Radiohistology and histochemistry of barium granuloma of the colon and rectum.

Barium granuloma of the colon and rectum is a rare complication of X-ray examination of the digestive tract using barium. The authors report 5 new cases occurring in the last 3 years. Histological examination revealed a granulomatous reaction with greyish finely granular refractile PAS-negative material located in the cytoplasm of histiocytes and in the interstitial space. The radiographic study of the paraffin blocks confirmed the nature of this material, which was X-ray opaque, and this was corroborated histochemically with the rhodizonate technique.     

Abdominal incisions for operations on the colon and rectum

The magnitude of extirpative operations of the colon and rectum, advanced by improved supportive measures, may be increased by decreasing the extent of transverse abdominal incisions. The right colon can be removed with facility through a transverse incision across the left upper abdomen.A left upper transverse incision, plus either an oblique or a Cherney incision, is preferable to a long vertical incision.     

Nerve endings of the walls of the descendent colon and rectum

Summary Two types of nerve endings in the muscular wall of the descendent colon and rectum are shown in this paper. The first one, is constituted by thick extrinsic fibers ending by neurofibrillar sharpened points which are subdivided in two groups; unlimited endings having its branches placed among the muscular fascicles is one of them (interfascicular nerve endings). The other one belongs to limited endings sited in connective spaces sourrounded by the muscular bundles. The second type of neuromuscular relation is integrated by long and slender fibers. In some cases its origine of a local neuron was prooved by us.Endings in the mucous layer were also found. The Lieberkühn glands have nervous fibers distributing only at its bottom; nervous fibers supply only the upper part of the glands and also the epithelial surface, and an intermediary type of them distributing its branches to the whole width of the mucosae.     

Modulatory influences on antegrade and retrograde tonic reflexes in the colon and rectum

Tonic reflexes in the colon and rectum are likely to be important in health and in disorders of gastrointestinal function. The aim of this study was to evaluate the fasting and postprandial "colorectal" and "rectocolic" reflexes in response to 2-min isobaric distensions of the colon and rectum, accounting for enteric sensation, compliance, and distending balloon volume. In 14 healthy fasting subjects, a dual barostat assembly was positioned (descending colon and rectum). A 2-min phasic distension was performed in the colon and rectum in random order while the opposing balloon volume was recorded. Sensation (phasic distension) and compliance (ramp distension) were also determined. The experiment was repeated postprandially. Colonic distension resulted in significant rectal tonic contraction in the fasting (rectal volume change: -35.4 +/- 8.4 ml, P < 0.01) and postprandial (-22.2 +/- 8.4 ml, P < 0.01) states. After adjustment for colonic sensitivity, for compliance, and for distending balloon volume, the rectal volume change remained significant; the extent of the tonic response, however, correlated significantly with increasing pain score (P < 0.01). In contrast, rectal distension did not produce a significant tonic response in the colon (fasting: -6.5 +/- 7.3 ml; postprandial: 2.7 +/- 7.3 ml), either unadjusted or adjusted for rectal sensitivity, compliance, and distending balloon volume. In conclusion, the colorectal reflex, but not the rectocolic reflex, can be readily demonstrated both before and after a meal in response to a 2-min isobaric distension in the colon and rectum, respectively. Although the presence of the colorectal reflex does not depend on colonic sensitivity or the volume of the distending colonic balloon, these factors modulate the reflex, especially in the fasting state.     

Actin distribution patterns in patients with adenomatosis of colon and rectum

The actin cytoskeleton was examined in cultured skin fibroblasts of control individuals and patients with adenomatosis of colon and rectum using a fluorescent dye specific for F-actin, NBD-phallacidin. We confirmed that the actin distribution pattern differs significantly between the group of controls and the group of patients. However, the method is not practicable for the diagnosis of individual patients due to the number of false positives and negatives to be expected.     

Iron concentrations in intestinal cancer tissue and in colon and rectum polyps

A prospective randomized trial was used to determine iron concentrations in intestinal cancer tissue and colorectum polyps. We investigated the possible difference between the concentrations of iron, ferritin, albumin, and hemoglobin in the serum of patients with colorectal cancer and polyps. We also determined the relationship between the iron and ferritin levels in cancer tissue, the localization of neoplasms, and the stage of their development. The study comprises 67 patients with colorectum cancer and 42 patients with colon and rectum polyps. The metal was determined by using the total-reflection X-ray fluorescence (TRXRF) method. The mean concentration of iron in colorectal cancer equaled 46.1 μg/g of the tissue and was higher than in the case of polyps (43.2 μg/g). The mean serum iron level in patients with colorectal cancer was statistically lower than in the serum of patients with polyp and in the control group (54.5, 91.3, and 108.0 μg/g, respectively). The determined average concentration of ferritin in the serum of patients with colorectal cancer equaled 60.4 μg/g and was statistically lower than the level of this enzyme in the serum of patients with polyps (85.2 μg/g) and in the control group (102.0 μg/g). There was no difference between the serum albumin and hemoglobin concentrations in patients with colorectal cancer, polyps, and the control. There was no difference in the levels of iron and ferritin depending on the location of the neoplasm and the stage of its development. Also, there was no difference between the concentrations of iron in the cancer tissue of malignant and benign tumors after taking into consideration sex and age of patients. During the examination we determined significantly higher concentrations of iron in the cancer tissue and not in the polyp. The low levels of iron in the serum of patients with malignant tumor may increase colorectal cancer risk.     

Composite intestinal adenoma-microcarcinoid in the colon and rectum: a case series and historical review

Background

Composite intestinal adenoma-microcarcinoid (CIAM) is a rare colorectal lesion that mostly comprises a conventional adenomatous component with a minute proportion of neuroendocrine (NE) component. Although microcarcinoids are well-recognized in the setting of chronic inflammatory disorders of the gastrointestinal tract, large intestinal microcarcinoids associated with intestinal adenoma are exceedingly rare and their clinicopathologic characteristics are yet to be elucidated. This study was performed to clarify their clinicopathologic characteristics and to review the relevant literature.

Methods

In total, 24 cases of CIAM in which tumors were excised endoscopically (n = 22) or surgically (n = 2) were retrieved from the Department of Pathology, Daehang Hospital. We analyzed their clinicopathologic characteristics and performed immunohistochemical staining for NE markers to determine their endocrine nature.

Results

CIAM usually developed in middle-aged and elderly patients, with a mean age of 62.0 years (range, 44–81 years). Thirteen patients were men and 11 were women, indicating a nearly equal sex ratio. Unlike classic carcinoid tumors, CIAMs occurred mostly in the colon (83.3% of cases), particularly in the proximal colon. Histologically, the microcarcinoid component consisted of low-grade NE cells arranged in small nests, glands or cords interspersed with glandular elements or less frequently resembled squamous morules. There was no expansile nodular or organoid growth pattern, which is typical of carcinoid tumors. The microcarcinoids were 1–20 mm in size (mean size, 4.7 mm) and were mostly situated in the basal lamina propria with no submucosal layer involvement; none showed desmoplastic reaction or increased proliferative activity. Follow-up data (mean, 23.1 months) were available for 18 patients; all patients are alive and well.

Conclusions

To the best of our knowledge, ours is the largest series of patients with CIAM in the English-language literature. Microcarcinoids found in CIAMs appear to show favorable clinical outcomes regardless of their size, likely due to the absence of submucosal extension and/or increased proliferative activity. We recommend avoiding additional radical surgeries in patients who have endoscopically undergone complete CIAM excision unless they exhibit ominous histologic features such as submucosal extension or increased proliferative activity.