Background: Colorectal cancer (CRC) is the third most common cancer in both men and women. In most Asian countries, both the incidence and mortality rates of CRC are gradually increasing. In Brunei Darussalam, CRC ranks first and second in lifetime risk among men and women respectively. This study aims to report the overall survival rates and associated factors of CRC in Brunei Darussalam. Methods: This is a retrospective study examining CRC data for the period 2007 to 2017 retrieved from a population based cancer registry in Brunei Darussalam. A total of 728 patients were included in the analysis. Kaplan Meier method was used to estimate survival rates. Univariate analysis using log-rank test was used to examine the differences in survival between groups. Multivariate analysis using Cox PH regression was used to estimate hazard of death and obtain significant predictors that influence CRC patients' survival. Results: The median survival time for colorectal, colon and rectal cancer patients were 57.0, 85.8 and 40.0 months respectively. The overall 1-, 3-and 5-year survival rates for CRC patients were 78.0%, 57.7% and 49.6% respectively. In univariate analysis, age at diagnosis, ethnicity, cancer stage, tumour location and histology were found to have significant difference in CRC patients' survival. In the Cox PH analysis, older age (≥70 years), cancer stage, ethnicity and other histological type were determined as associated factors of CRC patients' survival. Conclusion: This study found the overall 5-year survival rate of CRC in Brunei Darussalam is similar to that in some Asian countries such as Singapore and Malaysia. However, more efforts need to be carried out in order to raise awareness of CRC and improve the survival of CRC patients.

Splenic abscess is uncommon and is still associated with significant morbidity and mortality. Gram-negative bacilli are the most commonly isolated organisms, followed by Gram-positive cocci. However, the predominant organisms found depend on the geographic location. Shewanella putrefaciens is a Gram-negative non-fermentative oxidative bacillus found in the environment. Infection usually manifests with a number of clinical syndromes, most commonly as skin or soft tissue infections, typically in patients whose immune system is compromised. Intra-abdominal abscess is extremely rare. We report a case of a 22-year-old female who presented with S. putrefaciens splenic abscesses as the first manifestation of diabetes mellitus, which was successfully managed with a course of antibiotic therapy.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Common manifestations include bleeding, anemia or mass effect of the tumor (1-3). Intussusception as a first manifestation of gastric GIST is extremely rare.

Gastrointestinal lymphoma of the bowel is uncommon compared to adenocarcinoma. Signet ring cell lymphoma (SRCL) is a rare variant of non-Hodgkin's lymphoma that is characterized by clear cytoplasm with displaced nuclei to the periphery giving a signet ring appearance. Small bowel involvement has not been previously reported. We report the rare case of a 78-year-old female who presented with short history of fever, loss of appetite, nausea, vomiting, mild weight loss with abdominal discomfort and was later diagnosed to have SRCL of the ileum.

Paraneoplastic pemphigus is a relatively rare but significant acquired autoimmune mucocutaneous disorder that is characterised by diffuse erythema, painful blistering and sores of the skin and mucus membranes. The underlying pathogenesis is believed to be triggered by altered immune system in response to underlying neoplasm. The manifestations can predate, occur at the same time or after the diagnosis of cancer. Associations with gastric cancer have only been reported twice. A 78-year-old lady presented with a month's history of extensive skin lesions that started off as bullous lesions and biopsy revealed bullous pemphigus. Endoscopy for anemia revealed gastric cancer. This case reinforced the need to consider underlying malignancy in elderly patient with new onset dermatological presentation. Keywords Gastric cancer . Pemphigus vulgaris . Paraneoplastic manifestations . Bullous dermatological lesionsA 78-year-old lady presented with a month's history of extensive skin lesions that started off as bullous lesions. She had anorexia of recent onset but without any significant weight loss. Physical examination revealed multiple ruptured lesions throughout body (Fig. 1a) (trunk, genitalia and the extremities) with exudative discharge and bleeding. She also had painful lesions around the lip. Laboratory investigations revealed normocytic anemia of 7.3 g/dl. A skin biopsy showed ulcerated skin lesion lined by a layer of discohesive basal cells and direct immunofluorescence study showed pericellular positive staining for IgG consistent with pemphigus vulgaris (Fig. 1b, c). An upper gastrointestinal endoscopy showed diffuse esophageal candidiasis and multiple small geographic ulcers in the antrum (type IIc+a) (Fig. 1d). The biopsies of the antral ulcers showed diffuse infiltrating signet cell adenocarcinoma. Serum anti-desmoglin 3 was positive. A diagnosis of paraneoplastic pemphigus with the gastric cancer was made. A staging computed tomography scan revealed no metastases or any other abnormalities. Despite repeated discussions, the patient declined surgical intervention. She was managed with immunosuppressive therapy with some improvement of the skin condition. Her condition worsened and she passed away almost 2 years after the initial presentation.Paraneoplastic pemphigus is a relatively rare but significant acquired autoimmune mucocutaneous disorder that is characterised by diffuse erythema, painful blistering and sores of the skin and mucus membranes. The underlying pathogenesis is believed to be triggered by altered immune system in response to underlying neoplasm. The manifestations can predate, occur at the same time or after the diagnosis of cancer. Associations with gastric cancer have only been reported twice [1,2]. Associations with other malignancies such breast, colon and bladder cancers have been reported [3]. Other paraneoplastic cutaneous manifestations associated with gastric malignancies include Leser-Trelat syndrome, palmo-plantar keratoderma, acanthosis nigricans and paraneoplastic dermato...