Antonios Michalopoulos

Prognostic significance of mucinous component in colorectal carcinoma

BackgroundMany factors influence survival in colorectal cancer patients, one of them is the mucinous component of the tumour. Mucinous adenocarcinoma is characterized by the extracellular mucin of more than 50% of the tumour volume.MethodsFrom 1970 to 1999, 1160 patients were admitted to our clinic for colorectal cancer. They were divided into four groups according to mucinous character of the tumour, in two time periods of 15 years.ResultsThere was an increase in the incidence of mucinous tumours from 20.8 to 30.5% in the second period. These tumours were more advanced (Dukes’ C) and especially right sided (34.5% vs. 17.9%). Five-year survival was increased during the second period but was of a lesser degree in the mucinous group (51.5% vs. 65.5%).ConclusionsColorectal mucinous carcinomas present at a more advanced stage, predominantly in men, with higher right colon location rate, and a worse overall 5-year survival rate than the non-mucinous colorectal cancers.

Synchronous and metachronous colorectal carcinoma

BackgroundSynchronous and metachronous colorectal carcinoma have an incidence of 2–10%. The purpose of the study was to evaluate the clinical characteristics, the accuracy of diagnostic examinations and the survival of these patients.MethodsFrom 1970 to 1999, 1160 patients with colorectal cancer were admitted to our Department. During follow-up examination 50 patients (4.3%) were found to present with multiple primary colon cancers. Fifty-two per cent were synchronous and 48% metachronous tumours.ResultsThe overall 5-year survival of the patients was 45.87%. Mortality was 10% for multiple primaries, while in patients with single cancer was 4.1%. The overall 5-year survival of the patients with multiple primaries tumours was 46.67%.ConclusionsPatients with colorectal cancer must be fully studied endoscopically. There has been an improvement in survival in recent years due to better surgical techniques, the introduction of more sophisticated examination methods and the meticulous follow-up of patients at risk.

Colorectal cancer in patients over 70 years of age: determinants of outcome.

BackgroundThe aim of this study was to evaluate operative risk factors, the mortality, morbidity and survival in old patients with colorectal cancer.MethodsFrom 1160 patients with colorectal cancer, 398 patients aged 70 years or older, from 1970 to 2000, were followed-up. Dukes’ classification, differentiation, sex, anatomical site and survival were compared with patients <70 years old.ResultsLong-term results have been proved to be similar both in young and old patients. Relative survival rate for patients aged 70–95 (70.5%) were similar to those for patients less than 70 years old (71.6%) and also comparable between male (72.3%) and female (68%) patients.ConclusionsElderly patients have a lower capacity to react to postoperative complications, but the relative survival is similar to younger patients. Advanced age alone should not be used as a criterion to deny surgery for colorectal cancer.

Ciliated hepatic foregut cyst communicating with the gallbladder

Dear Editors: Ciliated hepatic foregut cyst (CHFC) has previously been considered to be a rare lesion. However, in the last 15 years, the advent of radiological procedures has resulted in the publication of a number of case reports as well as three case series [1, 3, 4], suggesting that this entity has been underreported because it is usually asymptomatic. CHFC has a strong predilection for segment IV of the liver (medial segment of left lobe) and is lined by respiratory-type epithelium, similar to that seen in bronchogenic and esophageal cysts. Therefore, CHFC is believed to be of maldevelopmental origin, arising from remnants of the embryonic foregut, which, in addition to the liver, also forms the tracheobronchial tree, esophagus and other organs. Review of the literature has disclosed seven cases of CHFC located in the gallbladder wall [1, 2]. No communication between the cyst and the gallbladder lumen was found in any of these cases. To our knowledge, this is the first report of a CHFC connected to the gallbladder through a patent duct. A 39-year-old woman presented with colicky pain in the right upper quadrant of the abdomen, which was accompanied by nausea. There was no fever or jaundice. Murphy’s sign was positive. The patient’s past medical history was remarkable for appendectomy at 18 years of age and lithiasis of the right kidney at 19 years. Laboratory findings on admission were unremarkable, including: white blood cell count 7320 per mm, hematocrit 44.9%, hemoglobin 14.9 g/dl, platelets 221 10 per mm, bilirubin 0.69 mg/dl, aspartate aminotransferase 19 U/l (nl: 0–37 U/l), alanine aminotransferase 16 U/l (nl: 0–41 U/l), alkaline phosphatase 58 U/l (nl: 40–129 U/l), gamma glutamyl transferase 23 U/l (nl: 8–61 U/l), albumin 3.99 g/dl and globulin 2.67 g/dl. Testing for hepatitis B surface antigen and hepatitis C antibody was negative. Serum levels of carcinoembryonic antigen, CA 19–9 antigen and CA 50 antigen were within normal ranges. Abdominal ultrasonography showed a cystic structure in the liver measuring 64 31 mm. The gallbladder and large bile ducts appeared normal. No other pathology was noted. Abdominal computed tomography scan suggested that the cystic structure was multilocular and was closely associated with the gallbladder (Fig. 1A). On magnetic resonance imaging, the cyst was localized in segment V of the liver, in close relation to the gallbladder, and measured 51 50 mm. On surgery, it was found that the gallbladder and the cyst communicated through a short duct measuring approximately 2 cm, which was located at the junction of the body and neck. An additional duct, connecting the cyst with the cystic duct, was visualized on intraoperative cholangiography. The cyst contained bile and bile sludge. The gallbladder, its connection to the cyst and portions of the cyst wall were resected. The common bile duct was explored and was found to be free of stones or bile sludge; a Kehr T-tube was placed. A portion of omentum was then placed in the residual cavity. No stones were identified within the gallbladder. On gross examination, the gallbladder measured 7.5 2.7 cm, had a wall thickness of 0.3 cm and was lined by velvet-like, green-tan mucosa with yellow specks. The connecting duct, measuring 0.1–0.2 cm in diameter, was identified. The portions of cyst wall that were received for examination were flat, gray-tan tissue fragments, measuring up to 3.1 cm in greatest dimension. Histological examination showed a multilocular cyst with a fibrous wall, which was lined by ciliated, pseudostratified, columnar epithelium (Fig. 1B). Occasional goblet cells were present. The fibrous tissue contained T. Koletsa · V. Tzioufa · P. Hytiroglou ()) Department of Pathology, Aristotle University Medical School, 540 06 Thessaloniki, Greece e-mail: phitir@med.auth.gr Tel.: +30-231-0999218 Fax: +30-231-0999229

Acute appendicitis secondary to Enterobius vermicularis infection in a middle-aged man: a case report.

IntroductionAcute appendicitis due to Enterobius vermicularis is very rare, affecting mostly children. Whether pinworms cause inflammation of the appendix or just appendiceal colic has been a matter of controversy.Case presentationA Caucasian 52-year-old man was referred to our Emergency Department with acute abdominal pain in his right lower quadrant. The physical and laboratory examination revealed right iliac fossa tenderness and leukocytosis with neutrophilia. An open appendectomy was performed. The pathological examination showed the lumen containing pinworms. Two oral doses of mebendazole were administered postoperatively. The follow-up to date was without incident and he was free of symptoms one year after the operation.ConclusionThe finding of E. vermicularis in appendectomy pathological specimens is infrequent. Parasitic infections rarely cause acute appendicitis, especially in adults.One should keep in mind that the clinical signs of intestinal parasite infection may mimic acute appendicitis, although rare. A careful evaluation of symptoms such as pruritus ani, or eosinophilia on laboratory examination, could prevent unnecessary appendectomies.

Colonic cancer in a patient with intestinal malrotation: a case report

We present a case of a 76-year-old patient with intestinal malrotation, with incomplete rotation of the small intestine and abnormal positioning of the duodenum and superior mesenteric vessels over the transverse colon. Furthermore, the patient suffered of a concomitant cancer of the ascending colon.

Surgical treatment of haemorrhoids with the use of the circular stapler and open haemorrhoidectomy. A comparative study

Abstract The surgical treatment of haemorrhoids with the use of a circular stapler is a novel method. A comparative retrospective study of two groups of patients treated surgically for third- and fourth-degree haemorrhoids was conducted. Fifty patients (group A) underwent a surgical intervention with the circular stapler in the rectal mucosa 4 cm above the dentate line. In another group of 50 patients (group B), the standard open haemorrhoidectomy (Milligan-Morgan) was carried out. The new method (group A) compared with the standard haemorrhoidectomy (group B) was found to be less time consuming (mean time, 10±2 minutes vs. 35±5 minutes, p<0.001). The majority of patients (28) in group A experienced mild pain (VAS, 3–5) while pain for the majority of patients in group B was 5–7 on the VAS scale (p<0.01). The duration of postoperative hospitalisation was 1±1 days for the patients of group A and 5±2 days for the patients of group B (p<0.05). The early postoperative bleeding rate was 6% in group A and 12% in group B (p<0.01). None of the patients of group A developed incontinence and 6 (12%) patients in group B developed mild liquid incontinence during the first postoperative month. During the period of follow-up (12 months to 3 years, median length 18 months in outpatient visits), no patient in either group developed recurrence of haemorrhoids or rectal prolapse. In conclusion, the surgical treatment of haemorrhoids with the circular stapler seems to be an efficient alternative to the standard open haemorrhoidectomy when this is indicated.

Calcifying Fibrous Tumor: Review of 157 Patients Reported in International Literature.

Abstract Calcifying fibrous tumor (CFT) is a benign lesion characterized by its specific histological findings and is found as solitary or multiple lesions in several locations of the human body. The aim of the present systematic review is to give a detailed account of all reported cases of CFT in the literature and to analyze the available data, to completely characterize the entity from epidemiological, medical, and surgical aspects. A bibliographic research was performed from 1988 until 2015. A database with the patients’ characteristics was made, including sex, age, location of the tumor, symptoms, symptoms duration, size of the tumor, diagnostic methods, treatment, metastasis, and follow-up. A total of 104 articles were identified, reporting 157 cases of CFT. Mean age of patients was 33.58 years and the ratio between men and women was 1:1.27. The most common locations of CFT were stomach (18%), small intestine (8.7%), pleura (9.9%), mesentery (5%), and peritoneum (6.8%). Mean diameter of the tumor was estimated 4.6 cm. The correlations proceeded showed that as age increases, size decreases (P = 0.001) and that the tumor is larger in females (P = 0.027). Kruskal-Wallis test showed that the larger tumors appear in the neck and adrenal gland (P = 0.001). The percentage of asymptomatic patients was 30.57%. Computed tomography and biopsy were the most common tests for the diagnosis of CFT. Open surgical procedure was performed in the majority of cases. The median hospitalization was 6.06 days and the mean follow-up period was 29.97 months. Recurrences were mentioned in 10 of 96 patients with available data. No deaths owing to CFT were mentioned in the literature. CFT should be included in the differential diagnosis of enlarging mass revealed by clinical or imaging examination either incidentally or after specific acute or chronic symptomatology.

Chronic constipation due to presacral teratoma in a 36-year-old woman: a case report

IntroductionTeratomas of the sacrococcygeal area are usually diagnosed in infancy and are rarely seen in adults.Case presentationWe report the case of a 36-year-old Greek woman experiencing chronic constipation due to a benign presacral teratoma. Imaging examinations showed a pelvic mass without evidence of malignancy. An ovoid tumour with a maximum dimension of 6 cm was surgically removed. A histologic examination revealed a mature cystic teratoma. Two years after surgery, the patient is well, with no evidence of recurrence and no constipation.ConclusionSacrococcygeal teratomas are rare in adults. A high index of suspicion is important in making an early diagnosis. Rectal examination and radiologic evaluation are also valuable.

Groin swelling, the anatomic way out of abdominal haematomas: a case report and explicative literature review.

Abstract This case report concerns a previously healthy thirty-five-year-old female with complaints of inguinal hernia that ultimately proved to be a retroperitoneal haematoma. The patient suffered from a car accident 5 months before admission and was hospitalized. During her prior hospitalization, explorative laparotomy revealed a haematoma of the mesentery. The haematoma was treated conservatively, with fluid resuscitation and rest. During her second admission, MRI of the inguinal region revealed localized haematoma. During inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free-flowing, non-clotting blood. The postoperative course was uneventful, and the patient was discharged six days following surgery.