Histological factors contributing to a high risk of recurrence of submucosal invasive cancer (pT1) of the colon and rectum after endoscopic therapy
Department of Surgery, Tokyo Medical University Kasumigaura Hospital, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan. Surgery Today
(Impact Factor: 1.53).
08/2008; 38(8):675-8. DOI: 10.1007/s00595-007-3701-7
We analyzed the histological high-risk factors for recurrence of submucosal invasive carcinomas (pT1) of the colon and rectum after endoscopic therapy, examining pT1 cancers treated primarily by endoscopic resection within a 23-year period. We compared recurrent and nonrecurrent cancers, evaluating the following "highrisk factors" of the primary lesion: massive invasion, a surgical margin<2 mm but negativity for cancer in the cut end, poorly differentiated adenocarcinoma (PD) (G3), undifferentiated carcinoma (G4), and/or positive angiolymphatic invasion. The following histological factors were defined as predictive of a low risk: minimum invasion, a surgical margin>2 mm, well or moderately differentiated adenocarcinoma (G1, G2), and no evidence of angiolymphatic invasion. We analyzed the records of 37 patients with pT1 cancers, including 15 with high-risk factors who underwent subsequent resection. Local recurrence with or without liver metastases developed in 4 of these 15 patients. The histological type was PD in three (75%) of the four recurrent lesions. All four (100%) lesions showed a desmoplastic response (DR). Only 1 (9%) of the 11 patients without recurrence after subsequent surgery had a lesion with a small component of PD, and only three (27%) lesions showed a mild DR. We concluded that endoscopic therapy is inadequate for pT1 cancers with a histological PD component, and/or a DR in the cancer stroma.
Available from: Ji Yeon Baek
- "In the second patient, both locoregional and systemic recurrences were observed 3.9 years after surgical resection, although lymph node metastasis was not identified in the primary tumor. Since a study of endoscopically-resected SICC demonstrated that recurrent primary cancers were significantly associated with poorly differentiated histology,18 we believed that other factors may have contributed to disease recurrence in these 2 patients. A thorough retrospective histologic review revealed frequent tumor budding from both tumors. "
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ABSTRACT: Complete resection of submucosal invasive colorectal cancer (SICC) showing favorable histology is regarded as curative. We report on two cases of SICC showing recurrence within 5 years despite complete resection. The first patient was a 68-year-old woman with well differentiated rectal adenocarcinoma invading the superficial submucosa, which recurred after 4.7 years. The second patient was a 53-year-old man with pT1N0 moderately differentiated colonic adenocarcinoma. He developed widespread tumor recurrence after 3.9 years. Retrospective pathologic review of the original tumors showed multiple foci of tumor budding at the invasive front. Immunohistochemical staining for D2-40 of deeper levels of the paraffin blocks showed rare foci of small lymphatic invasion. Tumor budding at the invasive front may be an important indicator for SICC aggressiveness or may reflect early lymphatic invasion. More aggressive pathologic examination and follow-up is required for patients with SICC showing tumor budding, even in the absence of unfavorable histologic findings.
06/2012; 46(3):272-7. DOI:10.4132/KoreanJPathol.2012.46.3.272
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ABSTRACT: Primary adenosquamous cell carcinomas (Ad-SCCs) of the colon and rectum are rare malignancies with a poor prognosis, in comparison to adenocarcinoma alone. Different roles of human papilloma virus (HPV) in its pathogenesis have been reported and the role of P16 in Ad-SCCs has not been explored. This report presents five cases of Ad-SCC of the colon to explore the clinicopathological features and the roles of P16, HPV 6/11, and 16/18. There was no confirmed evidence to support the relationship between the infection of HPV 6/11, 16/18, and pathogenesis of Ad-SCC of the colon. P16 overexpression was not related to HPV carcinogenesis and there might be another mechanism of P16 upregulation in Ad-SCC of the colon.
Surgery Today 02/2009; 39(7):619-23. DOI:10.1007/s00595-008-3884-6 · 1.53 Impact Factor
Available from: Tatsuro Yamaguchi
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ABSTRACT: Purpose The liver is the most common site of metastasis in patients with colorectal cancer (CRC), and this is a determinant of the
prognosis. However, no reliable molecular predictors of liver metastasis have yet been identified.
Methods Sixty-two surgical specimens of colorectal cancer were studied. The first group included 25 patients who achieved a disease-free
survival period of at least 6 years (CRC-M0), and the second group included 37 patients with synchronous (n = 22) or metachronous (n = 15) liver metastasis (CRC-M1). SMAD4, p53, and Ki-67 expression levels were assessed immunohistochemically.
Results The loss of SMAD4 expression and elevated Ki-67 expression were found significantly more frequently in CRC-M1 patients than
in CRC-M0 patients (P = 0.0047 and P = 0.013, respectively). Statistically significant differences were also observed between the CRC-M0 group and the metachronous
metastasis group. No difference was seen in the overexpression of p53 between the groups. A combination analysis of SMAD4
and Ki-67 revealed no cases with maintained levels of SMAD4 and a low Ki-67 expression had or developed liver metastasis.
Conclusion The loss of SMAD4 expression and elevated Ki-67 expression was therefore found to significantly correlate with liver metastasis,
regardless of the time of occurrence, thus indicating these factors to be predictive markers for liver metastasis in patients
Surgery Today 03/2010; 40(3):245-250. DOI:10.1007/s00595-009-4028-3 · 1.53 Impact Factor
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