We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative proctocolectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.

Gastrointestinal duplications are an uncommon congenital abnormality that manifest before the age of two in 80% of cases. Ileal duplication is the most common while colonic duplication, either cystic or tubular, occurs in 10%-15% of cases and remains asymptomatic and undiagnosed in most cases. Mostly occurring in pediatric patients, colonic duplication is encountered in adults in only a few cases. The most common clinical manifestations are abdominal pain and intestinal obstruction. Rarely, duplications present with signs of acute abdomen or acute bleeding. This study reports a case of colonic duplication in an adult who presented with chronic constipation. Complete diagnostic workup was made on several occasions during the previous eight year period, but no pathology was found and chronic constipation was attributed to hypothyroidism caused by long standing Hashimoto thyroiditis. Multislice CT, performed because of abdominal distension, defined colonic pathology but the definite diagnosis of duplication of the transversal colon was made at operation. The cystic duplication and the adjacent part of the ascending and transversal colon were excised en-block. This study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of chronic constipation even when precipitating factors for constipation, such as hypothyroidism are present.

BackgroundThe aim of this research was to study the levels of 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG) in tumour tissue samples of colorectal carcinoma based upon immunohistochemical detection and compare those results with patients’ outcome.MethodsTumour blocks of patients surgically treated for colorectal cancer were evaluated by 8-oxodG immunohistochemical staining. The expression was analysed in 500 tumour cells. The percentage of positive cells, as well as staining intensity, was recorded, and Allred score was calculated. For each patient, data of age, gender, tumour size and location, margin status, histologic grade, tumour stage, lymph node status, vascular invasion, overall survival, and therapy protocols were collected. Tumour grade was divided into two groups as low and high grade.ResultsIn this study, 146 consecutive patients with primary colorectal carcinoma were included. All data were available for 138 patients, and they were included in this research. There were 83 male and 55 female patients; the median age was 64 years (range 35–87 years). The results showed shorter 5- and 10-year survival in patients with 8-oxodG positive tumour cells (5-year survival, n = 138, Mantel–Cox, chi-square 4.116, degree of freedom (df) = 1, p < 0.05; 10-year survival, n = 134, Mantel–Cox, chi-square 4.374, df = 1, p < 0.05). The results showed a positive correlation between Allred score and high tumour grade (two-tailed Spearman’s ρ 0.184; p < 0.05), as well as with non-polypoid tumour growth (two-tailed Spearman’s ρ 0.198; p < 0.05). There was no significant difference of 8-oxodG expression related to age, sex, blood group, size and tumour site, distance from the edge of the resected tumour margin, lymph nodes involvement, and vascular invasion.ConclusionsIn this study, the positive correlation between 8-oxodG presence in the tumour cells, worse clinical outcome, higher tumour grade, and flat morphology was found.

Colorectal cancer (CRC) is one of the most prevalent oncological diseases globally, taking 3 rd place in incidence in the general population. High in mortality, it is also a form of cancer whose outcome is highly dependable on its stage at diagnosis. therefore, many countries have adopted a more or less successful screening process to ensure early diagnosis and, in turn, higher survival rates and better results overall. The COVID-19 pandemic has altered the established medical routines worldwide, with massively postponing diagnostic procedures and elective surgeries. This study aims to measure the effect the pandemic has had on colorectal cancer treatment in our institution. Variables such as deferral time from diagnosis to commencement of treatment, lapse of time between different phases of the treatment process, time of presentation (elective versus emergent surgery), the physical status of the patient at the time of surgery (ASA classification) and metastatic index (positive lymph node ratio), were taken into account. We juxtaposed data from patients treated at the Surgical Department of Clinical Hospital Center in Zagreb in 2019 and 2020, the latter being heavily affected by the pandemic. In 2019 and 2020, 347 and 314 patients, respectively, with c18-c20 diagnoses (International Statistical Classification of Diseases and Related Health Problems ICD-10), have been treated at our Hospital. With exclusion criteria applied, the patient count falls to 173 for 2019 and 157 for 2020. these numbers include operated cases with or without an anastomosis formation and with or without neoadjuvant chemotherapy applied. From the analysis we excluded patients with recurrent colorectal tumors, synchronous and metachronous tumors, and patients treated palliatively. Furthermore, colorectal adenomas were also excluded from the study. Our data shows significant difference between observed variables in the two patient groups, attributed to the COV-iD-19 pandemic. since there is still no reliable way to predict the duration of this global health crisis, it is imperative to implement strategies to lessen the damaging effect the pandemic has had on favourable oncosurgical treatment outcomes in colorectal cancer patients.

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