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The paper describes a case of small-cell high-grade endocrine carcinoma of the rectum concurrent with tubular-villous adenoma in a 58 year-old woman. All epithelial cells of adenoma have been ascertained to be "mixed" exoendocrine endocrinocytes (secrete mucus and contain neuroendocrine granules), contain progesterone receptors, and express CK 8, 18, and 19. Some high-grade neuroendocrine carcinoma cells also secrete mucus. The presence of mitotic activity (Ki-67, 35%), high p53 protein expression (more than 50%), marked CK 18 expression, and clinical data confirm high malignancy of this histological type of the tumor.

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

The authors discuss an original method for formation of a smooth-muscle cuff from the wall of a pulled-through colon in the region of a perineal colostoma. It was applied in 89 patients who had undergone extirpation of the rectum for malignant neoplasms. The smooth-muscle sphincter was formed during removal of the rectum in 72 patients and no earlier than 2 years after the extirpation in 17 patients. Inflammatory complications developed in the region of the perineal colostoa in the early postoperative period in 13.5% of cases. They were due to necrosis of the distal part of the pulled-through intestine in 3.4% of cases. There were no fatal outcomes. The late-term results were studied in follow-up periods of up to 7.5 years. Satisfactory functional results were produced in 83% of the patients. Physiological examination showed the presence of a functioning sphincter in the region of the perineal colostoma.

Between 1972 and 1990, 36 patients with leiomyoma of the rectum underwent surgery at the Proctology Institute (Moscow). There were 13 male (36.1 percent) and 23 female (63.9 percent) patients. Their median age was 52.1 years. Electroexcision of the tumors measuring below 1 cm was performed through the endoscope in 12 patients. Leiomyomas with a diameter of 2.5 to 5 cm were removed transanally in 10 patients. Six patients underwent excision of the tumor through the pararectal approach, whereas leiomyomas located in the rectovaginal wall were removed through the vagina in one patient. Abdominoperineal extirpation and abdominoanal resection of the rectum was performed in seven patients with tumors measuring from 8 to 20 cm. Recurrences were noted in nine patients after transanal, pararectal, or transvaginal excision of leiomyomas. In seven of them, malignant transformation of the tumor occurred at terms ranging from 9 months to 9.5 years.

From analysis of the surgical treatment of 36 patients with rectal leiomyoma the authors suggest and substantiate the indications for various types of operative interventions according to the size and location of the tumor. The late-term results of the treatment were studied in all patients who underwent surgery and a brief review of literature on the methods of diagnosis and surgical management of benign smooth-muscle tumors of the rectum is given.

67 segments of rectum and sigmoid removed surgically because of carcinoma were examined: the surface of intestinal mucosa stained with methylene-blue was studied in order to determine the number and localization of focal changes in the macroscopically unchanged areas. Colon microscopy was performed clinically in 24 patients with carcinoma of the rectum and in 24 control individuals. 28 hyperplastic polyps and 1037 microscopic hyperplastic foci were found in operative material. An active metabolism is established by means of electron autoradiography in the cells of hyperplastic focus. Areas of dysplastic epithelium were rarely found in big hyperplastic polyps. Areas of diffuse hyperplasia (transitional mucosa) with crypt deepening and presence of a high number of goblet cells were found near tumour. A certain role of hyperplastic processes in carcinogenesis is forwarded. Numerous microscopic changes in the mucosa epithelium may testify against the carcinoma development de novo.

Three cases of cloacogenous and 35 cases of squamous-cell carcinoma of the distal part of the rectum and anus were studied and compared histochemically to reveal considerable differences in mucopolysaccharides contained by the tumours. Squamous-cell carcinomas were characterized by the presence of glycogen which was not detected in cloacogenous carcinomas. In squamous-cell carcinomas, glycosamine glycanes were represented by sulfo- and sialo-mucin, while cloacogenous carcinomas largely contained a non-sulfated mucosubstance. The evidence obtained allows one to distinguish, among anal carcinomas of the rectum, a group of cloacogenous carcinomas that arose from the transitional epithelium of the serrate line and that differ from squamous-cell carcinomas in specific metabolic processes.

Two rare observations in which villous tumors affected the mucous membranes of the rectum and transverse colon are described. In one case the lesions extended for 60 cm, in the other the neoplasm occupied the entire inner surface of the rectum and colon as well as the adjacent area of the ileum, whereas in the area of the liver and spleen bends there were areas of adenocarcinoma. Both observations were characterized by marked inflammatory infiltration in some parts of the villous tumor.

Since 1955 to 1975 the authors observed one hundred sixty patients with teratoid formations of the pararectal cellular tissue. Under consideration are diagnostic methods used nowadays clinically and the problems of the differential diagnosis as well. The authors point out the basic principles of surgical treatment of the pathology involved. The authors' experience with surgical treatment and the complications observed are analysed. It is felt that this pathology is encountered much more frequently, than it was previously supposed.