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BACKGROUND The revised Bethesda guidelines (rBG) are generally used for screening of Lynch syndrome, and few researchers have investigated the associations between microsatellite instability (MSI) status and each item of the rBG. PATIENTS AND METHODS This retrospective study included patients with colorectal cancer who were classified into those fulfilling the rBG (Bethesda group) and those not (control group). The breakdown of each item in the rBG and predictors of high MSI (MSI-H) were determined in the Bethesda group. RESULTS Of 809 consecutive patients, 161 (19.9%) were found to fulfil the rBG criteria. As a predictor of MSI-H, items 2 or 5 of the rBG showed a sensitivity of 93.3%. Item 5 and right-sided tumour location were independent predictors of MSI-H in patients fulfilling the rBG (odds ratio(OR)=4.49 and 25.1; p=0.0260 and

AIM Clinical guidelines recommend adjuvant chemotherapy for high-risk patients with Stage II-III colorectal cancer. However, chemotherapeutic administration rates differ significantly between hospitals. We assessed the prognostic benefit of adjuvant chemotherapy in patients with Stage IIb/c colorectal cancer, and the prognostic impact of interhospital variations in the administration of adjuvant chemotherapy for Stage II-III colorectal cancer. METHOD We conducted a multicentre, retrospective study of 17 757 patients with Stage II-III colorectal cancer treated between 1997 and 2008 in 23 hospitals in Japan. Hospitals were classified as high-rate (rate > 42.8%) or low-rate (rate ≤ 42.8%), chemotherapy prescribing clinics. RESULTS The 5-year overall survival (OS) of patients with Stage II-III colorectal cancer receiving adjuvant chemotherapy was significantly higher than for those not receiving adjuvant chemotherapy (85.7% vs 79.2%, P

Background Although cases of multiple primary malignant neoplasms are increasing, reports of more than three or four primary metachronous malignant neoplasms are extremely rare. Moreover, very few publications have provided a genetic mutational analysis or have evaluated risk factors associated with such neoplasms. We present an extremely rare case of nine primary malignant lesions in a man who was successfully treated. We also report on microsatellite stability status, analyze risk factors, and discuss the relevant literature. Case presentation Between 67 and 73 years of age, a male patient developed nine primary metachronous malignant lesions: Three were located in the esophagus, two in the stomach, two in the colorectum, one in the prostate gland, and one in the external ear canal. The patient’s clinical history included hypertension, atrial fibrillation, an acoustic schwannoma, and heavy smoking. The lesions were diagnosed during regular screening over a six-year period. He was successfully treated with surgery (both open surgical and endoscopic resection of lesions) and adjuvant chemotherapy. Immunohistochemistry and mutational analysis showed that the lesions were microsatellite stable, and the KRAS, BRAF, p53, and nuclear β-catenin status was not uniform among the lesions. Conclusions Given that the presence of more than three or four neoplasms is extremely rare, the present case of nine primary malignancies with no associated microsatellite instability and no apparent predisposing hereditary conditions, is extraordinary. Our case study shows that it is possible for up to nine sporadic neoplasms to occur, and efficient disease management requires diligent screening and early detection. Electronic supplementary material The online version of this article (10.1186/s12885-017-3973-2) contains supplementary material, which is available to authorized users.

Background Stage IV colorectal cancer encompasses various clinical conditions. The differences in prognosis after surgery between different metastatic organs have not been fully investigated. Objective This study aimed to assess prognostic significance in peritoneal metastasis in R0 resected stage IV colorectal cancer. Design We conducted a multicenter retrospective study of patients with R0 resected stage IV colorectal cancer; they were categorized into 3 groups according to the number and location of metastatic organs, including single-organ metastasis in the peritoneum, single-organ metastasis at sites except the peritoneum, and multiple-organ metastases. Settings This study used data accumulated by the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer. Patients A total of 1133 patients with R0 resected stage IV colorectal cancer were registered retrospectively between 1997 and 2007 in 20 referral hospitals. Main outcome measures Cancer-specific survival rates between the groups were measured. Results The median cancer-specific survival of the single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group and was almost comparable to that of the multiple-organ metastases group (3.41 years, 6.20 years, and 2.99 years). In a multivariate analysis of cancer-specific survival, peritoneal dissemination was confirmed as an independent prognostic factor of survival. The median postrecurrence survival of single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group. Approximately half of the patients who experienced recurrence of single-organ metastasis in the peritoneum experienced peritoneal recurrence. Limitations This was a retrospective, population-based study that requires a prospective design to validate its conclusions. Conclusions Peritoneal metastasis of colorectal cancer frequently recurred in the peritoneum even after R0 resection. The cancer-specific survival of the single-organ metastasis in the peritoneum group was as poor as that of the multiple-organ metastases group. See Video Abstract at http://links.lww.com/DCR/A398.

Background We aimed to investigate the molecular features of synchronous colorectal cancer (CRC). Materials and methods Out of 1,262 patients with CRC, 130 lesions in 59 patients with synchronous CRC were retrospectively analyzed. Microsatellite, v-Ki-Ras2 Kristen rat sarcoma viral oncogene homolog (KRAS), v-raf murine sarcoma viral oncogene homolog B1 (BRAF), tumor protein 53 (TP53) and β-catenin status were evaluated and compared between synchronous CRC lesions in each patient. Results The subtypes of instability, BRAF and β-catenin subtypes was significant but low. Patients with discordant KRAS and TP53 were not concordant between lesions in the same patient, and concordance of microsatellite KRAS/BRAF subtypes comprised 50.8% of those with synchronous CRC. The rate of patients with lesions containing both mutL homolog 1 (MLH1) methylation and microsatellite stable status was 66.7% in those with synchronous CRC, with at least one lesion with high microsatellite instability. Conclusion The present study on synchronous CRC demonstrated a low concordance of molecular subtypes between lesions in the same patient. A molecular analysis of metastatic lesions is warranted for molecular targeted therapy of metastatic synchronous CRC.

Highlights • We experience involving a case of relatively rare anorectal malignant melanoma with skipped lesion. Multiple black lesions showed malignant melanoma were observed around main tumor. • Careful examination of the lesion is required for skip lesions in anorectal melanoma., Introduction We report our experience involving a case of relatively rare anorectal malignant melanoma with skipped lesion. Presentation of case The patient was a 72-year-old man who had visited a local clinic complaining of a mass in the anal region, whereupon he was referred to our hospital on suspicion of a malignant melanoma. Close examination revealed a 25-mm black type 1 tumor one-third the size of the circumference of the anal canal and located externally to it. We performed transanal resection of the tumor and confirmed a diagnosis of malignant melanoma. Notably, multiple macular black lesions spaced away from the main lesion were observed during surgery in half of the circumference of the anal canal, from the tumor to the pectinate line. A biopsy of the area also revealed malignant melanoma; therefore, we performed abdominoperineal resection. Pathological diagnosis indicated a submucosal depth; the patient was thus diagnosed with T4 N2c M0 stage IIIb malignant melanoma and was followed on an outpatient basis. Discussion Patients with anorectal malignant melanoma have very poor prognoses owing to early lymph node metastasis and hematogenous metastasis. Our case illustrates that small anorectal malignant melanoma lesions can spread from the main lesion and invade the mucosa; examinations may sometimes miss such skipped lesions. Conclusion Skipped lesions can occur in anorectal melanomas; thus, careful scrutiny of such lesions is required. Moreover, lesion resection is critical for anorectal malignant melanomas.

AIM This study aimed to clarify the difference in the clinicopathological and prognostic features between synchronous colorectal cancer (CRC) and solitary CRC. MATERIALS AND METHODS A retrospective analysis was conducted in patients with synchronous and solitary CRC. RESULTS A total of 92 (7.1%) out of 1,295 consecutive patients had synchronous CRC. Mucinous adenocarcinoma was more frequent in patients with synchronous CRC than in those with solitary CRC (13.0% vs. 3.7%; p

Background We present a case of asynchronously occurring adenocarcinomas 29 and 36 years after ureterosigmoidostomy for bladder cancer, respectively, at both anastomosis sites. Case presentation A colonoscopy that was performed on a 69-year-old man because of bloody stool and an elevated carcinoembryonic antigen (CEA) level revealed a polypoid lesion at the right ureterosigmoid anastomosis site 29 years after the patient’s ureterosigmoidostomy. Endoscopic resection was performed, and the lesion was diagnosed as adenocarcinoma. Seven years later (36 years after ureterosigmoidostomy), an elevated lesion was detected at the left ureterosigmoid anastomosis site by colonoscopy performed after detection of high CEA levels. Biopsy revealed an adenocarcinoma that was immunohistologically positive for CDX2; sigmoidectomy and ureterectomy were subsequently performed. The pathological diagnosis of the second tumor was adenocarcinoma arising in the ureterosigmoid anastomosis site and invading the left ureter. Conclusions Diligent long-term follow-up of patients who underwent ureterosigmoidostomy is essential.

Rheological properties in a molten state are studied extensively for poly(3-hydroxybutyrate-co-3-hydroxyvalerate), PHB-HV, with a small amount of crosslinked poly(epichlorohydrin), PECH, having low density of crosslink points. It is found that adding 2 wt % of xPECH greatly enhances the melt elasticity of PHB-HV, one of the serious defects of microbial PHB, whereas it has no effect on the shear viscosity. As a result, viscoelastic nature, and thus processability, of PHB-HV can be controlled by blending the crosslinked PECH. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2008

Gastrointestinal (GI) cancer, including gastric and colorectal cancer, is a major cause of death worldwide. A substantial proportion of patients with GI cancer have a familial history, and several causative genes have been identified. Gene carriers with these hereditary GI syndromes often harbor several kinds of cancer at an early age, and genetic testing and specific surveillance may save their lives through early detection. Gastroenterologists and GI surgeons should be familiar with these syndromes, even though they are not always associated with a high penetrance of GI cancer. In this review, we provide an overview and discuss the diagnosis, genetic testing, and management of four major hereditary GI cancers: familial adenomatous polyposis, Lynch syndrome, hereditary diffuse gastric cancer, and Li-Fraumeni syndrome.

Thermal degradation at processing temperature and the effect on the rheological properties for poly(3-hydroxybutyrate) have been studied by means of oscillatory shear modulus and capillary extrusion properties, with the aid of molecular weight measurements. Thermal history at processing temperature depresses the viscosity because of random chain scission. As a result, gross melt fracture hardly takes place with increasing the residence time in a capillary rheometer. Moreover, it was also found that the molecular weight distribution is independent of the residence time, whereas the inverse of the average molecular weight is proportional to the residence time. Prediction of average molecular weight with a constant molecular weight distribution makes it possible to calculate the flow curve following generalized Newtonian fluid equation proposed by Carreau as a function of temperature as well as the residence time.

Structure and mechanical properties for binary blends composed of a poly(3-hydroxybutyrate) (PHB) and a cellulose derivative, such as cellulose acetate propionate (CAP) and cellulose acetate butyrate (CAB), have been studied by means of dynamic mechanical analysis, isothermal crystallization measurements, and tensile testing. It is found that β relaxation temperature due to glass transition of PHB or PHB-rich phase in the blends, in which the cellulose derivative has lower molecular weight, is almost the same as that of the pure PHB. On the other hand, the peak location is shifted to even lower temperature than that of the pure PHB by blending the cellulose derivative with higher molecular weight, although the cellulose derivative is a glassy polymer with high glass transition temperature. Further, the blend with lower β relaxation temperature exhibits ductile behavior with low modulus in uniaxial deformation. The difference in the structure and mechanical properties for the blends are found to be determined by the crystallization rate. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3447–3452, 2007

In the oral field, it is rare for acute promyelocytic leukemia (APL) to be reported. A patient, who presented a chief complaint of bleeding tendency after a minor oral surgical procedure, was referred to us. The diagnosis of APL was reached and herein the case is reported.A 52-year-old male developed continuous gingival bleeding from the operative wound and fever after his 2 root apex was resected. He was referred to our department for further workups of fever and controlling the bleeding and was admitted on the spot. Intraoral findings revealed that the area was packed with spongel and bosmin gauze and that the amount of bleeding was minimal. The nearby gingivae were swollen and the lips were slightly anemic. CBC on admission reported the following values: RBC 188×104/mm3; Hgb 6.3g/dl; Hct 18.5%; PLT 6.1×104/mm3; WBC 59, 700/mm3, 81% myeloblasts, 12.5% promyelocytes, 1% myelocytes. Chromosomal study revealed the presence of 46 XY t (15;17). Based on some other studies, the diagnosis of APL or M3 variant according to the FAB classification, associated with DIC was established. A complete remission resulted after courses of DNR therapy. A temporary denture has been put in after the extraction of 32 tooth. His clinical course has been uneventful without bleeding tendency.