Clinicopathological characteristics and prognosis of schistosomal colorectal cancer

Colorectal Cancer Complicated with Chronic Schistosoma Japonicum Infected: A Case Report

BACKGROUND

Colonic schistosomiasis is a significant health issue in endemic areas, presenting diagnostic challenges due to its nonspecific clinical symptoms and radiographic features. This case report highlights a patient with concomitant colorectal cancer and chronic Schistosoma japonicum infection, emphasizing the need for a comprehensive diagnostic approach.

CASE PRESENTATION

A 67-year-old male from an endemic region presented with a six-month history of intermittent hematochezia. Initial colonoscopy revealed multiple mucosal elevations in the sigmoid colon and rectum. Subsequent investigations, including CT scans and endoscopic ultrasonography, indicated high echogenic changes and multiple lesions. The patient underwent endoscopic submucosal dissection (ESD), revealing adenocarcinoma of the rectal mucosa and tubular adenoma in the sigmoid colon, both with extensive deposition of Schistosoma japonicum eggs. Postoperative pathology confirmed the diagnosis of moderately differentiated adenocarcinoma with chronic schistosomiasis.

CONCLUSION

This case underscores the diagnostic complexity of colonic schistosomiasis, particularly when coexisting with malignancy. The integration of colonoscopy, histopathology, and auxiliary tests is crucial for accurate diagnosis. Clinicians should maintain a high index of suspicion for schistosomiasis in patients from endemic areas presenting with gastrointestinal symptoms. Regular screening and detailed medical histories are essential for early detection and treatment, improving patient outcomes and reducing the risk of misdiagnosis.

Schistosoma japonicum Associated Colorectal Cancer and Its Management

BACKGROUND

An association between Schistosoma japonicum and colorectal cancer in humans has been known since a long time; however, this association remains understudied and lacks comprehensive experimentation support.

OBJECTIVE

Various epidemiological and pathological studies have established the role of chronic inflammation as a major factor behind the induction of colorectal cancer. The aim of this review is to present the current knowledge on the association of Schistosoma japonicum with colorectal cancer.

RESULT

Mechanisms which lead to induction and progression of colorectal cancer are highlighted along with diagnosis and treatment for the same. Further, various methodologies, including mass drug administration, use of new drugs and vaccines, role of apoptosis, and histone-modifying enzymes, have been described which can either prevent the schistosomal infection itself or can check it from reaching an advanced stage.

CONCLUSIONS

Epidemiological, clinical, pathological and surgical studies suggest that Schistosoma japonicum is responsible for induction of colorectal cancer. However, thorough clinical studies are required to support and globally accept this notion. Further, methodologies highlighted in this work can be employed in order to take care of schistosomal infection or address the cancer induction and progression.

Conjoint analysis of clinical, imaging, and pathological features of schistosomiasis and colorectal cancer

This study aims to examine and compare clinical, radiological, and pathological data between colorectal cancer (CRC) patients with and without schistosomiasis and uncover distinctive CRC characteristics when accompanied by schistosomiasis. This retrospective study is based on data collected from 341 patients diagnosed with CRC post-surgery and pathology. Of these patients, 101 (Group A) were diagnosed with colorectal cancer co-occurring with schistosomiasis (CRC-S), while 240 patients (Group B) were diagnosed with colorectal cancer without concurrent schistosomiasis (CRC-NS). Both groups were compared and analyzed based on their clinical data, imaging-based TNM staging, lymph node metastasis, nerve invasion, vascular cancer thrombus, and histopathological differentiation. A Chi-squared test revealed a significant difference in gender distribution between the patients with CRC-S (Group A) and CRC-NS (Group B), with a p -value of 0.043 and χ2 = 4.115. Specifically, a higher incidence rate was observed among males in Group A. There was a difference in the overall distribution of TNM staging between the two groups (p = 0.034, χ2 = 6.764). After pairwise comparison, a statistically significant difference was observed in the T3 stage (p <0.05). The proportion of the T3 stage in Group A was significantly higher than that in Group B, indicating certain advantages. There was a difference in postoperative histopathological grading between the two groups (p = 0.005, χ2 = 10.626). After pairwise comparison, a statistically significant difference was observed between the well-differentiated adenocarcinoma and the moderately and poorly differentiated adenocarcinoma (p <0.05), with a higher proportion of welldifferentiated patients in Group A compared to Group B. There was no significant difference in age, lymph node metastasis, nerve invasion, and vascular invasion between the two groups of patients (p > 0.05). Among the 101 patients with CRC-S, 87 (86%) showed linear calcification on CT imaging. Patients with CRC-S are mainly male, with tumor staging mostly in the middle stage, high tumor differentiation, and low malignancy. CT imaging can help identify the presence of lumps and linear calcification indicative of schistosome deposits. MRI can early clarify TNM staging and determine the presence of lymph node metastasis and nerve and vascular invasion.

Presence of schistosome eggs in lymph node predict unfavorable prognosis in schistosomal colorectal cancer

OBJECTIVE

The purpose of this study was to investigate the prognostic significance of schistosome eggs' location in schistosomal colorectal cancer (SCRC).

METHODS

172 cases of SCRC were retrospectively analyzed. Patient clinicopathological parameters and survival rates were analyzed.

RESULTS

There were 102 males and 70 females, the median age was 71 years (range, 44-91). All patients were followed, and the median time was 50.1 months (range, 1.0-79.7). There were 87 patients with PS1 (presence site 1, eggs deposited in the mucosa) and 85 patients with PS2 (presence site 2, eggs deposited in the muscularis propria or throughout the full thickness of the intestinal wall), 159 patients presented with eggs in cutting edge and 83 patients presented with eggs in lymph node (LN). Hepatic schistosomiasis was found in 27.3% of patients by imaging modalities and correlated to patients with PS2 ( P < 0.001) and LNs' eggs ( P < 0.001). Survival analyses showed that in stage III SCRC, eggs' presence in LN associated with worse DFS ( P = 0.004) or marginally worse OS ( P = 0.056), patients with PS2 had shorter OS ( P = 0.044). Multivariate analyses revealed hepatic schistosomiasis was an independent prognostic factor for DFS and OS in stage III SCRC ( P = 0.001, 0.002, respectively). In adjusted multivariate analysis, eggs' presence in LN was an independent prognostic factor for DFS in stage III SCRC ( P = 0.006).

CONCLUSIONS

In stage III SCRC, eggs' presence in LN could predict poor prognosis and hepatic schistosomiasis was an independently unfavorable prognosis factor.

Clinicopathological characteristics and its association with digestive system tumors of 1111 patients with Schistosomiasis japonica

Schistosomiasis japonicum can cause different degrees of organ damage and complex human immune pathological reactions, which often invade the intestine and liver. The purpose of this study was to explore the pathological types and pathological changes of Schistosomiasis and their correlation with some digestive system tumors. Hematoxylin eosin staining was performed on the diseased tissues of 1111 Schistosomiasis cases. We counted the deposition sites of Schistosoma eggs, analyzed the pathological characteristics, and compared the clinicopathological characteristics of Schistosomiasis associated digestive system tumors and non-Schistosomiasis digestive system tumors. We found that Schistosoma japonicum can cause multi organ and multi system damage, with 469 cases of inflammation, 47 cases of adenoma, and 519 cases of adenocarcinoma. Other types include cysts, stromal tumors, malignant lymphomas, and neuroendocrine tumors. Schistosomiasis associated tumors, including gastric cancer, liver cancer, colon cancer and rectal cancer, were compared with non-Schistosomiasis tumors. There were significant differences in age, gender and tumor differentiation between the two groups. Our study shows Schistosomiasis is a systemic disease, causing multiple organ and system damage in the human body. Its clinicopathological types are diverse, and there may be a pathological change process of "Inflammation-adenoma-carcinoma". Schistosomiasis associated digestive system tumors differ from non-Schistosomiasis tumors in some clinicopathological features.

Comparison of the clinicopathological features and prognoses of patients with schistosomal and nonschistosomal colorectal cancer

Patients with schistosomal colorectal cancer (CRC) and nonschistosomal CRC have different clinicopathological features, laboratory test results and survival rates. Long-term infection with schistosomiasis in patients with CRC may affect the pathogenesis and subsequently change the mechanisms of CRC in these patients, resulting in changes in the survival rates of patients with schistosomal and nonschistosomal CRC. In China, the most common type of schistosomiasis is S. japonicum. The present study aimed to investigate the clinicopathological features and prognostic factors of schistosomal and nonschistosomal CRC. A total of 253 patients with schistosomal CRC and 2,885 patients with nonschistosomal CRC were analyzed and their symptoms, clinicopathological features and laboratory test results were retrospectively evaluated. Patients with CRC in the present study underwent radical resection at The First Affiliated Yijishan Hospital of Wannan Medical College between January 2012 and December 2018. A total of 3,138 patients with CRC were enrolled, 253 of whom were patients with schistosomal CRC. Patients were followed-up to examine differences in the 5-year survival rates between patients with schistosomal and nonschistosomal CRC to determine whether schistosomiasis impacted the prognosis of CRC. There were significant differences in age, sex, fecal occult blood positive, pathological T stage, and CA19-9, WBC, RBC and PLT levels between patients with schistosomal CRC and nonschistosomal CRC. For residents in areas with higher levels of schistosomiasis infections, especially middle-aged and elderly males, serum tumor markers and digestive tract endoscopy should be regularly evaluated to detect the presence of digestive tract tumors as early as possible.

Schistosoma japonicum-Associated Colorectal Cancer: A Review

Schistosoma japonicum is a digenetic blood fluke that has been implicated in the carcinogenesis of several human malignancies, notably liver and colorectal cancer (CRC). Schistosoma japonicum-associated colorectal cancer (SACC) is a distinct subtype with biological behavior analogous to colitis-induced CRC. The clinicopathological characteristics of SACC include young age at diagnosis, predominance among males, a strong predilection for the sigmoid colon and rectum, multifocal distribution, frequent mucinous histology, and poor prognosis. In addition to chronic inflammation, immunomodulation, and schistosomal toxins, bacterial coinfection appears to play an important role in the carcinogenic process. The present review provides the most recent updates on epidemiology, pathobiology, and clinical and prognostic features pertaining to SACC.

Could Mycobacterium avium subspecies paratuberculosis cause Crohn's disease, ulcerative colitis…and colorectal cancer?

Infectious agents are known causes of human cancers. Schistosoma japonicum and Schistosoma mansoni cause a percentage of colorectal cancers in countries where the respective Schistosoma species are prevalent. Colorectal cancer is a complication of ulcerative colitis and colonic Crohn’s disease, the two main forms of idiopathic inflammatory bowel disease (IIBD). Mycobacterium avium subspecies paratuberculosis (MAP), the cause of a chronic intestinal disease in domestic and wild ruminants, is one suspected cause of IIBD. MAP may therefore be involved in the pathogenesis of IIBD-associated colorectal cancer as well as colorectal cancer in individuals without IIBD (sporadic colorectal cancer) in countries where MAP infection of domestic livestock is prevalent and MAP’s presence in soil and water is extensive. MAP organisms have been identified in the intestines of patients with sporadic colorectal cancer and IIBD when high magnification, oil immersion light microscopy (×1000 total magnification rather than the usual ×400 total magnification) is used. Research has demonstrated MAP’s ability to invade intestinal goblet cells and cause acute and chronic goblet cell hyperplasia. Goblet cell hyperplasia is the little-recognized initial pathologic lesion of sporadic colorectal cancer, referred to as transitional mucosa, aberrant crypt foci, goblet cell hyperplastic polyps or transitional polyps. It is the even lesser-recognized initial pathologic feature of IIBD, referred to as hypermucinous mucosa, hyperplastic-like mucosal change, serrated epithelial changes, flat serrated changes, goblet cell rich mucosa or epithelial hyperplasia. Goblet cell hyperplasia is the precursor lesion of adenomas and dysplasia in the classical colorectal cancer pathway, of sessile serrated adenomas and serrated dysplasia in the serrated colorectal cancer pathway, and of flat and elevated dysplasia and dysplasia-associated lesions or masses in IIBD-associated intestinal cancers. MAP’s invasion of intestinal goblet cells may result in the initial pathologic lesion of IIBD and sporadic colorectal cancer. MAP’s persistence in infected intestines may result in the eventual development of both IIBD-associated and sporadic colorectal cancer.