Search

Background and Objectives The clinical meaning of mucinous type of colonic and rectal carcinoma is still controversial. We used clinicopathological and follow-up data prospectively recorded for our series of colon and rectum cancer to compare 2 matched groups of mucinous and nonmucinous cancer patients. Methods Two-hundred-forty-eight patients operated for colon and rectum cancer between January 1986 and January 1997 were considered. Thirty-six patients showed mucinous pattern on histologic examination but only 29 (11.7%) had more than 50% of mucin-secreting acini and could be classified as mucinous type. The 29 mucinous cancer patients were compared with 212 nonmucinous cancer patients to evaluate differences in epidemiological and clinical features. A control group from the nonmucinous patients was sorted by matching for age, sex, location, and Dukes stage. Results In the case-control groups, survival was better for nonmucinous than for mucinous tumours. Many of the epidemiological findings already observed for mucinous carcinoma were also confirmed. Conclusions The existence of prognostic, clinical, and epidemiological differences between mucinous and nonmucinous colorectal carcinoma, together with the preliminary reports about their difference as to genetic features, could support the hypothesis that mucinous type is a distinct biological entity. J. Surg. Oncol. 2000;73:70–74. © 2000 Wiley-Liss, Inc.

Microtubules are involved in cell growth and division, motility, signalling and in the development and maintenance of cell shape. Consequently, the non-equilibrium dynamics of these microtubules can be crucial to cellular function, including cancer development. Although the involvement of tubulins in human development has been well investigated, the role of alpha- and beta-tubulins in human tumorigenesis still remains controversial. The aim of this study was to investigate alpha- and beta-tubulin protein expression in rectal cancer development.By immuno-histochemistry, using alpha- and beta-tubulin monoclonal antibodies, 66 patients were examined, 32 of whom (22 male, 10 female; range 31-60 years, mean age 49.5 years) had preneoplastic lesions discovered during endoscopic surveillance, which were classified as mild, moderate and severe dysplastic polyps of the rectum, and 34 had invasive adenocarcinomas (24 male, 10 female; range 39-60 years, mean 52 years) of the rectum, with no local or distant metastases at the time of surgical resection.In preneoplastic lesions, no statistically significant relationship was found among alpha- and beta-tubulin protein expression, grade of dysplasia, or other clinical data. Statistical association among alpha- and beta-tubulin immunoreactivity and Dukes' stages B and C was found with p = 0.017 and p = 0.009, respectively. No statistical relationship was found between alpha- and beta-tubulin protein expression among different grades of dysplasia. On the contrary, a significant relationship was detected among tubulins in different stages of cancer.In this preliminary study a significant difference of alpha- and beta-tubulin protein expressions was found in polyps and invasive cancer of the rectum, indicating a possible role of tubulins in invasive, but not in preinvasive cancer development. This preliminary data suggest the possibility of performing alpha- and beta-tubulin protein expression in order to identify B stage versus C stage rectal cancer, before surgical treatment.

Genetic epidemiological studies have shown that the pathogensis of various neoplasias is due to defects in specific genes and the growth to multiple consequent genetic mutations.

The Authors consider whether it is possibile to classify and stage colo-rectal cancer not only on the grounds of its diffusion, histotype and grading, but also on the grounds of its biological expression.

The authors report a case of HIV-1 infection, primary miliary tuberculosis of the lung and secondary intestinal tuberculosis complicated with multiple intestinal perforations. The surgical emergency therapy, supported by specific antitubercular drugs, antibiotics, and total parenteral nutrition, consisted in suturing seven perforative sites of the small and large intestine. The Authors stress the possibility that in the future tubercular complications up till now considered atypical may become more and more frequent because of the HIV-1 infection association.

The evaluation of serial plasma carcinoembryonic antigen (CEA) levels is one of the most important parameter used to establish the prognosis of surgically cured colorectal cancer patients. Carcinoembryonic antigen is particularly useful in the identification of recurrences and metastasis. However, to improve the usefulness of this assay, it would be helpful to accurately determine, if possible, those patients whose cancers produce CEA. The evaluation of the presence of CEA in these cancer specimens by means of immunoperoxidase staining technique does seem to improve the sensitivity of the CEA test. Fifty-seven patients with colorectal cancer who underwent surgical treatment were studied. Tissue CEA evaluation was correlated with the plasma CEA levels, the pathologic stage and grade, and histologic type of the cancers. Results demonstrate that 66.6% of Dukes' B cancers, 78.9% of Dukes' C, and 77.7% of Dukes' D cancers stained positively for CEA by immunoperoxidase. Thirty of 57 patients with preoperative pathologic plasma CEA levels had positive tissue CEA, whereas 8/57 patients did not. Of patients with a well-differentiated cancer (G1), 81.4% had positive tissue CEA versus the 64% of G2 and 60% of G3 cancers. The authors conclude that the use of the immunoperoxidase stain to measure CEA in tissue, so that the CEA serum assay may be used in those patients known to produce CEA, results in a major increase in the sensitivity of the test.

We study the presence of Carcinoembryonic antigen (CEA) on 39 colorectal polyps by the immunoperoxidase technique. The histological examination demonstrated 15 tubular adenomas, one villous adenoma, two tubulo-villous adenomas, six tubular adenomas with slight dysplasia, one tubular adenoma with moderate dysplasia, four tubular adenomas with severe dysplasia, three tubulo-villous adenomas with severe dysplasia, five tubular adenomas with neoplastic degeneration, and two tubulo-villous adenomas with neoplastic degeneration. Twenty-eight of thirty-nine polyps (71.79%) showed a positive staining reaction for CEA. Regarding the intensity of the reaction (classified as absent or negative [-], slightly positive [+], and markedly positive [+ +]), 11/39 polyps presented a negative reaction (28.21%), 19/39 (48.71%) presented a slight reaction, and 10/39 polyps (25.64%) presented a marked reaction. Results demonstrated a higher intensity of the staining reaction in severely dysplastic polyps and in neoplastic degeneration. In conclusion, it is possible that the presence of CEA can be useful to show an initial cellular restlessness of certain polyps.

Mismatch repair gene hMSH2 is involved in correction of mispairing during replication and its mutation is associated both with microsatellite instability and with hereditary colorectal cancer. We evaluated its involvement in sporadic colorectal cancer tumorigenesis too.The protein expression pattern of hMSH2 was evaluated on 29 cases of resected sporadic adenocarcinoma using an immunohistochemical approach.In 14 cases, lack of hMSH2 protein expression was observed in adenocarcinoma and in peritumoral mucosa. In 12 patients, hMSH2 resulted in strong expression in the tumour as well as in the surrounding mucosa and at distant mucosa. In three cases, hMSH2 protein expression in tumoral, adjacent and at distance normal mucosa resulted negative.Repair genes could play an important role in tumour progression and in sporadic colorectal cancer. Detection of protein expression by immunohistochemistry may be a method to select tumours for successive genetic investigations.