A. Brouquet

Carcinogenèse colorectale: 1. Prédispositions héréditaires et cancer colorectal

Resume Les cancers colorectaux sporadiques representent 70 a 80 % des cancers colorectaux (CCR). Les deux formes familiales les mieux definies, la polypose adenomateuse familiale (PAF) et le syndrome HNPCC (pour « Hereditary Non Polyposis Colorectal Cancer ») representent respectivement moins de 1 % et 2 a 3 % des CCR. Entre ces syndromes genetiques rares (PAF, syndrome HNPCC, polyposes hamarthomateuses) dus a des mutations dans des genes majeurs de predisposition (gene APC , gene MMR , BMPR1A , SMAD4 …) et dans lesquels les facteurs environnementaux jouent un role tres faible, et les formes sopradiques, environ 25 % des CCR a composante hereditaire restante sont probablement lies a des alleles a faible penetrance ( APC*I1307K , TGF R1*6Ala …) avec une forte implication des facteurs environnementaux.

Un pseudo-kyste pancréatique responsable de trois complications hémorragiques simultanées

The onset of secondary hemorrhagic complications with the development of pancreatic pseudocysts is rare but has a high mortality rate. Management of the hemorrhagic complications of pancreatic pseudocysts is surgical despite the contribution of arterial embolization. We report the observation of a 59-year-old patient who had presented an episode of acute pancreatitis 1 month before consulting for abdominal pain associated with an episode of melena. The CT showed a pancreatic pseudocyst complicated by an intracystic tear, a splenic artery aneurysm in the Wirsung canal, and rupture of the spleen. These three lesions were treated simultaneously with left splenopancreatectomy starting with the splenic vessels. The simultaneous onset of three hemorrhagic complications of a pseudocyst is exceptional and has never been described to our knowledge.The onset of secondary hemorrhagic complications with the development of pancreatic pseudocysts is rare but has a high mortality rate. Management of the hemorrhagic complications of pancreatic pseudocysts is surgical despite the contribution of arterial embolization. We report the observation of a 59-year-old patient who had presented an episode of acute pancreatitis 1 month before consulting for abdominal pain associated with an episode of melena. The CT showed a pancreatic pseudocyst complicated by an intracystic tear, a splenic artery aneurysm in the Wirsung canal, and rupture of the spleen. These three lesions were treated simultaneously with left splenopancreatectomy starting with the splenic vessels. The simultaneous onset of three hemorrhagic complications of a pseudocyst is exceptional and has never been described to our knowledge.

Carcinogenèse colorectale: 2. Mécanismes génétiques et épigénétiques de la progression tumorale et classification moléculaire des cancers colorectaux

Resume Les alterations des genes impliques dans la carcinogenese colorectale sont sous-tendues par trois grands mecanismes: l’instabilite chromosomique, l’instabilite des microsatellites et les mecanismes epigenetiques (hypermethylation des ilots CpG des promoteurs). Les progres dans la comprehension de ces mecanismes d’instabilite genetique et epigenetique ont permis une avancee vers l’individualisation et la caracterisation de sous-groupes de tumeurs colorectales plus homogenes quant a leur voie de progression, leur pronostic et leur eventuelle reponse au traitement.

New Neoadjuvant Chemotherapy for Resectable Liver Metastases of Colorectal Cancer

Surgical resection is the only method for treating colorectal liver metastases, because it can ensure long-term survival and cure in some patients. Only approximately 20 % of colorectal cancer patients with liver metastases can undergo liver resection at the time of diagnosis. Modern chemotherapy regimens are received by other patients, which could achieve high response rates but are insufficient for cure. Recurrences are observed in the majority of patients who undergo liver resection despite developed surgical technique and improved surgical skills. Many patients with resectable metastases undergo neoadjuvant chemotherapy before liver resection. Its benefit in terms of long-term disease control has been recently demonstrated, but neoadjuvant chemotherapy has also potential disadvantages, in particular chemotherapy-associated liver injury.

The accuracy of preoperative imaging in measuring the length of the ileocolic segment affected by Crohn's disease: a prospective cohort study

The study aimed to evaluate the accuracy of imaging for measurement of the length of the ileocolic segment affected by Crohns disease.