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Journal of Gastronenterology and Digestive Diseases
|
Volume 3
J u n e 2 5 - 2 6 , 2 0 1 8 | D u b l i n , I r e l a n d
GASTROENTEROLOGY
International Conference on
Domenico Macaluso et al., J Gastroenterol Dig Dis 2018, Volume 3
SPREADING OF A COLON ADENOMA: A
CASE REPORT
Domenico Macaluso
1
, Italia F
2
and
Bianciardi G
3
1
Domenico Macaluso, Endoscopy Service, Ribera’s Hospital, Agrigento, Italy
2
Fabrizio Italia, Laboratory of Pathology “OncoPath”, Augusta, Siracusa, Italy
3
Giorgio Bianciardi, Department of Medical Biotechnologies, Pathologic Anatomy,
Siena University, Italy
T
he capacity to spread beyond the limits of the tissue in which it was
originated and to survive is the prerogative of malignant tumors, the
feature at the basis of the concept of malignancy. In 90% of cases, a
colon cancer originates from its dysplastic precursor, the adenomatous
polyp; evidence that 60-70% of that cancer is localized in the distal colon
suggests that environmental factors affect the progression of the tumor,
like the activation of HIF-1 transcription factor and the physiological
hypoxia that exists in this environment. Here we describe the finding of
a clinical case where a benign tubulovillous adenoma appears able to
survive and colonize the colonic mucosa away from the primary lesion.
It was supported by visual inspection, histological evidence and fractal
analysis (each tested morphometrical parameters- box dimension,
information dimension, mass dimension, perimeter-area dimension,
algorithmic complexity- overlapped each other, p<0.03). If this finding will
be confirmed in a high number of patients and by experimental studies,
the current diagnostic/therapeutic approaches of the colon tumors
should be modified, not only regarding colorectal adenomas, but also
the superficial cancer of the large bowel. The mechanisms of spread of
a malignant tumor in other tissues (metastasis) are well known since
the previous century (bloodstream, lymphatic circulation, contiguity, via
transcelomatic dissemination). It is a process affected by many factors,
like as the ability to overcome hypoxia and to be provided with a vascular
network. During a colonscopy, two benign lesions (adenomas, one large
vegetating proximal lesion and one small lesion, distally) were revealed
in a patient, the position and the aspect at gross and microscopic
levelssuggesting that the small lesion could be derived from the other.
In this work we face a clinical case that may suggest the possibility of an
adenomatous polyp, a benign tumor, to spread and colonize the colonic
mucosa remotely, with mechanisms considered, so far, prerogative of a
malignant tumor.
Case report:
During a colonoscopy performed at the Ribera’s Hospital
Endoscopy Service (Provincial Health Institution of Agrigento, Sicily) in
a 63-year-old male that came to our attention for a positive Fecal Occult
Blood Test (FOBT). Colonoscopy (Pentax EPM-3000 colonoscope)
demostrated the presence of two eteroplastic lesions:
1. Near the cecum, the presence of a
large vegetating lesion, dysplastic,
lumpy but not ulcerated, with a short
and thick peduncle; it invaded the
intestinal lumen and occupied the
entire whole of it.
2. Approximately 20 cm distal to the
above lesion, a small eteroplastic
lesion located just below the hepatic
flexure, lying on a colonic haustra.
The mass, approximately 3 mm in
diameter, was anchored to the colon
mucosa through thin threadlike
structures, and in relation with blood
capillaries.
The structure hadn’t a vascular pole and at
the detachment from the mucosa, the tumor
appeared without a peduncle; capillaries,
breaking away from the lumen of the colon,
giving rise to a modest bleeding. It was not
possible to proceedwith endoscopic resection
due to the high dimension of the first lesion,
and it was decided to perform some biopsies
for histological/historphometric evaluations.
In the present study, we describe a clinical
case where a benign adenoma appears able to
survive and colonize the colonic mucosa away
from the primary lesion. This was supported
by visual inspection during colonoscopy
(presence of a small mass, distally to a large
vegetating lesion; it was without a peduncle,
vascular axis and vascular pole, anchored
to the colon mucosa through thin threadlike
structures, and in relation with nest of
capillaries), histological evidence (the same
microstructure of a tubulovillous adenoma
with low-grade epithelial dysplasia and notes
of dyskaryosis) and fractal analysis (five
fractal parameters, obtained by analyzing
about 1500 microstructures for each lesion,
perfectly overlapped between the lesions).
The small distal adenoma appears to be the
daughter of the large vegetating proximal
lesion. The Warburg effect, known since 1956,
is the ability of cancer cells to respond to