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Repeated anastomotic recurrence of colorectal tumors: Genetic analysis of two cases

World Journal of Gastroenterology 2011年第32期17卷 3752-3758页

作者： Renato Costi Cinzia Azzoni federico marchesi Lorena Bottarelli Vincenzo Violi Cesare Bordi Dipartimento di Scienze Chirurgiche Università degli Studi di Parma 43100 Parma Italy Département de Chirurgie Digestive et Endocrinienne H pital Cochin Assistance Publique-H pitaux de Paris Université Paris Descartes 75679 Paris France Dipartimento di Patologia e Medicina di Laboratorio Sezione di Anatomia ed Istologia Patologica Università degli Studi di Parma 43100 Parma Italy

AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence. METHODS: Two cases are presented: a 65-year-old female receiving two colonic resections for primary anastomotic recurrences within 21 mo, and a 57-year-old female undergoing two local excisions of recurrent anastomotic adenomas within 26 mo. A loss of heterozygosity (LOH) study of 25 microsatellite markers and a mutational analysis of genes BRAF , K-RAS and APC were performed in samples of neoplastic and normal colonic mucosa collected over the years. RESULTS: A diffuse genetic instability was present in all samples, including neoplastic and normal colonic mucosa. Two different patterns of genetic alterations (LOH at 5q21 and 18p11.23 in the first case, and LOH at 1p34 and 3p14 in the second) were found to be associated with carcinogenesis over the years. A role for the genes MYC-L (mapping at 1p34) and FIHT (mapping at 3p14.2) is suggested, whereas a role for APC (mapping at 5q21) is not shown. CONCLUSION: The study challenges the most credited intraluminal implantation and metachronous carcinogenesis theories, and suggests a persistent, patient-specific alteration as the trigger of colorectal cancer anastomotic recurrence.

关键词： Anastomotic recurrence Colorectal cancer Allelic loss Genetic alterations

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Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study

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World Journal of Obstetrics and Gynecology 2014年第1期3卷 14-20页

作者： Mirco Nacoti Elena Colombetti Maria Simonetta Spada Marco Ceresoli Luca Ansaloni Gianmariano marchesi Luca Lorini Davide Corbella federico Coccolini Anesthesia and Intensive Care Department Papa Giovanni XXIII Hospital 24127 Bergamo Italy Centre for Bioethics Università Cattolica del Sacro Cuore di Milano 20121 Milan Italy Clinical Psychology Unit Papa Giovanni XXIII Hospital 24127 Bergamo Italy General Surgery Departement Papa Giovanni XXIII Hospital 24127 Bergamo Italy

This article provides a brief description of an epithelial ovarian cancer （EOC） case （stage Ⅳ） treated with the association of complete CytoReductive Surgery and hy-pertermic intraPEritoneal chemotherapy （HIPEC）. The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treat-ment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since defnitive cure is unlikely. We reviewed the entire decision making process considering the risk/beneft of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Function-ing, Disability and Health that permits evaluation of the person in relation to the psycho-social context is pre-sented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survi-vors are of central importance for decision making.

关键词： Advanced epithelial ovarian cancer Perito-neal carcinomatosis Platform World Health Organiza-tion-International Classifcation of Functioning Disability and health Ethical issues Hyperthemic intraperitoneal chemotherapy Health related quality of life

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