Diagnosis and Management of Lynch Syndrome

Case Summary: A 56-year-old man with a history of hypertension and hyperlipidemia was referred by gastroenterology for bleeding per rectum. Because of a family history of colon cancer, he had several prior colonoscopies, most recently 3 years ago, without evidence of pathology. His mother was diagnosed with colon cancer in her mid-40s. His current colonoscopy demonstrated a 2.4 × 1.5 cm cecal adenocarcinoma. Staging workup revealed no evidence of metastatic disease. Because of the patient’s family history, the specimen was further evaluated and found to have high microsatellite instability (MSI-H). The patient was referred to a genetic counselor and found to have a germline pathogenic variant in MSH6 on gene panel testing. The patient did not have a family history of any extracolonic malignancies. The patient underwent an uncomplicated laparoscopic total abdominal colectomy with ileorectal anastomosis, which revealed a T2N0Mx adenocarcinoma with abundant peritumoral lymphocytes. He was discharged on postoperative day 2, and recuperated appropriately from surgery. Follow-up surveillance proctoscopy showed no evidence of disease. His sole offspring, a 25-year-old man, was negative for a pathogenic variant in MSH6 and had no polyps on colonoscopy. His siblings did demonstrate a pathogenic variant in MSH6 and are currently opting for annual surveillance colonoscopy.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Resident’s Corner Source Type: research

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Publication date: Available online 9 December 2019Source: Gynecologic Oncology ReportsAuthor(s): Kumiko Seki, Hiroshi Ishikawa, Rei Hashimoto, Akira Mitsuhashi, Jun-ichiro Ikeda, Makio Shozu
Source: Gynecologic Oncology Reports - Category: OBGYN Source Type: research
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BP control is important for overall health and reduced mortality secondary to cardiovascular disease. Find out how teaching your patients about mindfulness can help.
Source: Nursing Made Incredibly Easy - Category: Nursing Tags: Feature: CE Connection Source Type: research
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Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: ASCRS Committee Report: Public Relations Source Type: research
CASE SUMMARY: A 62-year-old previously healthy man presented with left lower quadrant pain and fever. Physical examination showed left lower quadrant peritonitis. Computed tomography scan showed a pelvic abscess with extraluminal air (Fig. 1). Intravenous antibiotics were started, and CT-guided percutaneous drainage was performed. The drain was removed 1 week after discharge. One week later, he presented with dysuria and pneumaturia and was started on antibiotics. Colonoscopy confirmed diverticulosis with no other mucosal abnormalities. He underwent a successful laparoscopic sigmoidectomy with colovesical fistula takedown.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Resident’s Corner Source Type: research
BACKGROUND: In 2016, the American Society of Colon and Rectal Surgeons published a rectal cancer surgery checklist composed of the essential elements of preoperative, intraoperative, and postoperative care for patients undergoing rectal cancer surgery. OBJECTIVE: The purpose of this study was to assess whether compliance with preoperative checklist elements was associated with improved pathologic and 30-day postoperative outcomes after rectal cancer surgery. DESIGN: This was a retrospective cohort study. SETTINGS: The study involved North American hospitals contributing to the American College of Surgeons Nation...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSIONS: The residual disease rate in patients treated surgically was higher than previously reported (43.2%). Incidence of recurrence in patients treated conservatively was low (4.4%). Areas of improvements have been identified in adherence to endoscopic follow-up, histopathological reporting, and potential overuse of radiological surveillance. See Video Abstract at http://links.lww.com/DCR/B47. MANEJO ACTUAL DE PÓLIPOS COLORRECTALES MALIGNOS A TRAVÉS DE UNA RED REGIONAL DE CÁNCER DEL REINO UNIDO ANTECEDENTES: La incidencia de pólipos colorrectales malignos ha aumentado secundariament...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSIONS: Resections that were approached laparoscopically were more likely to achieve oncologic success. Minimally invasive approaches did not lengthen operative times and provided benefits of reduced surgical site complications and decreased postoperative length of stay. Further studies are needed to clarify clinical outcomes and factors that influence the choice of approach. See Video Abstract at http://links.lww.com/DCR/B70. RESULTADOS ONCOLÓGICOS Y PERIOPERATORIOS DE LOS ABORDAJES LAPAROSCÓPICOS, ABIERTOS Y ROBÓTICOS PARA LA RESECCIÓN DEL CÁNCER RECTAL: UN ESTUDIO DE COHORTE MU...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSIONS: The rates of total mesorectal excision performance and grade assignment are widely variable throughout the state of Michigan. Overall, grade assignment remains very low. This suggests an opportunity for quality improvement projects to increase total mesorectal excision performance and grading, involving both the surgeons and pathologists for effective implementation. See Video Abstract at http://links.lww.com/DCR/B53. IMPLEMENTACIÓN DE LA ESCISIÓN MESORRECTAL TOTAL Y LA CLASIFICACIÓN POR ESCISIÓN MESORRECTAL TOTAL PARA EL CÁNCER RECTAL: UN ESTUDIO A NIVEL ESTATAL. ANTECE...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
More News: Adenocarcinoma | Bleeding | Cancer | Cancer & Oncology | Colectomy | Colon Cancer | Colonoscopy | Colorectal Cancer | Gastroenterology | Gastrointestinal Polyps | Genetics | HNPCC | Hypertension | Laparoscopy | Lynch Syndrome | Pathology | Polyps