IntroductionMixed glandular-endocrine carcinomas are rare tumours of gastrointestinal tract (MANEC). They are more frequent in stomach and hardly one hundred cases have been described in colon. According to Lewis, they are classified into collision (side by side pattern), composite (intermingled) or amphicrine (neuroendocrine and glandular features inside a same cell). Collision tumours are related to biclonal theory: two simultaneous cancerogenic events. Conversely, multidirectional differentiation from a stem cell is accepted as origin of composite tumours.The aim of this paper is to analyse the behaviour of these tumours, with an especial concern about how these tumours metastasise, and the different theories about carcinogenesis.Presentation of caseWe report a rare case of collision adenocarcinoma-large cell neuroendocrine tumour of colon that after a three-year period of follow-up has presented a retroperitoneal recurrence that features adenocarcinoma and large cell neuroendocrine components.DiscussionAfter an exhaustive review of the English literature, we found that only two cases of collision tumour of colon with metastases showing glandular and endocrine components have been described up to date, so we report the third case, and the first happening in transverse colon.ConclusionWe conclude that not all collision tumours follow the biclonal theory and more studies are needed to clarify the origin of these neoplasms, and consequently, to reach an adequate treatment.

Background. The serum levels of CA 125 tumor‐associated antigen in patients with lung cancer have been previously related to TNM stage, histologic type, and survival rate. In the current study, the prognostic information provided by the CA 125 antigen assay was analyzed. Methods. Preoperative serum of CA 125 antigen was determined in 137 patients with non‐small cell lung cancer. The assay was performed by means of a solidphase enzyme‐immunoassay test. The influence of CA 125 serum level on postoperative outcome was studied by a multivariate analysis, performed with Cox's proportional hazards regression model. Results. Patients whose initial CA 125 level was higher than 15 U/ml had a 3.25‐fold greater likelihood of relapse (95% confidence interval [CI], 1.7–6.21) (P < 0.001) and a 4.27‐fold greater likelihood of death (95% CI, 2.42–7.55) (P < 0.001) due to cancer than patients with lower values. For patients with serum levels over 15 U/ml, the 36‐month survival rate posttreatment was lower (67% versus 20%) (P < 0.001), as was the disease‐free rate (64% versus 13%) (P < 0.001). After adjustment for TNM stages, histologic type, sex, and age, patients with CA 125 values over 15 U/ml continued exhibiting higher risk of relapse (hazard ratio, 2.2; 95% CI, 1.04–4.69) (P = 0.04) and higher risk of death (hazard ratio, 2.42; 95% CI, 1.29–4.54) (P = 0.006). Conclusions. CA 125 is an independent prognostic factor of survival and tumor relapse in non‐small cell lung cancer. The preoperative serum level of CA 125 antigen is inversely correlated with the outcome figures. The authors suggest that CA 125 be included in any future multifactorial analysis of survival. Cancer 1994; 73:1368–76.

To assess the prognostic value of pretreatment serum neuron-specific enolase (NSE) in nonsmall cell lung cancer (NSCLC), levels were measured in 84 NSCLC patients, 40 healthy controls, and 20 patients with benign pulmonary diseases. NSE concentration was higher in NSCLC (11.7 + 10.8 ng/ml) (mean + SD; median = 9.7 ng/ml) than in the two control groups (p < 0.001). Serum NSE was neither related with the tumor-node-metastasis (TNM) stage, nor with histologic subtype. At a cutoff value of 15 ng/ml, NSE had a sensitivity of 27.3% and a specificity of 96%. Patients with a preoperative NSE level < 15 ng/ml showed significantly longer 24-month survival than those whose initial levels were > 15 ng/ml (70 vs, 47%; p < 0.05), and this was confirmed after stratifying by TNM stage. Likelihood of tumor relapse in I, II, and Ilia TNM stages showed similar behavior. These findings suggest that NSE could be used as an adjunctive prognostic test in NSCLC patients.

Objectives: To investigate the relationship between the histopathologic effects of preoperative chemoradiotherapy in rectal cancer and the proteins, proliferating cell nuclear antigen (PCNA) and p53. Methods: Samples from 73 tumors were examined. The histopathologic effects observed in the resected specimens induced by preoperative chemoradiotherapy were correlated with the inmunohistochemical expression of PCNA and p53 in biopsies obtained by rectoscopy before chemoradiotherapy. Results: Thirty-five tumors showed a high PCNA index (48%). Nuclear accumulation of p53 protein was detected in 53 tumors (72%). Specimens were assigned one of four grades based on the amount of residual viable tumor. Three neoplasms (4%) showed complete regression; 8 other carcinomas (11%) showed only small numbers of tumor cells scattered within the field of stromal reaction. In these cases, it was considered that the tumor had responded significantly to radiotherapy. Tumors with a high PCNA index responded to chemoradiotherapy more frequently (8/35; 72%) than tumors with a low index (3/38; 43%) (p = 0.07). p53-negative tumors responded more frequently (4/20; 20%) than positive tumors (7/53; 13.2%) (p = 0.50). When pathologic and immunohistochemical characteristics of the tumors were included in a logistic regression model, only high PCNA index (odds ratio 5.35, 95% confidence interval 1.07–26.7) (p = 0.04) was significantly associated with the histologic response to preoperative chemoradiotherapy. Conclusion: High proliferative activity of rectal cancer, as determined by PCNA immunostaining, is predictive of the response to preoperative chemoradiotherapy.

Between 1990 and 1997, 284 patients were treated in our hospital for abdominal hernias. In the original group, 239 patients (84.15%) had midline hernia, and 45 (15.8%) had lateral hernia. A total of 152 midline hernia patients (63.5%) were treated using our variant of Rives technique. In all these cases, preperitoneal and retromuscular polypropylene mesh was used as a reinforcement and was subsequently attached by means of absorbable sutures to the external border of the rectus muscles. There were no deaths. A total of 42 of all patients operated on (27.6%) suffered from long-term postoperative pain. In seven cases (4.6%) it was necessary to remove the prosthesis because of chronic infection, and there were two recurrences in patients in whom the prosthesis had to be removed. In our experience, the Rives technique is a suitable and safe treatment for the repair of midline incisional hernias. The use of absorbable sutures and fixation of the mesh to the external oblique aponeurosis can reduce the original problems of abdominal pain and unaesthetic skin scars.