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Kogo H, Yamamoto K, Yoshida H. A case of transverse colon cancer with a large liver abscess that could be treated with a radical operation after infection control. Int J Surg Case Rep 2020; 77:182-186. [PMID: 33166816 PMCID: PMC7652707 DOI: 10.1016/j.ijscr.2020.10.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Advanced colorectal cancer is known to be associated with liver abscesses. A strategy to treat liver abscesses as early as possible is necessary to ensure high surgical curability before the cancer progresses and to prevent worsening nutritional status of the patient during surgery. PRESENTATION OF CASE An 82-year-old woman was hospitalized due to fever. A 10 cm in diameter liver abscess and advanced colon cancer were diagnosed. After conservative treatment of the liver abscess with antibiotics and puncture drainage, colorectal cancer surgery was performed on a standby basis. DISCUSSION We propose that empiric antibiotic therapy should be administered early in cases of liver abscesses that may require early colorectal surgery. Abscess drainage should be performed promptly if the abscess is of a size that can be punctured easily. CONCLUSION In patients with advanced colorectal cancer complicated by liver abscesses that required early surgery, prompt drainage of the liver abscesses is mandatory.
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Affiliation(s)
- Hideki Kogo
- Department of Surgery, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan.
| | | | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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2
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Morita M, Ogawa C, Omura A, Noda T, Kubo A, Matsunaka T, Tamaki H, Shibatoge M, Seno H, Minami Y, Ueshima K, Sakurai T, Nishida N, Kudo M. The Efficacy of Sonazoid-enhanced Ultrasonography in Decision-making for Liver Abscess Treatment. Intern Med 2020; 59:471-477. [PMID: 32062622 PMCID: PMC7056389 DOI: 10.2169/internalmedicine.2510-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The usefulness of contrast-enhanced ultrasonography (CEUS) for making decisions in the treatment of liver abscess is unknown. Methods We evaluated the internal blood flow in the arterial-predominant phase by CEUS using Sonazoid® in 21 patients. The stain area rate was evaluated in maximum parting plane of abscess in CEUS. Patients were divided into two groups: the vascular phase enhancement (VE) group, in which ≥50% of the abscess cavity was enhanced (12 patients), and the vascular phase non-enhancement (VNE) group, in which <50% of the abscess cavity was enhanced (9 patients). The rate of patients who were cured by conservative treatment alone was examined in both groups. The defect rate of all liver abscesses in the post-vascular phase was also evaluated. Results In the VE group, improvement by conservative treatment alone was obtained in 11 out of 12 patients (91.7%), while in the VNE group, improvement by conservative treatment alone was obtained in only 1 out of 9 patients (11.1%), a significant difference (p<0.001). In the VE group, one patient did not improve with conservative treatment alone because the abscess ruptured near the liver surface. In the VE group, the abscess size was smaller than in the VNE group. By examining the defect rate in the post-vascular phase, it was found that 16 out of 21 patients (76.2%) showed 71% or more defects. Conclusion The enhancement rate in the arterial-predominant phase of CEUS was considered useful for determining the treatment approach for liver abscess.
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Affiliation(s)
- Masahiro Morita
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Akina Omura
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Teruyo Noda
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Atsushi Kubo
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Toshihiro Matsunaka
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Hiroyuki Tamaki
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Mitsushige Shibatoge
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Japan
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
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Mohan BP, Meyyur Aravamudan V, Khan SR, Chandan S, Ponnada S, Asokkumar R, Navaneethan U, Adler DG. Prevalence of colorectal cancer in cryptogenic pyogenic liver abscess patients. Do they need screening colonoscopy? A systematic review and meta-analysis. Dig Liver Dis 2019; 51:1641-1645. [PMID: 31601537 DOI: 10.1016/j.dld.2019.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cryptogenic pyogenic liver abscess (PLA) could result due to compromised colonic mucosal barrier in patients with colorectal cancer (CRC). Association of PLA and CRC is unclear. Evidence is weak and limited to small sized studies. As a result, the need for colonoscopy in PLA patients is debatable. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings (from inception through January 2019) to identify studies that reported on the prevalence of CRC in PLA patients. Our goals were to evaluate the pooled rate of CRC in patients with cryptogenic PLA. RESULTS 12 studies were included in the analysis. 18,607 patients were diagnosed with PLA in study group and 60,130 patients were in control group. 63% were males in the age range of 56-94 years. 90.5% of the colonic lesions were left sided and 93.1% were positive for Klebsiella pneumoniae. The pooled rate of prevalence of CRC was 7.9% (95% CI (confidence interval) 5-12.1, I2 = 92.4, relative risk = 6.6) in patients with PLA, as compared to 1.2% (95% CI 0.3-5.7, I2 = 93.4) in control, with statistical significance (p = 0.001 respectively). CONCLUSION Our study, albeit limited by heterogeneity, demonstrates that patients with cryptogenic PLA are at a 7-fold risk of having CRC. A screening colonoscopy may be considered in population with cryptogenic PLA, especially if positive for K. pneumoniae. Well-conducted studies are needed to answer this question.
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Affiliation(s)
- Babu P Mohan
- Inpatient Medicine, Banner University Medical Center, University of Arizona, Tucson, AZ, USA
| | | | - Shahab R Khan
- Inpatient Medicine, Banner University Medical Center, University of Arizona, Tucson, AZ, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | | | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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4
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Jolobe OMP. Klebsiella-related liver abscess as a manifestation of occult colorectal and biliary tract cancer. QJM 2019; 112:555. [PMID: 30325461 DOI: 10.1093/qjmed/hcy236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- O M P Jolobe
- Medical Division, Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, UK
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5
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Colorectal Carcinoma Masquerading Empyema of the Gallbladder: A Case Report with Literature Review. J Gastrointest Cancer 2016; 43 Suppl 1:S60-3. [PMID: 21948294 DOI: 10.1007/s12029-011-9324-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Koo HC, Kim YS, Kim SG, Tae JW, Ko BM, Lee TI, Jeong SW, Jang JY, Kim HS, Lee SH, Kim BS. Should colonoscopy be performed in patients with cryptogenic liver abscess? Clin Res Hepatol Gastroenterol 2013; 37:86-92. [PMID: 22572520 DOI: 10.1016/j.clinre.2012.03.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/17/2012] [Accepted: 03/28/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM The interruption of a mucosal barrier by colon cancer or a polyp can lead to the development of a liver abscess. This study aimed to evaluate the possible contribution of colon cancer to the development of liver abscess and the necessity of colonoscopy in patients presenting with cryptogenic liver abscess. METHODS We reviewed the medical records of 268 patients diagnosed with liver abscess between January 2001 and April 2010. Among cases with no definite cause of liver abscess, differences between patients with and without colon cancer were evaluated in terms of clinical, laboratory, imaging, and microbiological findings. RESULTS Pyogenic liver abscess with no apparent etiology was encountered 163 patients; colonoscopy was performed in 121 of these 163 patients. The tumor diagnosis was confirmed by total colonoscopy in 12/163 (7.4%) patients with adenocarcinoma and 8/163 (4.9%) patients with high-grade dysplasia. Nine patients were diagnosed with stage I, two patients with stage II, and one with stage III disease according to the tumor, nodes, and metastases (TNM) staging system for colorectal cancer. The prevalence of incidental colon cancer in patients with pyogenic liver abscess was significantly higher than that of normal individuals who underwent colonoscopy (0.8%, 90/11,272) at our health care center. CONCLUSIONS Colon cancer may be one etiology of liver abscess. Colonoscopy should be considered in patients with pyogenic liver abscess with not an apparent primary source of infection.
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Affiliation(s)
- Hyun Cheol Koo
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Republic of Korea
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7
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Huang WK, Chang JWC, See LC, Tu HT, Chen JS, Liaw CC, Lin YC, Yang TS. Higher rate of colorectal cancer among patients with pyogenic liver abscess with Klebsiella pneumoniae than those without: an 11-year follow-up study. Colorectal Dis 2012; 14:e794-801. [PMID: 22776247 DOI: 10.1111/j.1463-1318.2012.03174.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Pyogenic liver abscess (PLA) has been reported as an early manifestation of colorectal cancer (CRC) in adults, but few studies have investigated this relationship. It is unclear if patients with Klebsiella pneumoniae PLA are at increased risk of subsequent CRC. Our aims were to estimate the incidence of CRC among patients with PLA and to compare the incidence of CRC between K. pneumoniae PLA and non-K. pneumoniae PLA groups. METHOD We conducted a retrospective study of patients with PLA diagnosed between 2000 and 2009 at a medical centre in northern Taiwan. CRC status and survival status were determined until December 2010. Incidence data from the general population were retrieved from the Taiwan Cancer Registry. Outcome measures were defined as standardized incidence ratio and the incidence rate per 100,000 person-years. RESULTS This study included 2294 patients, of whom 1194 (52%) had K. pneumoniae infection. During the follow-up period, 54 (2.3%) patients were diagnosed with CRC, corresponding to an overall incidence rate of 669.1 (95% CI, 490.7-847.6) per 100,000 person-years. The adjusted hazard ratio of CRC was 2.68 times greater for patients with K. pneumoniae PLA than for those with non-K. pneumoniae PLA (95% CI, 1.40-5.11). CONCLUSION Patients with K. pneumoniae PLA had a significantly higher rate of subsequent CRC than did patients with non-K. pneumoniae PLA. Colonoscopy is recommended to detect occult colonic malignancy in patients with PLA, particularly for patients over 60 years of age and with K. pneumoniae.
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Affiliation(s)
- W-K Huang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Medical Foundation Linkou Branch, Taoyuan, Taiwan
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Kao WY, Hwang CY, Chang YT, Su CW, Hou MC, Lin HC, Lee FY, Lee SD, Wu JC. Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study. Aliment Pharmacol Ther 2012; 36:467-76. [PMID: 22779737 DOI: 10.1111/j.1365-2036.2012.05212.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 04/04/2012] [Accepted: 06/20/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND There has been no large-scale population-based study on the relationship between pyogenic liver abscesses (PLA) and subsequent cancer risk. AIM To estimate all cancer risk following a diagnosis of PLA. METHODS Based on Taiwan's National Health Insurance Research Database, 1257 patients with PLA without prior cancers in the period 1996-2008 were identified and followed-up. The standard incidence ratio (SIR) of each cancer was calculated as the number of observed cancer cases arising among the PLA patients divided by the expected case number of cancer cases according to the national cancer rates. RESULTS Of the 1257 PLA patients identified, 598 (47.6%) had diabetes mellitus. After a median (±s.d.) follow-up of 3.33 ± 3.45 years, 186 were diagnosed with cancers, including 56 liver cancer, 22 biliary tract cancer and 40 colorectal cancer patients. Patients with PLA had a higher risk of all cancers (SIR, 3.83; 95% CI, 3.30-4.42), liver cancer (SIR, 7.87; 95% CI, 5.94-10.21), biliary tract cancer (SIR, 34.58; 95% CI, 21.67-52.36) and colorectal cancer (SIR, 5.27; 95% CI, 3.76-7.18). The highest SIRs of all cancers, liver cancer, biliary tract cancer and colorectal cancer occurred within 90 days of follow-up (360.82; 95% CI, 278.46-459.91, 257.28; 95% CI, 186.17-346.56, 1153.38; 95% CI 694.08-1801.24, and 52.63; 95% CI 25.2-96.8 respectively). CONCLUSIONS Pyogenic liver abscesses may herald the onset of cancer, especially hepato-biliary and colon cancer. Further surveys should be conducted for the detection of occult cancers in such patients.
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Affiliation(s)
- W-Y Kao
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Qu K, Liu C, Wang ZX, Tian F, Wei JC, Tai MH, Zhou L, Meng FD, Wang RT, Xu XS. Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: An increasing problem in Eastern Asia. World J Gastroenterol 2012; 18:2948-55. [PMID: 22736918 PMCID: PMC3380322 DOI: 10.3748/wjg.v18.i23.2948] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/15/2011] [Accepted: 03/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA).
METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by χ2 analysis and continuous variables were evaluated using Student’s t test.
RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneumoniae) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients.
CONCLUSION: K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
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Montvuagnard T, Thomson V, Durieux M, Mabrut JY, Marion-Audibert AM, Berthezene Y, Rode A. Superinfection of focal liver lesions after bile duct procedures. Diagn Interv Imaging 2012; 93:e191-5. [PMID: 22421283 DOI: 10.1016/j.diii.2012.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pyogenic liver abscess is a rare condition in the general population. The source of infection is most often biliary, and more rarely gastrointestinal via the portal tract, or even hematogenic. Other than in special contexts (scarring after radiofrequency ablation), focal liver lesions are not a usual risk factor for hepatic abscesses in patients with a history of bile duct procedures (sphincterotomy, biliary stenting, biliary enteric anastomosis). MATERIALS AND METHOD - RESULTS: We report four cases of focal liver lesions (two patients with benign lesions of the biliary cyst type and two other patients with lesions due to pancreatic cancer) complicated by a superinfection in patients with a history of bile duct procedures. There were no predisposing factors other than a context of cancer or diabetes. CONCLUSION Superinfection of a focal liver lesion should be considered when there is a suggestive clinical picture and a change in the appearance of the lesion in patients with a history of bile duct procedures in a context of cancer or diabetes.
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Affiliation(s)
- T Montvuagnard
- Department of Radiology, hôpital de la Croix-Rousse, hospices civil de Lyon, Lyon, France.
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Akagi I, Miyashita M, Makino H, Nomura T, Okawa K, Hagiwara N, Ueda J, Yamada T, Shimizu T, Takahashi K, Yokoi K, Uchida E. Pyogenic liver abscess caused by direct invasion of esophageal squamous cell carcinoma to the liver: report of a case. Surg Today 2011; 41:1247-51. [PMID: 21874424 DOI: 10.1007/s00595-010-4455-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 05/16/2010] [Indexed: 12/15/2022]
Abstract
We report a case of esophageal squamous cell carcinoma (ESCC) directly invading the liver and causing a pyogenic liver abscess. The patient was a 66-year-old man who presented with dysphagia. Esophagography, endoscopic study, and computed tomography (CT) showed a mass lesion in the lower third of the esophagus. A high fever developed on hospital day 17 and another CT scan revealed a liver abscess, 50 × 45 mm, in the left lateral lobe of the liver. Although imaging demonstrated a liver abscess continuous with the tumor, we performed percutaneous transhepatic drainage, followed thereafter by distal esophagectomy and total gastrectomy with a left lateral segmental resection of the liver. The pathological findings confirmed a diagnosis of ESCC with direct invasion (T4N1M0, stage IVa in the TNM classification). The patient had an uneventful postoperative recovery. Microscopic examination of the resected specimen revealed the expansive growth of tumor cells into the hepatocellular tissues. To our knowledge, this is the first report of the direct invasion of esophageal cancer to the liver causing a pyogenic liver abscess; however, it should be borne in mind when a patient with esophageal cancer becomes febrile.
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Affiliation(s)
- Ichiro Akagi
- Department of Surgery for Organ Function and Biological Regulation, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Abdulamir AS, Hafidh RR, Bakar FA. The association of Streptococcus bovis/gallolyticus with colorectal tumors: the nature and the underlying mechanisms of its etiological role. J Exp Clin Cancer Res 2011; 30:11. [PMID: 21247505 PMCID: PMC3032743 DOI: 10.1186/1756-9966-30-11] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 01/20/2011] [Indexed: 12/12/2022] Open
Abstract
Streptococcus bovis (S. bovis) bacteria are associated with colorectal cancer and adenoma. S. bovis is currently named S. gallolyticus. 25 to 80% of patients with S. bovis/gallolyticus bacteremia have concomitant colorectal tumors. Colonic neoplasia may arise years after the presentation of bacteremia or infectious endocarditis of S. bovis/gallolyticus. The presence of S. bovis/gallolyticus bacteremia and/or endocarditis is also related to the presence of villous or tubular-villous adenomas in the large intestine. In addition, serological relationship of S. gallolyticus with colorectal tumors and direct colonization of S. gallolyticus in tissues of colorectal tumors were found. However, this association is still under controversy and has long been underestimated. Moreover, the etiological versus non-etiological nature of this associationis not settled yet. Therefore, by covering the most of up to date studies, this review attempts to clarify the nature and the core of S. bovis/gallolyicus association with colorectal tumors and analyze the possible underlying mechanisms.
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Affiliation(s)
- Ahmed S Abdulamir
- Institute of Bioscience, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Rand R Hafidh
- Institute of Bioscience, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Fatimah Abu Bakar
- Institute of Bioscience, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Hsu WH, Yu FJ, Chuang CH, Chen CF, Lee CT, Lu CY. Occult colon cancer in a patient with diabetes and recurrent Klebsiella pneumoniae liver abscess. Kaohsiung J Med Sci 2009; 25:98-103. [PMID: 19321414 DOI: 10.1016/s1607-551x(09)70048-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Klebsiella pneumoniae (Kp) is a well-known leading cause of liver abscess in patients with diabetes, but recurrent Kp liver abscess in such patients within a period of time is seldom seen. Here, we report a patient with diabetes who experienced three episodes of Kp liver abscess within 1 year. The patient was subsequently diagnosed to have an occult sigmoid cancer. The liver abscess did not recur after resection of the colonic tumor. Occult sigmoid colonic cancer may have played an important role in the recurrent Kp liver abscess in our case. Therefore, further investigation of gastrointestinal malignancies, particularly of the colonic tract, is necessary in patients with diabetes and Kp liver abscess.
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Affiliation(s)
- Wen-Hung Hsu
- Department of Internal Medicine, Division of Gastroenterology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chiche L, Dargère S, Le Pennec V, Dufay C, Alkofer B. Abcès à pyogènes du foie. Diagnostic et prise en charge. ACTA ACUST UNITED AC 2008; 32:1077-91. [DOI: 10.1016/j.gcb.2008.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 09/04/2008] [Accepted: 09/25/2008] [Indexed: 01/09/2023]
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Zalinski S, Scatton O, Jacqmin S, Tacher V, Brézault C, Soubrane O. Portal venous gas following chemotherapy for colorectal cancer liver metastasis. Eur J Surg Oncol 2008; 35:557-60. [PMID: 18950980 DOI: 10.1016/j.ejso.2008.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/29/2008] [Accepted: 09/02/2008] [Indexed: 01/02/2023] Open
Abstract
The standard of care for patients with colorectal liver metastases is a combination of chemotherapy and surgery. New chemotherapy regimens with biologic agents (cetuximab, bevacizumab) have been shown to increase tumor response rates. Although this might be beneficial and this is an expected endpoint, it should be noted that patients with synchronous colorectal and liver metastases are at risk of septic complications. We recently encountered a case of hepatic portal venous gas after two cycles of chemotherapy in a patient with right colon cancer liver metastases. Complete necrosis of the liver metastasis subsequently turned into a liver abscess, which fistulized in the right portal vein. Infection of the necrotized metastasis was thought to be promoted by the colic tumor. Although this is a dramatic situation, it does not contraindicate a curative surgical resection.
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Affiliation(s)
- S Zalinski
- Department of Hepatobiliary Surgery and Liver Transplantation, Cochin Hospital, Paris, France
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