Our previous studies have shown that histologically normal mucosa adjacent to carcinomas of the large intestine is often abnormal histochemically. This „transitional”︁ mucosa, as we termed it, is characterized by an increase of sialomucins, accompanied usually by a decrease or absence of the sulphomucins which are predominant in the normal mucosa of the large intestine. The extent and intensity of these mucin changes were not clear, and so we have mapped them by cutting strips of mucosa from the whole length of 25 surgical specimens. This work confirms that the pattern of mucus secretion is altered around carcinomas, but also shows similar changes in patches of mucosa at a distance from frank tumors. The increase in sialomucins is directly related to the extent of invasion by a carcinoma according to Dukes' classification, but not to its degree of differentiation or to its histologic pattern. It is suggested that the mucin changes may reflect a transformation to a fetal type of epithelium and indicate an early stage in carcinogenesis. The practical value of these findings in diagnosis and prognosis is discussed.
The mucosa in 100 segments of colon and rectum resected for cancer were examined using light microscopy and histochemical techniques. The extent of abnormal or transitional mucosa was defined for each case. Transitional mucosa was present in 93 of 95 adenocarcinomas and one malignant melanoma. The average total length of transitional change was 3.4 cm and the maximum length was 19.5 cm. An inverse correlation was observed between the survival and the length of transitional mucosa around locally invasive (Dukes' B) carcinomas (P = 0.005). This may be related to increased amounts of sialic acid in transitional mucosa and the ability of sialic acid to depress tumor immuno-genicity. The raised levels of sialic acids in transitional mucosa may have practical value in assessment of prognosis in colorectal cancer. Cancer 46:764-770, 1980. LTHOUGH THICKENED MUCOSA has been noted in A carcinoma of the large intestine for many years, only recently have the changes in this mucosa been clearly defined. Initially, attention was drawn to the histochemical changes. Increased amounts of sialo-mucins with a corresponding decrease in sulphated mucosubstances have been described. 10m~13 This thickened or "transitional" mucosa also shows subtle morphological abnormalities of crypt architecture on light microscopy. 13~14,29 Transmission electron microscopy has revealed an alteration in the relative proportions of the different epithelial cell types with persistence of immature and intermediate cells in the upper parts of the crypts as well as an overall increase in the number of goblet cells.6 Studies using scanning electron microscopy have shown structural alterations in the surface of transitional mucosa.26 Lipkin has shown abnormal proliferative characteristics in apparently normal mucosa surrounding colon carcinoma of both humans and animals in studies using tritiated thymidine. 21 In a small series, the amount of transitional mucosa in colorectal carcinoma appeared greater in more
Erythema elevatum diutinum is a rare disease of unknown aetiology. It is usually symmetrical with multiple lesions. An association with rheumatoid has previously been reported. We report a case of atypical erythema elevatum diutinum affecting the right elbow of a female patient with seropositive rheumatoid arthritis.
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