Cancer colon
Adenocarcinoma of the Transverse Colon.

Video Endoscopic Sequence 1 of 15.

Adenocarcinoma of the Transverse Colon.

This is the case of a 42 year-old male, with no significant
past medical history presented with abdominal pain and no
weight loss was reported.

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All endoscopic images shown in this Atlas contain
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Virtual Colonoscopy colononic cancer

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Virtual Colonoscopy displays a large irregular mass in the transverse colon near to the splenic angle. (Comparison between both images, CT colonography and colonoscopy in our patient).

Virtual colonoscopy method of screening the colon Virtual colonoscopy takes the information produced by a CT scanner and processes this information to produce an image of the colon's inner surface. The examination is possible because of new, very fast CT scanners and the refinement of computer hardware and software that have been used to produce modern digital movies.

 

 

 

 

Endoscopic Image of Colon Adenocarcinoma

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Endoscopic Image of Colon Adenocarcinoma

Tumors of the colon arise as intramucosal epithelial lesions,
usually in adenomatous polyps or glands. As cancers grow,
they invade the muscularis mucosa and lymphatic and
vascular structures to involve regional lymph nodes,
adjacent structures, and distant sites, especially the liver.

 

Virtual Colonoscopy image of the inside of a colon. (CT colonography).

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Virtual Colonoscopy image of the inside of a colon. (CT colonography).

There are similarities between both images in this endoscopic sequence.

Constricting adenocarcinoma and nearly obstructing. 

 

Cancer of the colon

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The lumen of the colon is reduced in diameter.

Colorectal cancers are the second most common cause of
cancer-related deaths in developed countries and the most
common GI cancer.

 

Colonic Cancer

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Stenotic large mass, however the endoscope was advanced to the cecum.

The incidence of colon cancer has risen since 1950, while
the incidence of rectal cancer has remained stable. The
increased incidence of colon cancer is believed to be a
result of an increased intake of fat and beef and a
decreased intake of fiber.

 

Virtual colonoscopy The Cecum, the hole of the apendix is observed.

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The Cecum, the hole of the apendix is observed.

 

Virtual Colonoscopy the cecum of our patient.

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Virtual Colonoscopy the cecum of our patient.

Annular Carcinoma of the Transverse Colon Virtual Colonoscopy.

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Annular Carcinoma of the Transverse Colon Virtual Colonoscopy.

Virtual colonoscopy is a new procedure that fuses
computed tomography of the large bowel with advanced
techniques for rendering three dimensional images to
produce views of the colonic mucosa.

 

Colon Cancer

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This picture displays the surgical specimen at the operation room.

 

Colon Cancer

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A close up to the fragment of the colon with this tumor.

 

Colon Cancer

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More images of the colon with the neoplasia.

 

Colon Cancer

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The surgical fragment containing the adenocarcinoma.

 

Colon Cancer

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A large Ulcerated Mass.

 

Colon Cancer

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Colon Gross Adenocarcinoma with the gross napkin ring
pattern or apple core pattern. Note how narrow the lumen
becomes in the area of the carcinoma. The mucosa is
nodular and erythematous in this region, and is ulcerated.

 

Endoscopic Image of Rectal Adenocarcinoma

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Endoscopic Image of Rectal Adenocarcinoma

Rectal Adenocarcinoma near of the Dentate Line
(Pectinate Line) retroflexed image.
A 62 year-old male with rectal bleeding and thing feces no
weight loss.
The digital examination revealed a mass near of the
dentate line.

 

Video Endoscopic Sequence 2 of 12.

Another image of this neoplasia, the colonoscope in
retroflexed maneuver is appreciated.

Adenocarcinoma of the colon is a primary cause of
mortality and morbidity in North America and Western
Europe. Colonic cancers are the most common GI
carcinomas and have the best prognosis. The 5-year
survival rate is approximately 50%. Survival rates may be
improved by screening and removal of adenomatous
polyps. Almost all colonic cancers are primary
adenocarcinomas. 

 

Endoscopic Image of Rectal Cancer

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Endoscopic Image of Rectal Cancer

The treatment for rectal cancer depends on the location
and extent of the tumor. The goals of treatment are to cure
the malignancy and to do so without a permanent
colostomy.

Pathophysiology: Colonic tumors arise as intramucosal epitheliallesions, usually in adenomatous polyps or glands. As cancersgrow, they invade the muscularis mucosa and lymphatic andvascular structures to involve regional lymph nodes, adjacentstructures, and distant sites, especially the liver.

 

A magnifying colonoscope was used.

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A magnifying colonoscope was used.
A magnifying image of some areas of the tumor.

 

Videochromocolonoscopy

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Videochromocolonoscopy

Chromoendoscopy, the intravital staining of gastrointestinal
epithelia, provides additional diagnostic information with
respect to the epithelial morphology and pathophysiology.

 

Endoscopic Image of Rectal Cancer

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Endoscopic Image of Rectal Cancer

With the levels of magnification of the scope and structural
enhancement image processing function of the processor
set at maximal levels.

 

 

 

 

Endoscopic Image of Rectal Cancer

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Endoscopic Image of Rectal Cancer

Using magnifying chromoendoscopy, it is possible to
establish a surface neoplastic profile that corresponds to
the histological picture obtained with a vertical tissue
section. Optical zooming increases the information yield (up
to 150 ×) and provides images comparable to those
obtained with a low-powered microscope.

 

Endoscopic Image of Rectal Cancer

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Endoscopic Image of Rectal Cancer

The pit pattern analysis of colorectal lesions by magnifying
colonoscopy is a useful and objective tool for differentiating
neoplastic from nonneoplastic lesions of the large bowel.
In its current state of development, however, this technique
is not a substitute for histology.

 

Endoscopic Image of Rectal Cancer

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This magnifying image displays polymorphism of this
rectal adenocarcinoma.

 

Rectal Endosonography (EUS).

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Rectal Endosonography (EUS).

In this image made with the help of Endoscopic Ultrasound
(EUS), the tumour is shown to have infiltrated all wall
layers.

See the video clip.

 

Rectal Endosonography (EUS).

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Rectal Endosonography.

EUS can also obtain information about the layers of the
intestinal wall as well as adjacent structures such as lymph
nodes and the blood vessels.

 

Rectal Endosonography (EUS).

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Rectal Endosonography.

Endoscopic Ultrasound (EUS).
Different treatment concepts, including local excision,
radical resection and multimodality therapy, are available
for colorectal cancer depending on the tumour stage.
Consequently, access to an accurate and reliable method
for staging these tumours pre-operatively is essential if
patients are to receive appropriate treatment. However, it
is difficult to assess the depth of tumour invasion by the
routine methods of barium enema, colonoscopy and CT.
Endoscopic ultrasound (EUS) examination has added a new
dimension to the evaluation of tumour invasion and lymph
node involvement in gastrointestinal cancer.

 

Endoscopy of rectal adenocarcinoma and internal

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Endoscopy of rectal adenocarcinoma and internal
hemorrhoids

This 58 year-old male, believes that his rectal bleeding was due to hemorrhoids, in fact has internal hemorrhoids and also a rectal adenocarcinoma.

Rectal cancer and hemorrhoids often have the same symptoms.

Symptoms such as rectal bleeding or pain, sensitivity in the groin, changes in bowel habits, and excessive gas or bloating, may be ignored or attributed to hemorrhoids. The result, recounted by numerous Rectal cancer patients and confirmed in medical literature, is delayed diagnosis.

 

Endoscopy of rectal adenocarcinoma and internal

 

Endoscopy of Rectal Adenocarcinoma

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Endoscopy of Rectal Adenocarcinoma

The first rectal valve shows the adenocarcinoma.

 

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38 months after the surgery

Patient initiates with progressive cough, the PA chest
radiograph shows multiple metastastic nodules.

 

Left Lateral Chest Radiograph.

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Left Lateral Chest Radiograph.

 

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Right Lateral Chest Radiograph.

 

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The abdominal CT scan shows no metastases, there are a hepatic cyst (simple cysts).

The cause of simple liver cysts is not known Simple cysts
generally cause no symptoms but may produce dull right
upper quadrant pain if large in size. Patients with
symptomatic simple liver cysts may also report abdominal
bloating and early satiety. Occasionally, a cyst is large
enough to produce a palpable abdominal mass. Jaundice
caused by bile duct obstruction is rare, as is cyst rupture
and acute torsion of a mobile cyst. Patients with cyst
torsion may present with an acute abdomen. When simple
cysts rupture, patients may develop secondary infection,
leading to a presentation similar to a hepatic abscess with
abdominal pain, fever, and leukocytosis.

 

At the CT scan of the chest

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At the CT scan of the chest

Carcinoma remains one of the most common neoplastic diseases. Of all patients who had curative resection, 10 to 20% will develop pulmonary metastases and 10% of them have the lung as the sole metastatic site. Pulmonary metastases from colorectal cancer are usually resected by wedge resection, usually accomplished through a thoracotomy, median sternotomy, or clam shell incision. The reported postresection 5-year survival ranges from 9 to 47% independently from the access employed. Introduction of video-assisted thoracoscopy (VAT) has increased interest in using this minimally invasive approach for many thoracic surgical procedures, including resection of metastatic lesions. Nevertheless, the main concern about this approach is that, although VAT allows an excellent exposure of the lung surfaces, it does not permit complete lung palpation to identify and remove metastatic lesions not detected by the radiologic imaging.

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Carcinoma produces lung metastases that are often
solitary, and in most of these patients, resection through
thoracotomy fails to demonstrate additional foci of
malignancy not detected by preoperative evaluation,
video-assisted thoracoscopy VAT resection might therefore
be fully justified if the ultimate outcome does not differ
from that obtained after a more invasive approach.

 

Video Endoscopic Sequence 9 of 10.

Surgical metastasectomy has become a standard therapy in selected patients with lung tumor metastases. Complete resection proved to be the most important prognostic factor in these patients, who often underwent aggressive and iterative procedures to achieve this purpose. The frequent discovery of unexpected metastases at intraoperative manual palpation has provoked question as to whether video-assisted thoracoscopy (VAT) is adequate in this setting, since it does not allow bilateral manual palpation. Indeed, VAT has been proposed as a minimally invasive approach for the resection of unilateral metastases, but the advantages of the procedure may be frustrated by the inaccuracy in detecting nodules. To overcome this limitation, we recently developed a transxiphoid approach through which one can reach both hemithoraces in one operation without performing sternotomy. The low invasiveness and safety of this approach allowed us to routinely carry out bilateral manual palpation of the lung even in patients with radiologically unilateral disease.

 

Video Endoscopic Sequence 10 of 10.

There is a high incidence of lung metastases in patients
with rectal cancer, and thoracic computed tomographic
scanning should be performed as part of a staging protocol
in all patients before any form of treatment is planned.
There is a higher incidence of lung metastases with higher
T stage.

 

Adenocarcinoma of the ascending colon

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Adenocarcinoma of the ascending colon

A 43 year-old Salvadorean female living in the republic of
Belize for more than 20 years.
weight loss of more than 40 pounds and anemia with 9.2
gr./dl-
Physical examination found a palpable mass at right iliac
fosa.
The endoscopic image displays a Sub-mucosal masa
Ultrasonographycaly that tumor mesured a 9.2 cm. long.

 

Endoscopy of Adenocarcinoma of the Ascending Colon

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Endoscopy of Adenocarcinoma of the Ascending Colon

An ulcerated adenocarcinoma at the ascending colon is
displayed.

 

Endoscopy of Adenocarcinoma of the Transverse colon

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Endoscopy of Adenocarcinoma of the Transverse colon

A 65 year-old woman, with weight lost of more than 20
pounds, with a palpable, a mobile mass that was detected
in the epigastric by her family physician. Abdominal
ultrasound and CT scan was performed, the radiologist
detected a tumor that was suspected to be of the
transverse colon.

 

 

Post surgical statust.

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Post surgical statust.

Endoscopic image of termino-terminal anastomosis.
One year after the surgery, we performed a full
colonoscopy.

 

Cecum Adenocarcinoma

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Cecum Adenocarcinoma

An 80 year-old male that was under anemia screening.

 

Cecum Adenocarcinoma

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Table 1. Dukes Classification and 5-Year Survival

Table 1. Dukes Classification and 5-Year Survival

Stage

Description

5-Year Survival

A Limited to the bowel wall 83%

B Extension to pericolic fat; no nodes 70%

C Regional lymph node metastases 30%

D Distant metastases (liver, lung, bone) 10%

 

Endoscopy of sigmoids Adenocarcinoma

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Endoscopy of sigmoids Adenocarcinoma

This 76 year-old lady, who start with rectal bleeding, at the
colonoscopy presented this large mass at the sigmoid.

 

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Status after rubber band treatment for hemorrhoids.

One week previously a hemorrhoid was ligated.

 

Endoscopy of Adenocarcinoma of the Ascending Colo

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Endoscopy of Adenocarcinoma of the Ascending Colon

This 40 year-old male, that has been suffering of severe abdominal pain and weigh loss of 40 pounds.

 

Endoscopy of Adenocarcinoma of the Ascending Colo

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Several factors increase the risk for colonic cancer.

High-fat, low-fiber diet

Patient age greater than 50 years

Personal history of colorectal adenoma or carcinoma (3-fold risk)

First-degree relative with colorectal cancer (3-fold risk)

Familial polyposis coli, Gardner syndrome, and Turcot syndrome (all patients develop colorectal carcinoma unless they undergo a colectomy)

Juvenile polyposis syndrome, Peutz-Jeghers syndrome, and Muir-Torre syndrome (risk increased slightly)

Hereditary nonpolyposis colorectal cancer (as many as 50% of patients are affected)

Inflammatory bowel disease

Ulcerative colitis (risk is 30% after 25 years)

Crohn disease (4- to 10-fold risk)

 

Endoscopic view of Ascending Colon Cancer

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Endoscopic view of Ascending Colon Cancer

This is the case of a 74 year-old male, this mass was found in his colon screener colonoscopy.

 

Endoscopic view of Ascending Colon Cancer

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The tumor was found in the ascending colon limiting with
the cecum.

 

Terminal ileum.

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Terminal ileum.

 

Endoscopic view of Ascending Colon Cancer

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Some biopsies were send to the pathologist.

Colon cancers progress slowly and may be asymptomatic
for as many as 5 years; however, patients usually have
occult blood loss from their tumors.

 

Endoscopic view of Ascending Colon Cancer

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Symptoms depend on the location of the primary tumor.
Cancers of the cecum and ascending colon usually grow
larger than left-sided tumors before symptoms occur.
Fatigue, shortness of breath, and angina resulting from
microcytic hypochromic anemia are common presenting
features. Vague abdominal discomfort or a palpable mass
may occur later, but obstruction is uncommon (unless the
ileocecal junction is involved) because of the larger
diameters of the cecum and ascending colon.

 

Endoscopic view of Ascending Colon Cancer

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Cancers of the descending and sigmoid colons may present
with large bowel obstruction. Perforation is rare but may
occur as a result of distention proximal to the tumor
(usually in the cecum) or locally (at the site of the tumor).
The primary tumor may be palpable in the abdomen. Overt
rectal bleeding is more common in tumors of the sigmoid
colon, whereas occult bleeding is typical with proximal
tumors. A change in bowel habits may be the only
presenting feature. Weight loss, jaundice, and ascites are
associated with advanced metastatic disease.

 

Endoscopic view of Ascending Colon Cancer

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The macroscopic specimen

The patient undergone laparoscopic right hemicolectomy with transverse ileum.

 

Endoscopic view of Ascending Colon Cancer

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An ulcerated adenocarcinoma is displayed.

 

Endoscopic view of Ascending Colon Cancer

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Immunohistochemistry for cytokeratine of the colonic
adenocarcinoma.

 

Mucinous adenocarcinoma of the Appendix that invade the cecum posterior to Iliocecal valve.

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Mucinous adenocarcinoma of the Appendix that invade the cecum posterior to Iliocecal valve.

Appendix cancer is extremely rare

This is a 60 year-old, Male. At the colonoscopy this neoplasm is found in the cecum.

Tumors that occur in the appendix comprise a large group of both benign and malignant diseases. Neoplasms of the appendix are rare. They are found in about 1 percent of appendectomy specimens and account for only about one-half of 1 percent of intestinal neoplasms. Carcinoid tumors are the most common, comprising over 50 percent of appendiceal neoplasms in most series.


The majority of appendiceal adenocarcinomas
are well differentiated and mucinous

The majority of primary cancers of the appendix occur in 55–65 years of age, except for malignant carcinoid, which has a mean age diagnosis of 38. Men and women seem to be at equal risk for all appendiceal neoplasms except for malignant carcinoid which may have woman to man ratio in excess of 3 : 1.



 

Mucinous adenocarcinoma of the Appendix that invade the cecum posterior to Iliocecal valve.

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Image and Video of Mucinous Adenocarcinoma of Appendix invading the the cecum posterior to Iliocecal valve.

Cancers of the appendix are rare. Most of them are found accidentally on appendectomies performed for appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix are only 0.08% of all cancers and the treatment remains controversial.

Many patients with appendiceal adenocarcinoma have clinical features indistinguishable from acute appendicitis. Most of the remaining cases present as an abdominal mass.
Spread to the peritoneal cavity may produce large volumes of mucus, causing pseudomyxoma peritonei. Such cases may present with abdominal distension. Rarely, external
fistulation occurs.

Mucinous adenocarcinoma of the Appendix that invade the cecum posterior to Iliocecal valve.

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The cecal appendix had tumor-like, measuring 8 cm. in length and 3.5 cm. average diameter; in which found, neoplastic tissue appearance, mucosecretor infiltrating across the wall to the serosa and fat mesoapendicular,
The lumen containing mucus and necrotic debris in its proximal part. The neoplasia committed to the appendicular ostium.

Mucosecretor metastatic adenocarcinoma to the liver were found.

The function of appendix in humans is unclear, although it is thought to possibly play a role in the immune system. Very rarely, the appendix may become cancerous. Cancer of the appendix may cause appendicitis or rupture of appendicitis. Mostly this is the first symptom of appendix cancer.

The majority of appendiceal tumors are carcinoids, while the remaining 10% to 20% are mucinous cyst-adenocarcinoma, adenocarcinoma, lymphosarcoma, paraganglioma, and granular-cell tumors. Most common symptoms include acute pain in right lower quadrant and other symptoms of inflammation like fever, leukocytosis, and so forth. Appendectomy is performed as clinically indicated. If a mass in the appendix is encountered incidentally during the course of abdominal surgery, an appendectomy is performed with frozen-section analysis of the mass. Most masses are benign mucoceles or very small carcinoids. They do not require any further management. However, if lymphoma or larger carcinoid was identified, chemotherapy or more extensive surgery will be required. When the mass is adenocarcinoma, the treatment algorithm is less defined as the data remain controversial.

 

 

Mucinous adenocarcinoma of the Appendix

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Adenocarcinoma of the appendix is very rare, accounting for 0.5% of all gastrointestinal cancers . Within the adenocarcinoma malignancies there are three subtypes: mucinous (55%), colonic type (34%), and adenocarcinoid (11%) which has a mixed morphology. The mean age of diagnosis is in the fifth decade of life, with an even male to female ratio for all but colonic type, which may have a higher incidence in men . The incidence of adenocarcinoma has been stated to be from 0.004% to 0.08%.

Mucinous Adenocarcinoma
It is the malignant counterpart to the mucinous adenoma. Both present with similar symptoms. Adenocarcinoid, also called Goblet cell carcinoid, has features of both carcinoid tumor and mucinous adenocarcinoma. They account for 5% of cancers of the appendix, with an average age diagnosis of 58 years, and an even distribution between men and women.

Patients with chronic ulcerative colitis (UC) have an increased susceptibility to formation of epithelial dysplasia and malignancy in affected segments of bowel; inflammatory involvement of the appendix is seen in approximately half of UC cases with pancolitis.
Both adenoma and adenocarcinoma of the appendix have been described in patients affected by long-standing ulcerative colitis.

 

Mucinous adenocarcinoma of the Appendix

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Appendix cancer is rare, and most commonly found incidentally in an appendectomy specimen that was obtained for an unrelated condition. The main histologic types are carcinoids, adenocarcinomas, adenocarcinoids, cystadenomas, and cystadenocarcinomas. For appendiceal carcinoids, reoperation and right colectomy is recommended for tumors larger than 2 cm and for smaller tumors with mesoappendiceal invasion. Most patients have localized disease, and the prognosis is excellent.

The spectrum of epithelial tumors of the appendix ranges from the benign mucocele to an aggressive adenocarcinoma. Simple appendectomy, taking care not to rupture the tumor intraoperatively, is sufficient therapy for benign appendiceal mucoceles, cystadenomas, and some cystadenocarcinomas. A right colectomy is indicated for cystadenocarcinomas with mesenteric or adjacent organ involvement and complicated mucoceles with involvement of the terminal ileum or cecum, cystadenocarcinomas.

 

 

Adenocarcinoma of the appendix

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Adenocarcinoma of the appendix

At the microscope, there is a mucosecretor neoplasm arising in the mucosa of cecal appendix throughout its length from the cecal tip ostium to this wall until invading the entire fat with mucus lakes. No lymphatic invasion.

If signet-ring cells account for more than 50% of the neoplasm, the term signet-ring cell carcinoma
is appropriate. The term mucinous cystadenocarcinoma
may be used for well differentiated mucinous tumours with cystic structures. However, this designation is descriptive and does not constitute a separate disease entity.

 

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Adenocarcinoma of the ascending colon and cecum with signet ring cells

This a 50 year-old female, with abdominal pain localized to the right lower quadrant an abdominal ultrasound found a mass in the right iliac fossa as well as the computer tomography, colonoscopy found that mass.

Signet ring cell carcinoma of the colorectum very rare; most cases are detected at an advanced stage. Therefore, its prognosis is poorer than that of ordinary colorectal cancer.


 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Image and video clip of Adenocarcinoma of the ascending colon and cecum with signet ring cells.

Comprising 0.1%-2.6% of all colorectal cancers. Because clinical symptoms tend to occur late in the course of signet ring cell carcinoma, most cases are usually detected at an advanced stage]; therefore, its overall survival rate is reported to be poorer than that of ordinary colorectal adenocarcinoma. Early diagnosis is important to improve outcomes; however, there is little known about the early stages of signet ring cell carcinoma.

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Image and video clip of Adenocarcinoma of the ascending colon and cecum with signet ring cells.

Primary signet ring cell carcinoma of the colon and rectum was first described by Laufman and Saphir in 1951. Its characteristics include more advanced stages at presentation, younger age at presentation, chiefly peritoneal dissemination, lymphatic spread, few liver metastases, and poor prognosis. Because its clinical symptoms develop late, most cases are usually detected at an advanced stage. Bonello et al described three factors for this delay in diagnosis: the rarity of the tumor; intramucosal tumor spread with relative sparing of the mucosa, accounting for minimal symptoms and heme-negative stools; and radiographic tumor resemblance to inflammatory processes. Because most cases are detected at an advanced stage, the prognosis of such tumors is dismal. Median and mean survival times are reported as 20 and 45 mo, respectively, and 5-year survival rates are between 9% and 36%. Makino et al found that all 17 patients with stage 0/I disease were alive at the latest follow-up evaluation, and the 5-year survival rate of patients with T2 disease was 75.0%. Therefore, to improve outcome, early diagnosis is very important.

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Scanning view of the endoscopic mucosal resection site. Histologically, the resected specimen showed diffusely infiltrated signet ring cells-

Signet ring cell carcinoma SRCC of colon has poor survival rates compared to other histological subtypes. SRCC presents at an earlier age, has higher tumor grade and advanced stage at diagnosis when compared to mucinous and NMCC of colon. Due to rarity of this disease further prospective multi-institute studies are required for in-depth understanding of this disease.

 

 

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Hematoxylin/eosin staining.

Signet ring cell carcinoma (SRCC) of colon and mucinous adenocarcinoma (MCC) of colon are rare histologic subtypes of adenocarcinoma of colon accounting for approximately 0.5-1 percent and 15-20 percent of all adenocarcinomas of colon respectively. Signet ring cell cancers are most commonly seen in the stomach (95%) and occasionally found in colon, rectum, ovary, peritoneum and gallbladder. It is characterized by specific morphologic appearance of abundant intracytoplasmic mucin pushing nucleus to the periphery giving it a signet ring cell appearance. SRCC is similar to MCC in possessing abundant mucin. The World Health Organization classification of tumors has a specific criteria for diagnosis of these sub types--SRCC is defined as presence of more than 50 percent of signet cells and MCC is defined as presence of more than 50 percent of mucin component.

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Specific histologic types of colorectal carcinoma
such as mucinous carcinoma and signet ring cell
carcinoma (SCC) have a poor prognosis. SCC of
the colon and rectum is a subtype of colorectal mucinous
adenocarcinoma. It is characterized by cells
with abundant mucin in the cytoplasm and nuclei.

Mucinous malignant tumors of colon
located at the cell periphery. The infiltrating cells
may be arranged singly or in loose clusters, and they
spread diffusely throughout the bowel wall.(6)
According to Symonds et al, mucinous tumors located
in the rectum, rather than in the colon, have different
clinical outcomes than nonmucinous tumors.

 

Adenocarcinoma of the ascending colon and cecum with signet ring cells

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Colorectal SRCC mostly occurs in younger patients, is larger and has different site predilection compared with conventional colorectal adenocarcinoma. It can occur as one of the synchronous cancers in the colorectum. The cancer is usually diagnosed at advanced stages because of the late manifestation of symptoms and aggressive treatment strategy is required Limited reports in the literature have shown that the variant of colorectal cancer demonstrated a different pattern of genetic alterations of common growth kinase related oncogenes (K-ras, B-raf), tumour suppressor genes (p53, p16), gene methylation and cell adhesion related genes related to the Wingless signalling pathway (E-cadherin and beta-catenin) from conventional colorectal adenocarcinoma. Colorectal SRCC also showed high expression of mucin related genes and genes related to the gastrointestinal system. There was also a higher prevalence of microsatellite instability-high tumours and low Cox-2 expression in colorectal SRCC as opposed to conventional adenocarcinoma.

 

 

Synchronous Carcinomas of the Colon

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Synchronous Carcinomas of the Colon

Adenocarcinoma of the Ascending Colon and Cecum.

This image and the video shows the first cancer in the ascending colon, which causing obstruction because in its lumen was covered with solid stool.

This is the case of a 52 year-old male, Is hospitalized due to abdominal pain and signs of intestinal obstruction, and generalized fatigability. The patient did not have a family history of colon cancer.

Colonoscopy displays, two cancers of the colon, one in the ascending colon, near the hepatic flexure, and the other on the cecum, destroying the ileocecal valve, which is incompetent and facilitates the advance of the endoscope to the terminal ileum.

 

 

Synchronous Carcinomas colon adenocarcinomas

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Synchronous Carcinomas colon adenocarcinomas

After achieving crossing the tumor having managed to remove the obstruction caused by the cap of solid stool, to the distance shown the second cancer.

The caecum and the ascending colon are the colon segments most frequently affected by tumoral synchronism. Synchronous colorectal carcinoma etiopathogenesis is complex and most likely by malignancy of preexisting adenomas (adenoma-adenocarcinoma sequence). The following tumoral synchronism clinical case's particularity is represented by the simultaneous diagnosis of a flat-type adenocarcinoma of the caecum (less common histopathological type) and of a mucinous adenocarcinoma on the ascending colon.

 

 

 

 

Endoscopic Image of Colon Adenocarcinoma

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Endoscopic Image of Colon Adenocarcinoma

The second cancer is observed

Synchronous colorectal cancer, defined as two or
more primary colorectal cancers identified in the
same time. Each tumor must be clearly malignant as
determined by histological evaluation, geographically
separate and distinct. Not infrequently the patients had
two or more synchronous colorectal cancers and reported
incidence of synchronous cancer was between
2-5% in large series.

 

Colonoscopy image and video clip of the second cancer

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Colonoscopy image and video clip of the second cancer

A cecum adenocarcinoma is dispalyed that infiltrates de ileocecal valve

Resection of synchronous carcinomas might not only increase the patient’s chance of cure, but also avoid second or multiple operations. Despite its importance, a preoperative colonoscopy of the entire colon is often unobtainable due to bowel obstruction by the tumor, poor bowel preparation or limitations associated with available facilities.

 

 

ileocecal valve adenocarcinoma.

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ileocecal valve adenocarcinoma.

The association of synchronous adenomatous polyps
in colon cancer has been reported to be 15%-50% and
synchronous cancer as high as 2%-10% A routine
preoperative colonoscopy has been recommended
for patients diagnosed with colorectal cancer in order
to identify synchronous polyps and/or cancer, that
otherwise might have remained undetected at the time
of the surgery. The identified lesions can be removed
endoscopically or by surgery.

 

The endoscope was advanced to the terminal ileum

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The endoscope was advanced to the terminal ileum

Despite its importance, a preoperative colonoscopy
of the entire colon is often unobtainable due to bowel
obstruction by the tumor, poor bowel preparation or
limitations associated with available facilities. Several
authors have shown the usefulness of intraoperative
colonoscopy when a preoperative colonoscopy was
not possible. The detection of synchronous tumors
by intraoperative colonoscopy often alters the planned
surgery. However, not all investigators agree on the
effectiveness of intraoperative colonoscopy. Among the
concerns reported are the increased surgical time and
possible risk of infection.

 

Synchronous Carcinomas of the Colon, The first Cancer in the ascending colon

Video Endoscopic Sequence 7 of 7.

Synchronous Carcinomas of the Colon, The first Cancer in the ascending colon

The prevalence of colon cancer and polyps differ
widely by race and geographic location. The clinical
significance of synchronous polyps or cancer may be
different based on these epidemiologic factors.

 

Synchronous Triple Carcinoma of the colon and rectum and Multiple Synchronous Polyps

Video Endoscopic Sequence 1 of 5.

Synchronous Triple Carcinoma of the colon and rectum and Multiple Synchronous Polyps

This is the case of a 60 year-old, Lawyer, with a history of alcoholism, diabetic and morbid obese and no weight loss.

The patient did not have a family history of colon cancer.

Three months ago starts with rectal bleeding accompanied with mucus and tenesmus.

In a colonoscopy a rectal cancer and at least ten polyps of the transverse colon were detected, two of them with carcinoma in situ, some polyps with pedicles.

Also polyps are seen in a retroflexed maneuver and thus examining from the transverse colon to the rectosigmoid junction.

 

Synchronous Triple Carcinoma of the colon and rectum and Multiple Synchronous Polyps

 

 

Synchronous triple carcinoma of the colon and rectum and Multiple Synchronous polyps

Video Endoscopic Sequence 2 of 5.

Synchronous triple carcinoma of the colon and rectum and Multiple Synchronous polyps

In this image and the video clip, is observed one of the transverse colon polyp with carcinoma in situ, there is another polyp of transverse also with adenocarcinoma in-situ by biopsies. Both are sessile in which multiple biopsies were acquired.

This image displays a colonic chicken skin mucosa: an endoscopic and histological abnormality adjacent to colonic neoplasms.

Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown.

Mucosal abnormalities and molecular changes associated with colorectal adenomas have been reported since colonoscopy began to be widely used for the screening of colorectal cancer. However, the clinical significance of colonic mucosal abnormalities on endoscopy is still unknown. Among the endoscopic mucosal abnormalities in the colon, chicken skin mucosa (CSM) was first identified in 1998 and was described with specific morphologic changes surrounding a colorectal adenoma. CSM is a pale yellow-speckled pattern of colonic mucosa on endoscopy; lipid-filled macrophages in the lamina propria are noted on histopathology. Previous findings might have suggested presence of colonic xanthoma in CSM but CSM demonstrates distinct features that only occur adjacent to colorectal neoplasms.

 

 

 

Two polyps of the transverse colon

Video Endoscopic Sequence 3 of 5.

Two polyps of the transverse colon, both with pedicle are seen.

 


 

Retroflexed colonoscopy from the transverse colon to the rectosigmoid junction

Video Endoscopic Sequence 4 of 5.

Retroflexed colonoscopy from the transverse colon to the rectosigmoid junction.

The polyp displayed in this image have also a adenocarcinoma in situ by biopsies.


 

 

retroflexed colonoscopy multiple polyps are seen

Video Endoscopic Sequence 5 of 5.

Retroflexed colonoscopy from the transverse colon to the rectosigmoid junction

At retroflexed colonoscopy multiple polyps are seen

 

 

Synchronous Carcinomas of the Colon

Video Endoscopic Sequence 1 of 6.

Synchronous Carcinomas of the Colon

Adenocarcinoma of the Ascending Colon and Sigmoid.

This is the case of a 70 year-old, female with weight loss of 30 lbs.

At colonoscopy two colon cancers one in the ascending colon and the other in the sigmoid are detected.

 

Synchronous multiple primary malignant tumors are relatively unusual, although the number of patients diagnosed with multiple primary tumors is increasing due to development of more sophisticated invasive and non-invasive diagnostic tools and an increase in the number of elderly patients.

 

 

 

Synchronous Carcinomas of the Colon

Video Endoscopic Sequence 2 of 6.

Synchronous Carcinomas of the Colon

Adenocarcinoma of the Ascending Colon and Sigmoid. This endoscopic image as well as the video clip displays the sigmoid cancer.

 

 

 

 

 

Imagen Endoscópica de Cánceres Sincrónico del Colon

Video Endoscopic Sequence 3 of 6.

A lobulated small adenoma was removed with polypectomy


 

Synchronous Carcinomas of the Colon

Video Endoscopic Sequence 4 of 6.

The second colon cancer was found at the ascending colon

 

 

 

Synchronous Carcinomas of the Colon

Video Endoscopic Sequence 5 of 6.

More images and video clips of this syncronic cancer showing at ascending colon near of the cecum.

 

 

Synchronous Carcinomas of the Colon

Video Endoscopic Sequence 6 of 6.

More images and video clips of this syncronic cancer showing at ascending colon near of the cecum.

 


 

Remission rectal cancer

Video Endoscopic Sequence 1 of 9.

Rectal Adenocarcinoma and Remission

A 77-year-old male. Who suffer from renal failure and who has been on hemodialysis, with creatinine level of 8.0 mg / dl.

The interesting thing about this case is the endoscopic comparison before and after the therapeutic treatment with a linear accelerator and chemotherapy.

Subsequently, he underwent surgery and the histopathology study showed no malignancy , Showing effectiveness of linear accelerator and chemotherapy

See Video Endoscopic Sequence 6 from 9 to 9 of 9.

 

 

 

Remission rectal cancer

Video Endoscopic Sequence 2 of 9.

Proximal part of the tumor (image from the anus).

 

Remission of rectal cancer

Video Endoscopic Sequence 3 of 9.

Medial part of the neoplasia

Remission of rectal cancer

Video Endoscopic Sequence 4 of 9.

Retroflexed image where the distal part of the tumor is seen.

 

Remission of rectal cancer

Video Endoscopic Sequence 5 of 9.

Another image and video of the tumor

Remission of rectal cancer

Video Endoscopic Sequence 6 of 9.

7 months later

Ulceration is observed in the second rectal valve and tumor remission occurs.

 

7 meses después

Se observa una ulceración en la segunda válvula rectal y hay remisión del tumor.

 

Remission of rectal cancer

Video Endoscopic Sequence 7 of 9.

Another image and video clip, after treatment with radiotherapy with linear accelerator and chemotherapy. There are edema, ulceration and fragility.

 

Remission of rectal cancer

Video Endoscopic Sequence 8 of 9.

Distal part there are edema ulceration and erythema

 

Remission of rectal cancer

Video Endoscopic Sequence 9 of 9.

Another image and video following treatment with radiotherapy with linear accelerator and chemotherapy

 

 

 

 

 

 

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