Misdraji et al. found patients with low-grade neoplasms confined to the appendix had a 100% survival at a median survival time of 6 years. Those with extra-appendiceal spread had a survival at 86% at 5 years. Those diagnosed with mucinous adenocarcinomas had a 5-year survival of 44% (21). SEER data 5-year survival for localized adenocarcinoma was 95%, and 80% in mucinous or cystadenocarcinomas (9). Right hemicolectomy Inhibitors,research,lifescience,medical with appropriate adjuvant therapy is recommended for both mucinous and nonmucinous carcinomas (21). Conclusions Mucinous adenocarcinoma of the appendix is a rare entity that in most cases

is found incidentally. It is estimated that general surgeons may only see one or two cases of adult intussusception during their career (7). When intussusception is found in an adult a clinician should have malignancy high on their differential. We would like to impress Inhibitors,research,lifescience,medical the importance of pursuing the underlying etiology behind intussusception so appropriate treatment may be given prior to a malignancy becoming inoperable or untreatable if not diagnosed on initial presentation. Acknowledgements Disclosure: The authors declare no conflict of interest.
To the

Editor, Inhibitors,research,lifescience,medical Fleming et al. (1), by reviewing the pathologic aspects of colorectal neoplasms, summarized the Smoothened inhibitor pathogenesis and molecular classification Inhibitors,research,lifescience,medical of colorectal carcinoma (CRC) including mainly molecular pathways and environmental factors. However, they did not mention the potential pathologic aspects of environmental factors involved in colorectal oncogenesis, particularly in sporadic

CRC. More than 95% of colorectal cancers are sporadic, also mentioned by the authors (1), without a significant hereditary risk. Geographic variation in the incidence of CRC is substantial with a higher incidence observed in the West. Environmental factors contribute considerably to this variation (2); the majority of the sporadic cancer is believed to be due to modification Inhibitors,research,lifescience,medical of mutation risk by other genetic and/or environmental factors. Dietary factors many may influence the oncogenic process by modifying intestinal transit time, altering the flow and recycling of bile, or changing the intestinal bacterial flora composition. Numerous studies support a role for the gut microbiota in colorectal oncogenesis and the colonic microbiota drives the progression towards colorectal malignancy including generation of reactive metabolites and carcinogens, alterations in host carbohydrate expression and induction of chronic mucosal inflammation (3); long-term colonization of the colon by rogue commensal bacteria capable of inducing chronic DNA damage could contribute to sporadic CRC developement, thereby suggesting sporadic CRC as an infectious disease (4).