐old woman with advanced sigmoid colon cancer and liver metastases. She underwent open sigmoidectomy, and histologically, the lesion was a differentiated‐type tubular adenocarcinoma. Postoperative chemotherapy was initiated. However, she experienced repeated hypoglycemia attacks 10 months after the operation, while the liver metastases increased. We examined the cause of hypoglycemia, and finally diagnosed her with NICTH associated with high molecular weight IGF‐II production, which was proven by Western immunoblot of the serum. She died 12 months after surgery and was examined by autopsy. Liver metastases showed a transition from adenocarcinoma to carcinoma with neuroendocrine differentiation. Immunohistochemistry showed that both metastatic carcinoma of the liver and primary colonic adenocarcinoma were positive for IGF‐II. Neuroendocrine differentiation in liver metastases proven by an autopsy may have contributed to tumor growth, which may have exacerbated the symptoms. [ABSTRACT FROM AUTHOR]

As the inguinal lymph nodes do not serve as the primary route for the lymphatic drainage of the colon, inguinal metastasis from colorectal carcinomas is considered an unusual finding, especially in the 2nd year follow-up. A 76-year-old male patient, operated on for non-metastatic right colic adenocarcinoma, consulted 2 years after for a right inguinal swelling. A biopsy was performed. Unexpectedly, it showed an adenocarcinoma metastasis in favor of a colonic origin. There was no relapse of the disease. The pathological examination of the resected inguinal lymph node confirmed malignant cells from a colonic origin. As the positron emission tomography scan showed no other tumoral localizations, a multidisciplinary discussion ensued, culminating in the choice of chemotherapy for optimal pathological response. This case highlights the fact that colic drainage may encounter inguinal lymph nodes and thus inguinal groin metastasis could exceptionally have been seen in colonic carcinomas. [ABSTRACT FROM AUTHOR]

Background: Colonic masses are clinically important because some of them are malignant and others have a tendency to become malignant such as polyps. CT pneumocolon may have a role in the evaluation and diagnosis of these masses. Objective: To determine the accuracy of computed tomography (CT) pmeumocolon in the detection of colonic masses compared with colonoscopy. Patients and Methods: A total of 60 patients with colorectal symptoms underwent evaluation for the presence of colorectal neoplasms by using both colonoscopy and CT pneumocolon and a comparison was made between them. Results: On colonoscopy, 10 out of 60 patients were having a negative colonoscopy. The results of colonoscopy of the other 50 patients were as follow; three out of fifty colonoscopies revealed invasive colorectal carcinomas in threse patients. The remaining 47 colonoscopies for 47 patients revealed benign polyps. The sizes of these polyps were as follows; (6 polyps were ?1 cm in diameter), (17 polyps were 6-9 mm), and (24 polyps were =5 mm). CT pneumocolon detected all 3 malignant masses seen and biopsied by colonoscopy, but only (28 single polyps) which according to their size (4 polyps were = 1cm), (11 polyps were 6-9 mm) and (13 polyps =5 mm), this gives CT pneumocolon a sensitivity of (63%), specificity of (70%) and accuracy (63%). Conclusion: CT pneumocolon has high sensitivity and specificity for a detection of largesized masses, but not for small ones. CT pneumocolon may be suitable for investigating patients with symptomatic colorectal masses noninvasively. [ABSTRACT FROM AUTHOR]

Background: Parvimonas micra is a gram-positive anaerobe and a part of the normal commensal flora of the gastrointestinal tract. Factors predisposing to anaerobic bacteremia include malignant neoplasms, periodontal disease, immune deficiencies, chronic renal insufficiency, decubitus ulcers and perforated abdominal viscus. Cases of Parvimonas bacteremia in a patient with esophageal carcinoma and in a patient following ERCP procedure have been reported but to our best knowledge no case has been reported yet in which a patient had colonic carcinoma. Case presentation: We present a rare case of a 94-year-old male who presented with chief complaint of fever and constipation. Complete blood count revealed normal white blood cell count anemia. Urinalysis came out to be unremarkable for any evidence of infection. Two blood cultures grew Parvimonas micra and Gamella morbillorum and patient was later switched to ampicillin-sulbactam as per blood culture susceptibility results. Echocardiogram came negative for any evidence of infective endocarditis. CT abdomen/pelvis showed soft tissue mass in the ascending colon just superior to the ileocecal valve (fig.1, 2). Colonoscopy showed non-obstructing eccentric mass (fig. 3). Biopsy of the mass revealed moderately differentiated adenocarcinoma. Because of lack of distant metastasis, surgical resection of the mass as definitive curative treatment was done. Conclusion: Immune deficiency is a risk factor for anaerobic bacteremia. Apart from immediately starting the patient on antibiotics, a thorough search for malignancy may be considered when a patient presents with anaerobic bacteremia, especially, when the source of infection is not known. Identifying malignancy in earliest stages may improve treatment outcome.

The purpose of this paper is to investigate the immune function of the tumor microenvironment and its clinical correlation with colonic carcinoma. Immune genes were downloaded from the The Cancer Genome Atlas database. Five subtypes are obtained by cluster screening based on immune gene expression data. The C3 and C4 subtypes show stronger immune activity. In addition, the C4 subtype has the largest number of gene mutations and the worst prognosis. Most of the immune signatures are upregulated in the C4 subtype, while most of the immune infiltration‐related cells are upregulated in the C3 and C4 subtypes. The different immune microenvironments between these subtypes may provide new ideas for immunotherapy strategies in colon carcinoma. [ABSTRACT FROM AUTHOR]

Colonic cancer has become a main reason of mortality associated with cancer; however, left and right-sided colonic cancer have diverse outcomes in terms of epidemiological, histological, clinical parameters and prognosis. We aimed to examine the discrepancies between these two types of colon cancers to identify potential therapeutic targets. In the present study, three gene expression profiles (GSE44076, GSE31595, GSE26906) from Gene Expression Omnibus (GEO) database were downloaded and further analyzed. A PPI (protein-protein interaction) network of the differentially-expressed genes (DEGs) of GSE44076 between tumor and normal was established with the Search Tool for the Retrieval of Interacting Genes database. Then, the DEGs of these two colon cancers (left, right) samples were identified. Subsequently, the intersection of DEGs of left and right-sided colon cancer samples obtained from three databases, and DEGs of tumor and normal samples were analyzed. Collagen type XI α1 chain (COL11A1), Twist family bHLH transcription factor 1 (TWIST1), insulin-like 5 and chromogranin A were upregulated proteins, while 3β-hydroxysteroid dehydrogenase was downregulated protein in right colon cancer than in left-sided tumor samples. Through further experimental verification, we revealed that COL11A1 and TWIST1 were significantly upregulated at the mRNA and protein levels within right-sided colon cancer compared with in left-sided colon cancer samples (P<0.05), consistent with bioinformatical analysis. Furthermore, a positive correlation between COL11A1 and TWIST1 protein expression was observed (P<0.0276). Collectively, our data showed that COL11A1 and TWIST1 may be potential prognostic indicators and molecular targets for the treatment of right-sided colon cancer. [ABSTRACT FROM AUTHOR]

Background: Parvimonas micra is a gram-positive anaerobe and a part of the normal commensal flora of the gastrointestinal tract. Factors predisposing to anaerobic bacteremia include malignant neoplasms, periodontal disease, immune deficiencies, chronic renal insufficiency, decubitus ulcers and perforated abdominal viscus. Cases of Parvimonas bacteremia in a patient with esophageal carcinoma and in a patient following ERCP procedure have been reported but to our best knowledge no case has been reported yet in which a patient had colonic carcinoma. Case presentation: We present a rare case of a 94-year-old male who presented with chief complaint of fever and constipation. Complete blood count revealed normal white blood cell count anemia. Urinalysis came out to be unremarkable for any evidence of infection. Two blood cultures grew Parvimonas micra and Gamella morbillorum and patient was later switched to ampicillin-sulbactam as per blood culture susceptibility results. Echocardiogram came negative for any evidence of infective endocarditis. CT abdomen/pelvis showed soft tissue mass in the ascending colon just superior to the ileocecal valve (fig.1, 2). Colonoscopy showed non-obstructing eccentric mass (fig. 3). Biopsy of the mass revealed moderately differentiated adenocarcinoma. Because of lack of distant metastasis, surgical resection of the mass as definitive curative treatment was done. Conclusion: Immune deficiency is a risk factor for anaerobic bacteremia. Apart from immediately starting the patient on antibiotics, a thorough search for malignancy may be considered when a patient presents with anaerobic bacteremia, especially, when the source of infection is not known. Identifying malignancy in earliest stages may improve treatment outcome. [ABSTRACT FROM AUTHOR]

As revealed as a colocutaneous fistula with an abscess in the abdominal wall, colon cancer is rare. It should be suspected in case of a painful abdominal wall mass in elderly patients. This case presentation of an infected sigmoid adenocarcinoma aims to highlight this uncommon presentation presenting some therapeutic issues. A 90-year-old woman with a past medical history of hypertension and major depressive disorder consulted the Emergency Department for lower left quadrant abdominal pain. The physical examination objectified a mild fever; lower left abdominal quadrant guarding, and abdominal mass of 10 cm with inflammatory signs. The abdominal CT scan showed a concentric thickness of the sigmoid colon with an abdominal wall abscess. She underwent an emergent laparotomy. Intraoperatively, we found an infected sigmoid tumour that invades the abdominal wall and is associated with a peritumoral abscess. This tumour was at the origin of the abdominal wall fistula. She underwent surgical drainage of the abscess, sigmoid colectomy, and colostomy. The postoperative follow-up was uneventful. The pathological examination of the operative specimen concluded with a colonic adenocarcinoma with lymph node invasion classified as pT4N2M0. Despite initial medical and radiological interventions, emergent surgery became necessary to address the infected sigmoid tumour invading the abdominal wall. Pathological examination revealed advanced cancer, but timely intervention and adjuvant therapy resulted in a positive outcome with no recurrence after two years. This case emphasizes the importance of recognizing unusual colon cancer presentations and the need for swift diagnosis and intervention. The diagnosis of colon cancer complicated with a colocutaneous fistula remains based on pathological examination after surgical management. These tumours presented an advanced stage and correlated to a poor prognosis. This highlights the interest in screening colonoscopy in front of any digestive symptoms in elderly patients. • This atypical presentation is a rare occurrence, emphasizing the need for clinicians to consider it in cases of painful abdominal wall masses. • The introduction underscores that while medical treatment and radiological drainage may be suggested as first-line treatments for this unusual presentation, emergent surgery becomes necessary if these initial interventions fail. • In the absence of early diagnosis and treatment, the condition could progress to a spontaneous colocutaneous fistula. [ABSTRACT FROM AUTHOR]

Cutaneous vasculitis may behave as a paraneoplastic syndrome. Paraneoplastic vasculitis as a phenomenon of colonic adenocarcinoma has been described in the literature. To the best of my knowledge, this is the first case report of urticarial vasculitis being an initial presentation of signet-ring cell carcinoma of the colon. I here report a case of 27-year-old woman who had rash, arthritis, and episodic bleeding per rectum. The rash was biopsy-proven to be leukocytoclastic vasculitis. There was only partial response to high-dose steroid, and rectal bleeding continued. Colonoscopy revealed a stenosing growth of sigmoid colon, which proved to be signet ring cell carcinoma of the colon. It is important to remain vigilant with regard to the association between leukocytoclastic vasculitis and malignancies.

Chronic or nonhealing wounds is a complex disease influenced by a multitude of factors, such as infection, ischemia, malnutrition, and diabetes and infrequently relates to retroperitoneal carcinoma. We present a case of an adenocarcinoma of ascending colon in a 68-year-old male who had lumbago and waist fistulas with retroperitoneal abscesses preceding other signs or symptoms of colonic malignancy. Supplemental information regarding the diagnosis and treatment of nonhealing wounds and colon carcinoma has also been included in the report. Adenocarcinoma of ascending colon is rarely associated with nonhealing wounds; nevertheless, it should be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term nonhealing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause. [ABSTRACT FROM AUTHOR]

Purpose: Few studies compare management and outcomes of obstructive colonic cancer, depending on the tumor site. We aim to evaluate the differences in patient characteristics, tumor characteristics, and outcomes of emergency surgery for obstructive right-sided versus left-sided colonic cancers.Methods: Between 2000 and 2009, 71 consecutive patients had an emergency colectomy following strict and clear definition of obstruction in a single institution. We retrospectively analyzed pre, per, and postoperative data that were prospectively collected.Results: There were 31 and 40 patients in the right and left group, respectively. Patients aged over 80 were more frequent in the right group (p = 0.03). At operation, ileocecal valve was less often competent in the right group (p = 0.03). The one-stage strategy was more frequent in the right group (p = 0.008). Patients in the right group had a higher rate of nodes invasion (p = 0.04). One- and two-year mortality rate in the right group had a tendency to be higher.Conclusions: Patients presenting with a right obstructive colonic cancer are older, have a more advanced locoregional disease, and are more often treated in a one-stage strategy than patients with a left obstructive tumor. [ABSTRACT FROM AUTHOR]

The etiology of Cronkhite-Canada syndrome (CCS) remains unknown and many cases are refractory to treatment. Therefore, new therapies are urgently needed. Furthermore, a number of CCS cases with gastrointestinal carcinoma have been reported. Our patient had rapid onset of CCS and early development of colon carcinoma associated with adenomas. High anterior resection of the sigmoid colon and ileostomy were performed, and her symptoms and endoscopic and histological findings improved. Helicobacter pylori eradication was carried out 2 years later, surgical closure of an ileal fistula the following year. After 4 months, upper gastrointestinal endoscopy and colonoscopy showed that the CCS lesions had completely disappeared, and biopsies confirmed a normal stomach, duodenum, ileum and colon histologically. The patient has maintained remission for 2 years. The clinical course of this case, showing complete regression of CCS lesions following abdominal colectomy and H. pylori eradication, suggests the significance of H. pylori infection in the treatment of CCS.

Aim: This prospective, randomized comparative study conducted in Kashmir evaluated the clinical profile of colonic carcinoma and the efficacy, side effects and survival advantage of adjuvant treatment with 5FU/CLV versus FOLFOX7. Materials and Methods: Between 2007 and 2009, the clinical profiles of 50 patients enrolled and randomized equally into Arm A receiving 5FU/CLV alone (Mayo Clinic Regimen) and Arm B receiving the FOLFOX7 regimen (including oxaliplatin) were evaluated. Results: Majority of the patients were in the 5 th and 6 th decade of life (males 70% versus females 30%), and most were from urban dwellings. Consumption of red meat, obesity and physical inactivity were common risk factors. A family history of colonic carcinoma was reported in 12% of the patients. Event-free and disease-free survival for the two arms were: Arm A - 12.8 ± 5 months and 14.2 ± 6 months; Arm B - 13.0 ± 6.7 months and 13.1 ± 6 months, respectively. Treatment-related morbidity was significant in Arm B whereas general well being and surrogate laboratory markers including a hemogram, favored Arm A. Conclusion: The clinical profile, risk factors and familial predisposition of Kashmiri colonic carcinoma patients matches that of colon cancer patients elsewhere. There was no added survival advantage by adding oxaliplatin to 5FU and CLV. Although the interim results showed that the Mayo Clinic Regimen has a better total survival advantage compared with the FOLFOX7 regimen, the results were not statistically significant. The Mayo Clinic Regimen was better than the FOLFOX7 regimen in terms of the toxicity profile. However, this finding needs to be studied further. The main idea of conducting this study was to reveal that there is no added advantage of adding oxaliplatin to 5FU and CLV, thereby (a) reducing the toxicity (b) and lowering cost of therapy.

The present study aimed to determine the effect of recombinant DNA vaccine-based human epidermal growth factor receptor-2 (HER2) and Interleukin 12 (IL-12) on the development of colonic carcinoma in mice and the potential immune mechanisms involved. Recombinant plasmids pVAX1-HER2, pVAX1-IL-12 and pVAX1-HER2-IL-12 were constructed, and injected into female mice intramuscularly (i.m.) followed by an electric pulse. The humoral and cellular immune responses after immunization were examined by enzyme linked immunosorbent assay (ELISA) and enzyme-linked immunospot assay (ELISPOT), respectively. To evaluate the anti-tumor efficacy of the plasmids, a mouse model with a HER2-expressing tumor was designed. Mice vaccinated with the HER2-IL-12 plasmid generated the strongest inhibition efficacy on the growth of HER2-expressing tumors and prolonged mouse survival. These observations emphasized the potential of IL-12 as an adjuvant for DNA vaccines and of vaccines based on HER2 and IL-12 as a promising treatment for colonic carcinoma. [ABSTRACT FROM AUTHOR]

Colo-colic intussusception is a rare manifestation of a primary tumour in an adult patient. This article aims to document the rarity of colo-colic intussusception features on the 18 FDG- PET-CT in a patient with primary colonic carcinoma. An 18 FDG-PET-CT was performed for the purpose of pretreatment staging of a colonic carcinoma in a 61-year-old man following a diagnostic colosnoscopic biopsy. He presented with abdominal distension and peri-rectal bleeding for a month. The fused 18 F-FDG PET-CT image revealed an FDG-avid mass in the left hemicolon showing a rim of FDG avidity denoting the head of intussusceptum. There are also multiple FDG-avid nodules seen along the anti-mesenteric colonic fat suspicious for lymph nodes metastasis. Debulking of tumour revealed a mucinous adenocarcinoma of colon with a metastatic lymph node. 18 FDG PET-CT features of intussusception in colonic carcinoma have never been described before. It can potentially become a preferred diagnostic tool in delineating a potential tumour mass within the intussusceptions that help improve prognosis in patients with malignancy [ABSTRACT FROM AUTHOR]

Objective To observe the expression changes in levels of miR-92a in the colon cancer tissues and cells and to explore its clinical significance. Methods ①The relative expression levels of miR-92a in the tissues of 75 patients with stagesⅡwith high risk factors or stagesⅢcolon cancer was detected by real-time q-PCR and was calculated by using the equation 2 -ΔΔCt , and its association with clinicopathological parameter was evaluated. ②HT-29 cells were plated onto 96-well plates and were divided into the experimental group, negative control group, liposome group and control group, each group set up three holes. The experimental group was transfected with miR-92a inhibitor, the negative control group was transfected with miR-92a negative control oligonucleotide, and liposome group was transfected liposome.We detected the expression changes of miR-92a to evaluated the effects of transfection. Then the cells were treated with 50μg/mL oxaliplatin for 24 h, and at different time points (24, 48 and72 h), the culture medium was removed and replaced with culture medium containing 10μL CCK-8 solution. After incubation at 37℃ for 2 h, the absorbance at 450 nm on each well was measured by an enzyme immunoassay analyzer. After the transfection for 48 h and being treated by oxaliplatin for 24 h, the apoptosis rate was detected and measured by TUNEL. Results The expression of miR-92a was significantly higher than that of the normal adjacent mucosa. The expression of miR-92a was not related with gender, age, tumor location, depth of invasion, lymph node metastasis, cancer embolus or tissue differentiation (all P>0.05) , but was related with lo-cal recurrence and distant metastases (P<0.05). The experimental groups' A value of HT-29 were lower and the apoptosis rate was higher as compared with that of the other three group at different time points (24,48 and 72 h) after transfection (all P<0.05). Conclusions The expression of miR-92a in the colon cancer tissues is increased. The relative expression of miR-92a in the colon cancer tissues is related with local recurrence and distant metastases.Suppressing the expression of miR-92a can increase the chemosensitivity of colon cancer cells. [ABSTRACT FROM AUTHOR]

Objective To construct the lentiviral vector co-expressing human miR-200c gene and luciferase, and establish a stable colorectal cancer multidrug resistance (MDR) cell model , in order to lay an experiment foundation for exploring the function of miR-200c in MDR. Methods miR-200c gene was cloned into the lentiviral vector (pGC-Lentivir-us), which was verified by PCR and sequencing analysis. After sequencing, we made lentiviral vector and titer test.Using cell transfection technique, miR-200c lentiviral vector was infected into MDR cell line HCT-116/L-OHP. A nude mouse model of colorectal MDR cancer was established by subcutaneous inoculation of this kind of cell; meanwhile, the empty vector was taken as the control group. Experimental nude mice were randomly divided into 4 groups after 2-week tumor-growth. Mice in the control group were administered with normal saline daily. Mice in the experiment group were administered with oxaliplatin (L-OHP). After treatment for 4 weeks, mice in each group were sacrificed to measure tumor volume. Results The best titer was 2 ×108 TU/mL.The qPCR showed that the levels of miR-200c mRNA expression in the resistant cells of human colon cancer which were transfected by miR-200c-Lentivirus were significantly higher than those in the empty vector group and the blank control group (all P<0.01). In vivo imaging confirmed that HCT-116/L-OHP-miR-200c-luc cells with luciferase could be tested quickly and sensitively, and could be used to watch the tumor growth. Com-pared with HCT-116/L-OHP-luc group, HCT-116/L-OHP-miR-200c-luc group showed more sensitive to L-OHP (P <0.05). Conclusion The lentiviral screening vector with human miR-200c gene is successfully constructed, which realizes the stable integration of the recombinant in the human colon cancer HCT-116/L-OHP MDR cells; meanwhile, its MDR colon cancer animal models which have miR-200c overexpression with luciferase are successfully constructed. [ABSTRACT FROM AUTHOR]

Colonic tuberculosis may masquerade colonic carcinoma. Also, intestinal tuberculosis may mimic colonic carcinoma, Crohn's disease, ulcerative colitis, etc. A 40 years female was diagnosed with cervical carcinoma FIGO Stage IIB underwent chemo-radiotherapy. She was symptom-free for a few months and then she developed right-sided abdominal pain and abdominal fullness for 4 months. She underwent a colonoscopy that showed ulcerative growth and friable tissue in hepatic flexure of colon and histopathology and immunohistochemistry findings suggested non-Hodgkin's lymphoma or poorly differentiated carcinoma. Then right standard hemicolectomy was performed and histopathology showed tuberculosis. The patient received medications for tuberculosis and the patient improved. Preoperatively suspected colonic carcinoma in developing countries (where the prevalence of tuberculosis is high) may sometimes come out as colonic tuberculosis in histopathology. The biopsy sample taken from colonoscopy was examined by histopathology, which showed nonspecific results, and the case was mistakenly thought of as colonic carcinoma preoperatively. The case underwent right standard hemicolectomy and to the surprise, the excised specimen came out as tuberculosis. The patient received anti-tubercular drugs and the patient is symptomatically better. Colonic tuberculosis can mimic colonic carcinoma. Histopathology will confirm colonic tuberculosis and response to anti-tuberculosis drugs will verify the diagnosis. Though a patient undergoing chemotherapy may develop lymphoma, colonoscopic biopsy may not be conclusive. In any symptomatic patient with colonic stricture, surgery is the treatment of choice. • The clinical presentation of colonic carcinoma and colonic tuberculosis may be the same preoperatively. • Colonic tuberculosis may masquerade as colonic carcinoma, Crohn's disease or ulcerative colitis. • Histopathological diagnosis is required to confirm abdominal tuberculosis when in doubt. • Response to anti-tubercular drugs verifies the diagnosis of tuberculosis. [ABSTRACT FROM AUTHOR]

Recent treatment advances now allow a realistic chance of cure in selected patients with metastatic colorectal carcinoma (CRC). Accurate pre-treatment staging is crucial to ensure appropriate management by identification of patients with more advanced disease who will not benefit from surgery. Fluorine 2-fluoro-2-deoxy- d-glucose positron emission tomography-computed tomography (PET-CT) has a firmly established role in staging, restaging, and recurrence detection of a range of tumors. This article will review the role of PET-CT in patients with CRC with a particular emphasis on optimizing the technique in patients with potentially operable metastatic disease. [ABSTRACT FROM AUTHOR]

Background: PGP 9.5 is a cytoplasmic protein and is a specific marker for neurites and neurons. Aims: Using anti-PGP 9.5, this study aimed to localize nerve fibers in normal colons, polyps, adenomas and adenocarcinomas. Methods: Colonic polyps, adenomas and T to T adenocarcinomas with adjacent normal colon were immunostained for PGP 9.5 using rabbit anti-PGP 9.5. Results: In normal colon, numerous nerve fibers were localized in inner and outer muscles, from which submucosa and lamina propria were innervated. In hyperplastic polyps and tubular adenomas, the stalk revealed Meissner's plexus and large-diameter nerve fibers, and fine nerve fibers innervated abundantly in lamina propria of hyperplastic polyps and small tubular adenomas. In villous adenomas, large-diameter nerve fibers and Meissner's plexus were localized in the stalk whereas a few or no fine nerve fibers were localized in fine stroma. In adenocarcinomas, more fine fibers were localized in submucosal stroma adjacent to the invading carcinoma in T carcinomas but there were no nerve fibers in the midst of tumors in T and T carcinomas. There were focally and sporadically increased nerve fibers adjacent to invading cancer nests in 5 of 8 T cases. In T carcinomas, fragmented Auerbach's plexus were noted in cancer-invaded colonic muscles and there were no increased fine nerve fibers in the cancer-invaded subserosa in the majority of cases. PGP 9.5 immunostaining revealed tumor-associated neurogenesis in submucosa but no obviously increased nerve fibers within cancer-invaded muscles. Conclusions: This lack of tumor-associated neurogenesis supports insidious and often silent clinical presentation of colonic carcinomas until invading through the colonic wall to adjacent organs. [ABSTRACT FROM AUTHOR]

Abstract: The novelty of this work derives from the use of nitrogenous heterocycles as building block in the synthesis of conjugate bile acid derivatives. New piperazinyl bile acid derivatives were synthesized and tested in vitro against various human cancer cells (GBM, KMS-11, HCT-116). The best pro-apoptotic activity was obtained with N-[4N-cinnamylpiperazin-1-yl)-3α,7β-dihydroxy-5β-cholan-24-amide (7b) and N-[4N-cinnamyllpiperazin-1-yl)- 3α,7α-dihydroxy-5β-cholan-24-amide (7c) on these human cancer cell lines (IC50: 8.5–31.4μM). This activity was associated with nuclear and DNA fragmentation, demonstrating that 7b induces cell death by an apoptotic process as 7c. This study shows the possibility of hydrid heterocycle-steroids as new anticancer agents with improved bioactivity and easy to synthesize. [Copyright &y& Elsevier]

Background: Although metabolic syndrome (MS) has received a lot of attention in recent years, the correlation between MS and colorectal carcinoma is still not very clear. This study aims at exploring the relationship between MS and colorectal carcinoma. Methods: Data was collected from 507 cases of colorectal carcinoma and 507 cases of healthy patients between January 2002 and March 2007 to establish the database. The patients with colorectal cancer were divided into two groups based on the presence of MS. Multivariate analysis of these data for the overall survival and recurrence was performed with the Cox proportional hazard model. Variables examined by multivariate analysis were sex , age, location, histotype, differentiation, tumour, node, metastasis (TNM) stage, the number of lymph nodes detected, etc. Results: The existence of MS in the colorectal carcinoma group was clearly more than that in the control group. The existence of two to four types of abnormal metabolic diseases was significantly more in the colorectal cancer group than in the control group. MS is one of the important elements that can independently influence the survival (odds ratio (OR) = 1.501, 95% confidence interval (CI) = 1.057–2.131) and have the highest risk with worse survival compared with other parameters. Conclusion: There is a close relationship between MS and colorectal carcinoma, and MS is a significantly independent element that influences the survival of the colorectal carcinoma. Decreasing the incidence of MS maybe play a role in improving therapeutic efficacy and prognosis of the cancer. [ABSTRACT FROM AUTHOR]

Aims: Local peritoneal involvement (LPI) and extramural venous invasion (EMVI) are of prognostic value in Dukes’ B colonic cancers and may be used to select patients for adjuvant chemotherapy. There is marked variation in the frequency with which they are reported however, ranging from 7% to 39% and 10% to 90%, respectively. A grading system for diagnosing LPI has been proposed by Shepherd et al. and partially incorporated into the Royal College of Pathologists guidelines for reporting colorectal cancer. This study aimed to determine the degree of interobserver variation in the reporting of LPI and EMVI amongst a group of experienced pathologists with a special interest in gastrointestinal pathology. Methods and results: Four pathologists specialising in gastrointestinal pathology independently assessed LPI according to the grading system described by Shepherd et al. and the presence or absence of EMVI on 138 and 131 slides of pT3 and pT4 colonic cancers, respectively. Kappa statistics were performed to assess interobserver agreement. Kappa values for LPI ranged from κ = 0.74 (substantial agreement) to κ = 0.89 (almost perfect agreement). Kappa values for EMVI ranged from κ = 0.29 (poor agreement) to κ = 0.59 (moderate agreement). Conclusions: Using Shepherd’s grading system there was good agreement between pathologists in reporting LPI in colonic carcinomas. The reporting of EMVI in colonic carcinomas on haematoxylin and eosin-stained slides had only poor to moderate agreement however, even amongst gastrointestinal pathologists working together in a single unit. Introduction of standardized criteria and/or the use of an elastin stain in the diagnosis of EMVI may assist in improving interobserver agreement. [ABSTRACT FROM AUTHOR]

Abstract: Nonbacterial thrombotic endocarditis (NBTE) is a well-known complication of hypercoagulable states, particularly in patients with malignancies. Its complications comprise thrombembolism rather than valvular dysfunction. We present a case of a 71-year-old man treated for colonic carcinoma, who died 1 month after tumor resection with clinical signs of respiratory failure. Ante mortem, there was no suspicion of cardiac disease. The autopsy revealed NBTE affecting all four cardiac valves simultaneously, as well as multiple systemic and pulmonary thrombemboli. Microscopically, neither microorganisms nor inflammation were found in the thrombi and/or valve tissues. To the best of our knowledge, this is the fourth case of quadri-valvular NBTE reported in the English-written literature so far. [Copyright &y& Elsevier]

Berberine is the major constituent of Coptidis Rhizoma with multiple pharmacological activities, including anti-inflammation, promotion of apoptosis and anticancer potential effect. Mitogen-activated protein kinase (MAPK) and reactive oxygen species (ROS) may contribute to the causal relationship between tumorigenesis and pro-apoptotic function. Berberine is studied for the mechanism of its action in apoptotic pathway in human colonic carcinoma cell. Treatment of SW620 cells with 50 μM berberine resulted in activation of the caspase 3 and caspase 8, cleavage of poly ADP-ribose polymerase (PARP) and the release of cytochrome c; whereas, the expression of BID and anti-apoptosis factor c-IAP1, Bcl-2, and Bcl-XL were decreased markedly. Berberine-induced, dose-dependent induction of apoptosis was accompanied by sustained phosphorylation of JNK and p38 MAPK, as well as generation of the ROS. Furthermore, the induction of apoptosis was alleviated by inhibitors specific for JNK and p38. In addition, there was an increase in the cellular levels of phospho-c-Jun, FasL and t-BID in the berberine-induced apoptosis via the activation of JNK and p38 signaling modules. NAC administration, a scavenger of ROS, reversed berberine-induced apoptosis effects via inhibition of JNK, p38 and c-jun activation, and FasL and t-BID expression. These results leads us to speculate that berberine may play an apoptotic cascade in SW620 cells by activation of the JNK/p38 pathway and induction of ROS production, providing a new mechanism for berberine-induced cell death in human colon cancer cells. [ABSTRACT FROM AUTHOR]

Abstract: Methotrexate action in viable cells was monitored by registering changes in EGFP (Enhanced Green Fluorescent Protein) fluorescence intensity. Treatment with 1 μM methotrexate for 48 h of human colorectal adenocarcinoma C85 cells, stably transfected to express EGFP, caused 5-fold increase in EGFP fluorescence assayed by flow cytometry with no distinct increase in EGFP protein level. This was correlated with morphological changes, including an increase of cell granularity and cell shape flattening, as well as cell cycle G1 phase arrest revealed by DNA content analysis. Methotrexate removal allowed the morphology of the cells in culture to revert in 10 days to normal. The cells that survived methotrexate exposure were propagated as C85r cell subline and displayed kinetics of methotrexate sensitivity parallel to that of the parental C85 line. As the increase in EGFP fluorescence could also be visualized by fluorescence microscopy, this reporter system may be employed to image methotrexate action in cancer cells in living models. [Copyright &y& Elsevier]

Aims: To follow and compare immunohistochemical expression of epidermal growth factor receptor (EGFR) in tumour cells during the entire natural history of colonic carcinoma, from primary tumour to paired lymph node and sequentially resected liver metastases; and to test interobserver reproducibility of EGFR analysis. Methods and results: Forty patients had resection of colonic adenocarcinoma (27 with metastatic lymph nodes) and at least one partial hepatectomy (PH) for liver metastases; a second and a third PH were performed, respectively, in 14 and three patients; seven patients had tumour liver biopsy. EGFR immunohistochemistry ( n = 130) was analysed independently by two pathologists. EGFR expression (membranous staining detected in ≥ 1% of tumour cells) was detected in 38/40 colonic carcinomas, 23/26 lymph nodes and 51/64 liver metastases. Both primary tumours and related metastases were EGFR+ in 28 patients (73%). Discrepancies were found in EGFR status between liver and lymph node (23%) and among the different liver samples (31%). Interobserver agreement was very good (intraclass correlation coefficients of 0.81, 0.91 and 0.85, respectively, for interpretation of staining in colon, lymph node and liver metastases). Conclusions: Since immunohistochemical detection of EGFR remains a prerequisite for EGFR-targeted therapy eligibility, different tumour samples should be tested to allow every patient a chance to take advantage of this treatment. [ABSTRACT FROM AUTHOR]

Abstract: Arsenic trioxide (As2O3) is highly efficacious for acute promyelocytic leukemia (APL). Environmental arsenic exposure predisposes to malignancies, but the risk for therapeutic arsenic is undefined. Three APL patients (de novo, 2; therapy-related, 1) in a cohort of 59 cases given oral-As2O3 for induction and maintenance treatment developed secondary cancers (nasopharyngeal carcinoma, 2; colonic adenocarcinoma, 1) at 16, 36 and 55 months post-As2O3 therapy. Retrospective analysis of biomarkers (Epstein Barr virus serology and quantification, carcinoembryonic antigen) showed the potential presence of cancers before or shortly after As2O3 therapy, suggesting that As2O3 had not initiated these malignancies. Compared against matched background population, there was an increased risk of second cancer (p =0.012, standard incidence ratio=6.5; 95% confidence interval=1.4–19.0). [Copyright &y& Elsevier]