Background.-Colorectal neuroendocrine tumors are a rare malignancy, yet their incidence appears to be increasing. The optimal treatment for the high-grade subset of these tumors remains unclear. We aimed to examine the relationship between different treatment modalities and outcomes for patients with high-grade neuroendocrine carcinomas (HGNECs) of the colon and rectum. Methods.-The National Cancer Database (2004-2015) was used to identify patients diagnosed with colorectal HGNECs. The primary outcome was overall survival. A Cox Proportional hazard model was used to identify risk factors for survival. Results.-Overall, 1208 patients had HGNECs; 452 (37.4%) patients had primary tumors of the rectum, and 756 (62.5%) patients had primary tumors of the colon. A total of 564 (46.7%) patients presented with stage IV disease. The median survival was 9.0 months [95% confidence interval (CI) 8.2-9.8]. In multivariable analysis, surgical resection [hazard ratio (HR) 0.54, 95% CI0.44-0.66; p < 0.001], chemotherapy (HR 0.74, 95% CI0.69-0.79; p < 0.001), and rectum as the primary site of tumor (HR 0.62, 95% CI 0.51-0.76; p < 0.001) were associated with better overall survival, while older age (HR1.01, 95% CI 1.00-1.01; p = 0.02) and the presence of metastatic disease (HR 3.34, 95% CI 2.69-4.15; p < 0.001) were associated with worse survival. Conclusions.-Patients with colorectal HGNECs selected for chemotherapy and surgical resection of the primary tumor demonstrated better overall survival than those managed without resection. Patients who were able to undergo systemic chemotherapy may benefit from potentially curative resection of the primary tumor. AUTHOR CONTRIBUTIONS All authors made substantial contributions to the design of the work, drafted the work, approved the final version submitted for publication, and agreed to be accountable for all aspects of the work. Adam C. Fields and Pamela Lu MD were co-first authors on this work. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Modular implants are currently widely used in total hip arthroplasty because they give surgeons versatility during the operation, allow for easier revision surgery, and can be adjusted to better fit the anatomy of the specific patient. However, modular implants, specifically those that have metal-on-metal junctions, are susceptible to crevice and fretting corrosion. This can ultimately cause implant failure, inflammation, and adverse local tissue reaction, among other possible side effects. Surgeons should be aware of the possibility of implant corrosion and should follow a set of recommended guidelines to systematically diagnose and treat patients with corroded implants. Ultimately, surgeons will continue to use modular implants because of their widespread benefits. However, more research is needed to determine how to minimize corrosion and the negative side effects that have been associated with modular junctions in total hip arthroplasty. [Orthopedics. 2017; 40(6):355-366.].

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A number of genetic syndromes that predispose patients to colon cancer have been well described, allowing for improved surveillance, diagnosis and treatment. However, other syndromes likely exist but have yet to be thoroughly characterized. I report the case of a 50-year-old woman who was found to have over 50 polyps on routine screening colonoscopy. Genetic sequencing revealed a mutation in Axin2, a rare gene implicated in oligodontia-colorectal cancer syndrome. It was later found that the patient lacks several permanent teeth, as does her mother, who also had a history of multiple colonic polyps. Given the rarity of Axin2 mutations, there are no guidelines for management of such patients. This highlights the importance of a thorough review of system when screening for colon cancer as well as documenting cases of Axin2 mutations to create management guidelines for these patients.

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