Resolution of Paraneoplastic Lumbosacral Plexopathy in a Patient With Stage III Rectal Cancer after Curative Resection

2021 ◽  
pp. 000313482110488
Author(s):  
Joseph J. Bengart ◽  
Konstantinos Chouliaras ◽  
Steven Nurkin

Paraneoplastic syndromes are rare but possible manifestations of colorectal cancer. We present THE CASE of a 51-year-old female diagnosed with cT3N2 rectal adenocarcinoma who developed back pain and progressive muscle weakness during preoperative treatment. She had a rapid worsening in mobility and was ultimately ambulating with a wheelchair, despite physical therapy and conservative treatments. Extensive laboratory workup including onconeural antibodies was negative and her lower extremity electromyogram was suggestive of a subacute demyelinating lumbosacral plexopathy. After multidisciplinary discussion, the decision was made to proceed with curative resection. She had significant improvement in her weakness following resection, suggesting a paraneoplastic etiology. One year after resection, she remains free of disease and is ambulating comfortably. Onconeural antibodies can be a helpful diagnostic tool, but their absence does not rule out paraneoplastic disease. A high index of suspicion is necessary when assessing patients with atypical symptoms, particularly with the rise of colorectal cancer in young adults.

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2259
Author(s):  
Ruth Vera ◽  
María Luisa Gómez ◽  
Juan Ramón Ayuso ◽  
Joan Figueras ◽  
Pilar García-Alfonso ◽  
...  

Background: The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Methods: Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2 bid on days 1–14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3–5 weeks later, followed by four cycles of bevacizumab + XELOX. Results: A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. Conclusion: CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14567-14567
Author(s):  
A. Takeda

14567 Background: Because alternations of the p53 tumor suppressor gene are the most commonly observed and can occur early in the carcinogenic process, the accumulation of mutant p53 often leads to the production of p53 antibodies in the sera. The aim of this study is to evaluate the clinical usefullness as early detection marker and as a predictive biomarker of serum p53 antibodies in primary colorectal cancer. Methods: Serum samples are obtained before treatment and from time to time postoperatively and stored - 800C until assay. We employed the newly produced quantitative p53 antibodies ELISA Kit (MESACUP anti-p53 Test, MBL, Japan) to determine the presence of p53 antibodies in 311 patients with colorectal adenocarcinoma compared with the conventional two markers of CEA and CA19–9. Post operative clinical course and the long time survival were evaluated in sero-positive patients after resection. Results: The sensitivities of serum p53 antibodies, CEA and CA19–9 were 32.9%, 36.0% and 23.1%, almost equivalent to CEA and significantly higher than CA19–9. No obvious correlations were evident between the status of serum p53 antibodies and values of two markers, resulting in independent of the other markers. The sensitivity rate of CEA turned up as promotion of pathological stage, but the presence of serum p53 antibodies was more significantly associated with stage 0,I,II. One hundred-nine patients who showed preoperatively sero-positive patients were monitored for at least one year after resection. There was a significant correlation between operative curability and postoperative absence of serum p53 antibodies. Most of repeatedly positive patients treated as curative resection developed recurrence within one year in stageIIandIII. Repeatedly detected patients for serum p53 antibodies have a significantly poor prognosis compared with changed negative patients after curative resection in stageIIandIII. Conclusions: Serum p53 antibodies is easy and convenient, non- invasive, detectable many times and not necessary for surgical specimens for assay. Surveillance of p53 antibodies is rapid and readily facilitated test, which appears to be useful as a new tool for early diagnosis and as a postoperative predictive marker for colorectal cancer patients. No significant financial relationships to disclose.


2017 ◽  
Vol 99 (2) ◽  
pp. e56-e57
Author(s):  
M Bailon-Cuadrado ◽  
JI Blanco-Alvarez ◽  
R Velasco-Lopez ◽  
M Rodriguez-Lopez

Introduction The two mechanisms postulated for cancer recurrence at the anastomosis site (‘anastomotic recurrence’ (AR)) after curative surgery for colorectal cancer are: (i) intraluminal dissemination of viable cancer cells; (ii) metachronous carcinogenesis related with changes in the local milieu provoked by the materials employed to carry out the anastomosis. Case History We describe a 79-year-old female who underwent a left hemicolectomy due to a stenotic lesion shown on colonoscopy: an adenocarcinoma (pT3NO, G2). One year after surgery, control colonoscopy revealed an AR, so a new resection was carried out. Pathology showed it to be a recurrent adenocarcinoma over the staple line (pT3N0, G2). One year after the second surgical procedure, control colonoscopy evinced a new AR, resulting in a new resection. Pathology revealed a new AR. Conclusions This is only the second time that a second isolated AR after curative resection for colorectal cancer has been reported.


HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S339-S340
Author(s):  
M. Hamano ◽  
S. Katagiri ◽  
M. Oota ◽  
S. Onizawa ◽  
Y. Niwa ◽  
...  

Surgery Today ◽  
2021 ◽  
Author(s):  
Hirotaka Furuke ◽  
Tomohiro Arita ◽  
Yoshiaki Kuriu ◽  
Hiroki Shimizu ◽  
Jun Kiuchi ◽  
...  

2007 ◽  
Vol 50 (11) ◽  
pp. 1783-1799 ◽  
Author(s):  
Joe J. Tjandra ◽  
Miranda K. Y. Chan

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.


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