Squamous Cell Rectal Carcinoma: About A Rare and Unusual Case: A Case report

Primary squamous cell rectal carcinoma is a rare malignancy that accounts for 0.3% of rectal tumors. To this date, no sure risk factors have been determined. The etiopathogeny is still unknown, despite the different suggested hypotheses. Specific diagnosis criteria have been set, to identify rectal squamous cell carcinoma from another entity. Moreover, due to its rarity, only few data exist on its management, and no standardized therapeutic regimen was set. We report a very rare case of primary squamous cell rectal carcinoma found in the middle rectum, in a 73-year-old woman. Rectos copy was used to visualize the tumor mass and to take biopsies; their histological study revealed a rectal location of a squamous cell carcinoma. After discussion of the case in a multidisciplinary consultation meeting, management consisted of definitive chemo-radiation.

Histogram analysis of diffusion-weighted magnetic resonance imaging as a biomarker to predict LNM in T3 stage rectal carcinoma

Background Preoperative identification of rectal cancer lymph node status is crucial for patient prognosis and treatment decisions. Rectal magnetic resonance imaging (MRI) plays an essential role in the preoperative staging of rectal cancer, but its ability to predict lymph node metastasis (LNM) is insufficient. This study explored the value of histogram features of primary lesions on multi-parametric MRI for predicting LNM of stage T3 rectal carcinoma. Methods We retrospectively analyzed 175 patients with stage T3 rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging (DWI) before surgery. 62 patients were included in the LNM group, and 113 patients were included in the non-LNM group. Texture features were calculated from histograms derived from T2 weighted imaging (T2WI), DWI, ADC, and T2 maps. Stepwise logistic regression analysis was used to screen independent predictors of LNM from clinical features, imaging features, and histogram features. Predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis. Finally, a nomogram was established for predicting the risk of LNM. Results The clinical, imaging and histogram features were analyzed by stepwise logistic regression. Preoperative carbohydrate antigen 199 level (p = 0.009), MRN stage (p < 0.001), T2WIKurtosis (p = 0.010), DWIMode (p = 0.038), DWICV (p = 0.038), and T2-mapP5 (p = 0.007) were independent predictors of LNM. These factors were combined to form the best predictive model. The model reached an area under the ROC curve (AUC) of 0.860, with a sensitivity of 72.8% and a specificity of 85.5%. Conclusion The histogram features on multi-parametric MRI of the primary tumor in rectal cancer were related to LN status, which is helpful for improving the ability to predict LNM of stage T3 rectal cancer.

Case Report: Miles Surgery Ameliorates High Blood Pressure in a Rectal Carcinoma Patient With Essential Hypertension

Hypertension is one of the major causes of public health problems. Multiple factors affecting gastrointestinal tract function are involved in hypertension. Emerging studies have manifested that gut intervention may play significant roles in regulating blood pressure but the underlying mechanisms are complex and not fully clear. Here, we report a case of 66 years old male who had a long history of hypertension and received Miles surgery for rectal carcinoma. The blood pressure of this patient was returned to normal levels after the operation. The possible reasons could be the modulation of sympathetic tone and the gut microbiota-brain axis. This report provides evidence about the relevance between hypertension and gut intervention particularly in the colorectal sites and gives hints for investigating the possible mechanisms of hypertension and the novel strategy for blood pressure control.

An Integrating of Clinical, Pathological, and Radiomic Approach to Predict the Microsatellite Instability in Rectal Carcinoma

Objective: To develop an integrative model with clinical, pathological, and radiomic characteristics to predict the status of microsatellite instability (MSI) in rectal carcinoma (RC). Methods: A cohort of 788 RCs with 97 high MSI status (MSI-H) and 691 microsatellite stable status (MSS) were enrolled. The clinical and pathological characteristics were recorded. The radiomic features were calculated after segmentation of volume of interests and then patients were divided into the training set and validation set with a random proportion of 7:3. The logistic models of simple clinical characteristics (LM-Clin), pathological characteristics (LM-Patho), and radiomic features (LM-Radio) were constructed to distinguish MSI-H from MSS. The relevant radiomic score was calculated. Finally, a integrative nomogram (LM-Nomo) including significant clinical, pathological characteristics, and radiomics was developed. The area under receiver operator curve (AUC) was calculated to evaluate the efficacy of prediction. Results: The AUC of simple LM-Clin including variables of CEA and hypertension and LM-Patho including characteristics of gross type and lymph node metastasis ratio (LNR) was 0.584 (95%CI, 0.549-0.619) and 0.585 (95%CI, 0.550-0.619), which was lower than that of LM-Radio including 12 radiomic features with AUC of 0.737 (95%CI, 0.675-0.799). The LM-Nomo contained CEA, hypertension, LNR, and radiomic score, and the AUC was 0.757 (95%CI, 0.726-0.787). Conclusion: The AUCs of LM-Clin and LM-Patho were disappointing and lower than that of LM-Radio. The LM-Nomo demonstrated the best performance in predicting MSI-H status.