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Background: An important goal of serum tumor marker research is to provide a test for detecting cancer in early stages. Expression of carbohydrate antigen (CA) 19.9 has been described in various malignancies., Methods: The possible prognostic value measuring cytosol CA 19.9 expression in tumors was evaluated in a study of 63 colorectal carcinoma (CRC) patients who were followed for at least 2 years. CA 19.9 expression in cytosol was determined by enzyme-linked immunoadsorbant assay, and measurement of this protein achieved by quantitative assay., Results: Mean levels of cytosol CA 19.9 found in tumor samples were significantly higher than those in nontumoral areas in CRC patients (P<0.0005). Patients with more than 3 positive lymph nodes had a higher expression of the marker (P<0.05). Univariate and multivariate analyses revealed that cytosol CA 19.9 concentration was an independent prognostic variable for relapse. Furthermore, the probability of relapse increased 4.2 times for every increase in cytosol tumor marker of 5000 U/mg, and tumors located in the rectum had a probability of relapse 9.5 times greater., Conclusions: Cystol CA 19.9 expression in CRC can be an independent prognostic factor for relapse. Patients with high levels of CA 19.9 have worse prognosis than those with lower values. Therefore, this group of patients should receive special management with regard to their follow-up and treatment. Moreover, quantitative cytosol tumor marker measurement is an easy and highly effective method for determining the prognoses of CRC patients., (Copyright 1999 American Cancer Society.)

Hepatic adenoma and focal nodular hyperplasia are unfrequent benign lesions of the liver with individual histologic characteristics, but not always clinically distinguishable. The main difference is the intratumoral or intraperitoneal bleeding risk (high in adenoma and virtually zero in focal nodular hyperplasia). Surgery is the elective treatment for the first, while a more conservative attitude is allowed for the second. We present the case of a woman with an hepatic mass that clinically and radiologically seemed to be an adenoma. An atypical hepatectomy was done uneventfully. The examination of the specimen showed shaw focal nodular hyperplasia. We review the diagnostic and therapeutic controversy between these entities, because only the histologic examination of the entire surgical specimen could demonstrate the real nature of the lesion.

Small-cell anaplastic carcinoma of the colon is a very infrequent tumour (less than 1% of all colorectal neoplasms). Thirty-two cases have been described in the international literature up to 1992. A case, in a 54 year-old patient who underwent successful resection is presented. The importance of this tumour is due to its great aggressivity, and its great tendency to produce early hematogenous and lymph node metastases. It implies a bad prognosis and a survival of around 0% at one year. Because of these facts, treatment must include, beside surgical resection, an aggressive systemic protocol.

In the last years the relationship between congenital hypertrophy of retinal pigment epithelium (CHPRE) and familial adenomatous polyposis (FAP) has been described. It has been said that ophthalmoscopy would be a good screening method for following up the relatives of patients with FAP. We present an ophthalmoscopic study of 14 member of a family with FAP. Four members with FAP were operated on in our department. Only a six years-old child, to this date without FAP, presented CHPRE. We review the relationship between FAP and CHPRE, and emphasize the importance of follow-up in FAP specially when CHPRE is present.

A new case of cecal herniation through the foramen of Winslow is reported in a 67 year-old woman, preoperatively diagnosed by water-soluble contrast enema. Herniation through Winslow's foramen is an uncommon variety of internal hernias. Of 144 cases reported up to 1991 in the world literature, the cecum was involved in only 25-30%; and less than 10% of these were radiologically diagnosed before surgery.