The aim of the present study was to classify colorectal carcinoma (CRC) into molecular subtypes, based on immunohistochemical (IHC) assessments. A total of 112 CRC samples were molecularly classified based on the expression levels of epithelial-mesenchymal transition (EMT)-associated IHC markers. A total of three molecular subtypes were defined: Epithelial, membrane positivity for E-cadherin and β-catenin, negative for vimentin; mesenchymal, E-cadherin-negative, nuclear β-catenin-and vimentin-positive; and hybrid cases, epithelial tumor core and mesenchymal tumor buds. Most of the cases were diagnosed as moderately differentiated adenocarcinoma (n=89; 79.46%). The majority of cases (n=100; 89.28%) exhibited a mismatch repair proficient status (microsatellite stable CRCs). A predominance of epithelial-type (n=51; 45.54%) and hybrid CRCs (n=47; 41.96%) was observed, whereas a few cases (n=14; 12.50%) were classified as mesenchymal-type CRCs. This molecular classification was associated with pathological stage (P<0.01), pT stage (P=0.04), pN stage (P<0.01), the grade of tumor budding (P=0.04), and maspin expression in both the tumor core (P=0.04) and the invasion front (P<0.01). The mesenchymal-type cases predominantly exhibited lymph node metastases, high-grade budding and a tendency towards maspin nuclear predominance. All epithelial-type cases with maspin-only expression (n=18) were non-metastatic. Patients with CRC of the epithelial subtype and those with a lymph node ratio (LNR) ≤0.15 presented the best overall survival, followed by those with hybrid and mesenchymal subtypes. Nuclear maspin positivity was more frequent in cases with a high-budding degree compared with those with a low-budding degree (P=0.03). The EMT-associated molecular classification of CRCs may be used to identify the most aggressive CRCs, which show a mesenchymal phenotype, high-budding degree, maspin nuclear positivity and lymph node metastases. The pN stage, LNR and budding degree of patients, which can be evaluated with maspin expression, remain the most important prognostic factors.

Background: In patients with synchronous colorectal cancer (SCRC), understanding the underlying molecular behavior of such cases is mandatory for designing individualized therapy. The aim of this paper is to highlight the importance of transdisciplinary evaluation of the pre- and post-operative assessment of patients with SCRCs, from imaging to molecular investigations. Methods: Six patients with SCRCs presented with two carcinomas each. In addition to the microsatellite status (MSS), the epithelial mesenchymal transition was checked in each tumor using the biomarkers β-catenin and E-cadherin, same as KRAS and BRAF mutations. Results: In two of the patients, the second tumor was missed at endoscopy, but diagnosed by a subsequent computed-tomography-scan (CT-scan). From the six patients, a total of 11 adenocarcinomas (ADKs) and one squamous cell carcinoma (SCC) were analyzed. All the examined carcinomas were BRAF-wildtype microsatellite stable tumors with an epithelial histological subtype. In two of the six cases, KRAS gene status showed discordance between the two synchronous tumors, with mutations in the index tumors and wildtype status in the companion ones. Conclusions: Preoperative CT-scans can be useful for detection of synchronous tumors which may be missed by colonoscopy. Where synchronous tumors are identified, therapy should be based on the molecular profile of the indexed tumors.

Introduction: Colorectal cancer is one of the most common types of malignant tumors worldwide. In patients with situs abnormalities such as situs inversus totalis or situs ambiguus, the presence of this tumor could be a challenge for the surgeon, especially in cases in which the laparoscopic approach is considered. Case presentation: We report the case of a 69-year-old male patient with situs inversus totalis. This particular case of situs inversus totalis was not a classical type because the patient had bilateral bilobed lungs, polysplenia, preduodenal portal vein in association with midgut malrotation. The pathology report after surgery revealed moderately differentiated adenocarcinoma of the sigmoid colon, stage pT3 N1c M1a, liver metastases but without metastases in the eight resected lymph nodes. We compared this rare association of diseases of particular anatomic aspects with other reports in the specialty literature. Conclusion: The identification of situs abnormalities or other malformations in patients with resectable colorectal cancer is essential, thus preoperative imaging studies are imperative for a proper surgical management. Colorectal cancer metastasizing patterns in patients with intestinal malrotation need to be further investigated.

Preoperative staging of colorectal cancer (CRC) based on imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) is crucial for identification and then removal of the positive lymph nodes (LNs). The aim of this study was to evaluate the correlation between preoperatively seen morphologic criteria (number, size, shape, structure, borders, or enhancement patterns) and histopathological features of LNs using an in-house validated map of nodal stations. A total of 112 patients with CRC that underwent surgery were preoperatively evaluated by CT scans. The locoregional, intermediate, and central LNs were CT-mapped and then removed during open laparotomy and examined under microscope. The analysis of correlations was interpreted using the suspicious-to-positive ratio (SPR) parameter. The greatest correlation was found in tumors located in the sigmoid colon, descending colon and middle rectum; SPR value was 1.12, 1.18, and 1.26, respectively. SPR proved to be 0.59 for cases of the transverse colon. Regarding the enhancement type, the dotted pattern was mostly correlated with metastatic LNs (OR: 7.84; p < 0.0001 ), while the homogenous pattern proved a reliable indicator of nonmetastatic LNs (OR: 1.99; p < 0.05 ). A total of 1809 LNs were harvested, with a median value of 15 ± 1.34 LNs/case. Transdisciplinary approach of CRC focused on pre-, intra-, and postoperatively mapping of LNs might increase the accuracy of detecting metastasized nodes for tumors of the distal colon and middle rectum but not for those of the transverse colon. In addition to morphologic criteria, the enhancement pattern of LNs can be used as a predictor of nodal involvement improving the CT-based preoperative staging.

Bevezetés: Az óriás hasfali defektusok kezelése kihívást jelent a sebészek számára. CT-vizsgálattal meghatározható a sérvzsák és a hasüreg térfogata közötti arány, megállapítva a téraránytalanság mértékét, amely a műtét utáni hasűri nyomás mértékének kifejezője lehet. Célkitűzés: A posztoperatív óriás hasfali defektusok kivizsgálásában alkalmazott CT-vizsgálat jelentőségének alátámasztása, a rekonstrukciós módszer hatékonyságának elemzése a hasűrinyomás-méréssel. Módszer: Prospektív kutatást végzünk klinikánkon, vizsgálva az óriás hegsérvvel kezelt betegeinket, akiknél műtét előtt hasi CT-vizsgálat készül. A hasfal rekonstrukciója feszülésmentesen, retromuscularisan elhelyezett Prolene hálóval és sérvzsákból készített peritoneumlebenyekkel történik. Műtét alatt és műtét után hasűri nyomást mérünk, posztoperatívan 2, 4, 6 hónap után telefonon keresztül követjük betegeinket.Eredmények: Elért eredményeinket három eset kapcsán mutatjuk be. 1. eset: A 48 éves nőbetegnél óriás kiújult hegsérv, több társbetegség állt fenn. Testtömegindexe 43,6, a hasfali defektus átmérője 155 mm, a hegsérv térfogata 1536,63 cm 3 volt. A műtét utáni 7. napon hazabocsátottuk. 2. eset: Az 51 éves férfi betegnél multilocularis óriás hegsérv keletkezett, testtömegindexe 26,85 volt. A két hasfali defektus átmérője 123 mm és 105 mm, térfogatuk együttes értéke 406,41 cm 3 volt. A műtét utáni 5. napon a beteget elbocsátottuk. 3. eset: A 67 éves férfi beteg testtömegindexe 23,7, a hasfali defektus mérete 100 mm, térfogata 258,10 cm 3 volt. A beteget a műtét utáni 4. napon elbocsátottuk. Következtetés: A preoperatív CT-vizsgálat adatai fontosak az alkalmazott műtéti technika megválasztásában. A sérvzsák és a háló együttes alkalmazása az óriás hegsérvek rekonstrukciójában olcsó és feszülésmentes műtéti technikát biztosít a fokozott rizikóval rendelkező betegek esetében. A technika rövid távú hatékonyságának elemzésére a húgyhólyagon keresztül mért hasűri nyomás a választandó módszer. Orv Hetil. 2020; 161(9): 347-353.