Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the hi...Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.展开更多
Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the ...Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the scarcity of these NENs has hindered extensive clinical investigations,thereby leading to a dearth of robust evidence for guiding clinical practice and impeding the establishment of standardized approaches for diagnosis and treatment.However,with the increasing awareness of population screening,as well as the increasing popularity of colonoscopy screening programs,the incidence of colorectal NENs has gradually increased.Moreover,some high-grade NENs are highly malignant and invasive,thereby leading to poor treatment outcomes and prognoses.These challenges have elicited increased attention from clinical physicians,thus prompting researchers to explore relevant studies using limited specimens and clinical data.This scenario has resulted in preliminary findings that provide evidence for addressing diagnostic and therapeutic challenges associated with NENs of the colon and rectum.In this article,we review recent literature reports and summarize the advances regarding the diagnosis and treatment of colorectal NENs.展开更多
OBJECTIVE To investigate the clinical and pathologic features of rectal gastrointestinal stromal tumors （GIST） and to evaluate their reasonable management. METHODS The clinical and pathological data for 19 patients ...OBJECTIVE To investigate the clinical and pathologic features of rectal gastrointestinal stromal tumors （GIST） and to evaluate their reasonable management. METHODS The clinical and pathological data for 19 patients with rectal GIST over the past 19 years were studied retrospectively. RESULTS The diagnosis of the 19 cases was identified by surgery and pathology. All the rectal GISTs were spindle cell type with immunohistochemical analysis showing positive reactivity for CD117 （100%） and CD34 （73.7%）. There were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk of aggressive behavior in this study. CONCLUSION Rectal GIST, without specific symptoms in the early stage, has a low incidence and usually shows low risk of aggressive behavior. It is difficult to produce an accurate pathological diagnosis before operation and it is difficult to decide whether to save the sphincter before or during operation. Reasonable initial treatment includes trans-anal local resection as the best recommend management of low risk submucosal rectal GIST （〈3.0 cm）.展开更多
Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent pr...Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.展开更多
BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, eso...Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, esophagus and other organs have been reported. We herein report a case of a 37-year-old man with severe rectal bleeding. Digital examination revealed nodular mucosa. No rectal mass was palpated, but bleeding in the ampulla was detected. Colonoscopy revealed an extensive hypervascular submucosal lesion arising from the rectosigmoid junction colon to the distal edge of the anus. Endoscopic ultrasonography demonstrated an extensive anechoic mass with clear edge. Magnetic resonance imaging (MRI) showed a significant thickness of the rectal wall, extending to the distal edge of the anus, with a narrowing lumen. A sphinctersaving rectal surgery was performed. Due to a lack of knowledge of the clinical, endoscopic and radiological features, preoperative recognition of hemolymphangioma is not easy. Computed tomography and MRI are helpful in confirming the diagnosis, and defining the extent and invasion of the lesion. For the low malignant potential tumors, a sphincter-saving rectal surgery is recommended after a full evaluation of the tumor.展开更多
Objective To investigate whether the kainate （KA） receptor subunit GluR6 is involved in the acute inflammatory pain. Methods Formalin was injected into the mucosa of rectum in Sprague-Dawley rats to induce visceral ...Objective To investigate whether the kainate （KA） receptor subunit GluR6 is involved in the acute inflammatory pain. Methods Formalin was injected into the mucosa of rectum in Sprague-Dawley rats to induce visceral pain. The antisense oligodeoxynucleotides （ODNs） of GluR6 were injected once per day for 3 d before formalin injection, after which GluR6 protein level was examined by immunoblotting method. The change of visceral pain was also investigated. Results The expression of GluR6 in the spinal cord of rats increased after the formalin injection. Moreover, pre-treatment of GluR6 antisense ODNs could suppress GluR6 expression in the spinal cord of rats and decrease the scores of visceral pain at 45 min following formalin injection. Conclusion Kainate receptor subunit GluR6 plays an important role in the visceral pain induced by injection of formalin into the wall of rectum. GluR6 may serve as a potential target for the treatment of acute inflammatory visceral pain.展开更多
Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clin...Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clinical date, including anal resting pressure (resting pressure) assay. Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence . The formula use for calculating post operative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37(R 2=0.58; P <0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results: It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure;r=0.62; P <0.01). Conclusion: Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.展开更多
The existence and composition of the lateral ligaments of the rectum(LLR)are still the subjects of anatomical confusion and surgical misconception up to now.Since Miles proposed abdominoperineal excision as radical su...The existence and composition of the lateral ligaments of the rectum(LLR)are still the subjects of anatomical confusion and surgical misconception up to now.Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer,the identification by"hooking them on the finger"has been accepted by many surgeons with no doubt;clamping,dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks.But in cadaveric studies,many anatomists could not find LLR described by the textbooks,and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision.The anatomy of LLR has diverse descriptions in literatures.According to our clinical observations,the traditional anatomical structures of LLR do exist;LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum,run between rectal visceral fascia and pelvic parietal fascia above the levator ani,and covered by superior fascia of pelvic diaphragm.They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.展开更多
Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5...Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.展开更多
A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidos- copy, which proved to be a leiomyosarcoma upon biopsy. ...A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidos- copy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, me- tastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melano- ma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemina- tion studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be pre- ferred in case of small tumors. The same loco-regional control is achieved with less "loss of function" compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.展开更多
Liposarcoma is one of the most common soft tissue sarcomas found in adults,and it usually occurs in the retroperitoneum and the extremities.Here,we describe a case of dedifferentiated liposarcoma originating from a we...Liposarcoma is one of the most common soft tissue sarcomas found in adults,and it usually occurs in the retroperitoneum and the extremities.Here,we describe a case of dedifferentiated liposarcoma originating from a well-differentiated liposarcoma of the mesorectum that presented as a protruding mass in the rectal lumen.Hartmann's operation with total mesorectal excision was performed and the tumor was removed radically.No management guidelines are currently available for liposarcoma of the rectum.We propose that complete surgical resection be required for the treatment of rectal liposarcoma and that a long-term detailed follow up is necessary.展开更多
文摘Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 to 55% seems immutable in several published series. The main cause for those results is the high incidence of recurrence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the pectinate line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients – 400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radiotherapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducing the number of undifferentiated cells and in diminishing the tumor volume and the carcinomatous infiltration of the rectal wall.
文摘Compared with colorectal adenocarcinoma,neuroendocrine neoplasms(NENs),which affect the colon and rectum,are uncommon tumor conditions that have received relatively limited attention in basic research.Furthermore,the scarcity of these NENs has hindered extensive clinical investigations,thereby leading to a dearth of robust evidence for guiding clinical practice and impeding the establishment of standardized approaches for diagnosis and treatment.However,with the increasing awareness of population screening,as well as the increasing popularity of colonoscopy screening programs,the incidence of colorectal NENs has gradually increased.Moreover,some high-grade NENs are highly malignant and invasive,thereby leading to poor treatment outcomes and prognoses.These challenges have elicited increased attention from clinical physicians,thus prompting researchers to explore relevant studies using limited specimens and clinical data.This scenario has resulted in preliminary findings that provide evidence for addressing diagnostic and therapeutic challenges associated with NENs of the colon and rectum.In this article,we review recent literature reports and summarize the advances regarding the diagnosis and treatment of colorectal NENs.
文摘OBJECTIVE To investigate the clinical and pathologic features of rectal gastrointestinal stromal tumors （GIST） and to evaluate their reasonable management. METHODS The clinical and pathological data for 19 patients with rectal GIST over the past 19 years were studied retrospectively. RESULTS The diagnosis of the 19 cases was identified by surgery and pathology. All the rectal GISTs were spindle cell type with immunohistochemical analysis showing positive reactivity for CD117 （100%） and CD34 （73.7%）. There were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk of aggressive behavior in this study. CONCLUSION Rectal GIST, without specific symptoms in the early stage, has a low incidence and usually shows low risk of aggressive behavior. It is difficult to produce an accurate pathological diagnosis before operation and it is difficult to decide whether to save the sphincter before or during operation. Reasonable initial treatment includes trans-anal local resection as the best recommend management of low risk submucosal rectal GIST （〈3.0 cm）.
文摘Rectal neuroendocrine tumors(NETs)are increasingly detected and are the most common gastrointestinal NET sites.Often discovered incidentally during endoscopy,most are small,well differentiated,and have an excellent prognosis.Local resection is typically considered curative.Several guidelines,namely the European Neuroendocrine Tumor Society guidelines 2023,National Comprehensive Cancer network 2025,and the Polish Network of Neuroendocrine Tumors(2017)emphasize the use of endoscopic and endoscopic ultrasound staging to select the appropriate therapy,ranging from resection to advanced techniques for larger or metastatic diseases,highlighting the need for an accurate initial assessment.
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
基金Supported by National Natural Science Foundation of China,No. 81000189
文摘Intestinal hemolymphangioma is a rare vascular and lymphatic malformation and is manifested as anaemia and recurrent alimentary tract hemorrhage. Few cases of hemolymphangioma occurring in small intestine, spleen, esophagus and other organs have been reported. We herein report a case of a 37-year-old man with severe rectal bleeding. Digital examination revealed nodular mucosa. No rectal mass was palpated, but bleeding in the ampulla was detected. Colonoscopy revealed an extensive hypervascular submucosal lesion arising from the rectosigmoid junction colon to the distal edge of the anus. Endoscopic ultrasonography demonstrated an extensive anechoic mass with clear edge. Magnetic resonance imaging (MRI) showed a significant thickness of the rectal wall, extending to the distal edge of the anus, with a narrowing lumen. A sphinctersaving rectal surgery was performed. Due to a lack of knowledge of the clinical, endoscopic and radiological features, preoperative recognition of hemolymphangioma is not easy. Computed tomography and MRI are helpful in confirming the diagnosis, and defining the extent and invasion of the lesion. For the low malignant potential tumors, a sphincter-saving rectal surgery is recommended after a full evaluation of the tumor.
基金supported by the Natural Science Foundation of Jiangsu Province,China(No:BK2004028)
文摘Objective To investigate whether the kainate （KA） receptor subunit GluR6 is involved in the acute inflammatory pain. Methods Formalin was injected into the mucosa of rectum in Sprague-Dawley rats to induce visceral pain. The antisense oligodeoxynucleotides （ODNs） of GluR6 were injected once per day for 3 d before formalin injection, after which GluR6 protein level was examined by immunoblotting method. The change of visceral pain was also investigated. Results The expression of GluR6 in the spinal cord of rats increased after the formalin injection. Moreover, pre-treatment of GluR6 antisense ODNs could suppress GluR6 expression in the spinal cord of rats and decrease the scores of visceral pain at 45 min following formalin injection. Conclusion Kainate receptor subunit GluR6 plays an important role in the visceral pain induced by injection of formalin into the wall of rectum. GluR6 may serve as a potential target for the treatment of acute inflammatory visceral pain.
文摘Objective: To study the relationship between internal anal sphincter function and length of remaining rectum after resecting rectal carcinoma. Methods: Preoperatively, 21 patients were evaluated via patients' clinical date, including anal resting pressure (resting pressure) assay. Six months postoperatively, repeated manometric studies and clinical evaluations were performed to assess the level of continence . The formula use for calculating post operative resting pressure is as follows: postoperative resting pressure=0.42×preoperative resting pressure+1.56×length of remaining recturm+12.37(R 2=0.58; P <0.01).Degree of continence was graded based on severity of the dysfunction and grade of the continence score. Results: It was demonstrated the patients with low postoperative resting pressures (<4.0 Kpa) had incontinence, and those with high postoperative resting pressures (>4.7 Kpa) were continent. There were significant correlations between length of the remaining rectum and ratio of the decrease in maximum resting pressure (postoperative/preoperative maximum resting pressure;r=0.62; P <0.01). Conclusion: Continence of rectum is influenced by maximum resting pressure of function of the internal anal sphincter, length of remaining rectum is shorter, the more damage to the internal anal sphincter. It is able to foretell stool incontinence by using the postoperative resting pressure formula, and to determine the length of the remaining rectum.
文摘The existence and composition of the lateral ligaments of the rectum(LLR)are still the subjects of anatomical confusion and surgical misconception up to now.Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer,the identification by"hooking them on the finger"has been accepted by many surgeons with no doubt;clamping,dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks.But in cadaveric studies,many anatomists could not find LLR described by the textbooks,and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision.The anatomy of LLR has diverse descriptions in literatures.According to our clinical observations,the traditional anatomical structures of LLR do exist;LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum,run between rectal visceral fascia and pelvic parietal fascia above the levator ani,and covered by superior fascia of pelvic diaphragm.They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.
基金Supported by the National Natural Science Foundation of China,No.81600413 and No.81600414
文摘Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.
文摘A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidos- copy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, me- tastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melano- ma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemina- tion studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be pre- ferred in case of small tumors. The same loco-regional control is achieved with less "loss of function" compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.
文摘Liposarcoma is one of the most common soft tissue sarcomas found in adults,and it usually occurs in the retroperitoneum and the extremities.Here,we describe a case of dedifferentiated liposarcoma originating from a well-differentiated liposarcoma of the mesorectum that presented as a protruding mass in the rectal lumen.Hartmann's operation with total mesorectal excision was performed and the tumor was removed radically.No management guidelines are currently available for liposarcoma of the rectum.We propose that complete surgical resection be required for the treatment of rectal liposarcoma and that a long-term detailed follow up is necessary.
