Heterotopic Ossification in Rectal Carcinoma: Report of a Case and Review of the Literature

Heterotopic ossification in colorectal carcinoma is extremely rare. This report presents the case of a 57-year-old male who had undergone a low anterior resection following a diagnosis of rectal carcinoma. Histological examination showed heterotopic ossification in the tumor. The patient was referred to Ibaraki Medical Center, Tokyo Medical University, with a diagnosis of rectal carcinoma by a local physician. Abdominal computed tomography revealed thickening of the rectal wall with calcified deposits, and virtual colonoscopy showed stenosis with a mass in the rectum. The patient underwent a low anterior resection and diverting ileostomy in May 2014. Histological examination of the excised tumor showed moderately differentiated adenocarcinoma and an infiltration of spindle cells with numerous foci of osteoid and ossification, with osteoblastic rimming in the stroma. Immunohistochemical analysis of these spindle cells and osteoblasts revealed negative staining for AE1/AE3, suggesting a reactive change. There was metastasis in 1 of the 12 lymph nodes, and the tumor was diagnosed as stage IIIB (T4a, N1a, M0) rectal carcinoma. The patient had an uneventful recovery and was followed up at our outpatient clinic. In conclusion, the malignant potential of heterotopic ossification in rectal carcinoma has not been determined. However, heterotopic ossification is induced by tumor progression in a microenvironment, suggesting a high tumor malignity. The patient should be carefully monitored after surgery in terms of improved patient outcome.

Download Full-text

Complications of Diverting Ileostomy after Low Anterior Resection for Rectal Carcinoma

The American Surgeon ◽

10.1177/000313481608201039 ◽

2016 ◽

Vol 82 (10) ◽

pp. 1033-1037 ◽

Cited By ~ 4

Author(s):

Sean Maroney ◽

Carlos Chavez De Paz ◽

Marjunphilip Duldulao ◽

Tracey Kim ◽

Mark E. Reeves ◽

...

Keyword(s):

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Medical Center ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Tumor Location ◽

Diverting Ileostomy ◽

Loma Linda University ◽

The Difference

There have been few studies directly comparing the postoperative complications in patients with a diverting ileostomy to patients who were not diverted after low anterior resection (LAR) for rectal carcinoma. This study is a retrospective chart review of all rectal carcinoma patients (99) who underwent a LAR from January 2009 to December 2014 at Loma Linda University Medical Center and Veterans Affairs Loma Linda Healthcare System. A majority of patients were diverted (58% vs 42%). The diverted patients were more likely to have a low tumor location ( P < 0.01), preoperative chemoradiation ( P < 0.01), and more intraoperative blood loss ( P < 0.01). Our study shows a statistically significant higher overall complication rate among patients receiving a diverting ileostomy in the six months after LAR (61% vs 38%, P = 0.02). The difference is due to a higher rate of readmission (27% vs 14%) and acute kidney injury (14% vs 5%) in patients with a diverting ileostomy. It also shows that there is a higher rate of unplanned reoperation (11% vs 6%) due to anastomotic leak (17% vs 5%) in nondiverted patients. Further studies are needed to refine the specific indications to maximize the benefit of diverting ileostomy after LAR for rectal carcinoma.

Download Full-text

The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

BMC Geriatrics ◽

10.1186/s12877-020-02001-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amal Rhemouga ◽

Stefan Buettner ◽

Wolf O. Bechstein ◽

Guido Woeste ◽

Teresa Schreckenbach

Keyword(s):

Rectal Cancer ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Older Patients ◽

Retrospective Cohort ◽

Loop Ileostomy ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

Download Full-text