Article

Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum

Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.88). 10/2009; 133(10):1539-51. DOI: 10.1043/1543-2165-133.10.1539
Source: PubMed
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    • "Regarding the relationship between tumor and peritoneum, the following were recorded: (1) pT3 versus pT4 according to CAP criteria [1] [7], (2) LPI score, and (3) distance of tumor to the peritoneal surface (in millimeters). Shepherd LPI score was assigned as described above (Fig. 1) [3] [4]. "
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    ABSTRACT: Peritoneal involvement in colorectal cancer (CRC) is an adverse prognostic feature, which may prompt consideration of adjuvant chemotherapy in stage II disease. Controversies and challenges surrounding its assessment have led to consideration of peritoneal elastic lamina invasion (ELI) as an alternative marker of advanced local spread. The objectives of this study were (1) to evaluate the prognostic significance of peritoneal ELI in stage II CRC and (2) to determine the feasibility of ELI assessment in routine practice with the use of an elastic stain. Two hundred seventeen patients with stage II CRC (186, pT3; 31, pT4) were assessed for ELI and other established adverse histologic features. Of the pT3 tumors, 31 (16.7%) were ELI positive, 121 (65%) were ELI negative, and 34 (18.3%) lacked an identifiable elastic lamina. There were no significant differences in disease-free survival between pT3 ELI-negative and ELI-positive tumors (P = .517). The disease-free survival of pT4 tumors was significantly lower than that of pT3 ELI-negative tumors (P = .024) and pT3 ELI-positive tumors (P = .026), respectively. The elastic lamina was detected less frequently in right-sided pT3 tumors compared with left-sided tumors (65/91 [71.4%] versus 87/95 [91.6%], P < .001). Right-sided tumors were also associated with a reduction in the staining intensity of the elastic lamina (P < .001). In conclusion, peritoneal ELI was not an adverse prognostic factor in this study. The frequent absence of an identifiable elastic lamina, particularly in right-sided tumors, may limit the use of ELI as a prognostic marker in CRC.
    Human pathology 09/2013; 44(12). DOI:10.1016/j.humpath.2013.07.013 · 2.81 Impact Factor
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    • "Following the ICAT/IDS publication for CRC in 1991 which included a comprehensive overview of prognostic factors for CRC, new potentially independent variables were evaluated and summarised in a UICC monograph by Hermanek and Sobin in 1995, 47 and later revised by Compton in 2006, 48 with further discussion by Washington in 2009. 36 However, it must be stressed that outside of a selected small number of proven adverse histopathological features which are influential in a large heterogenous patient group with lymph node positive tumors, 29,49 most promoted prognostic factors fail to impact on patient survival independently of stage. "
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    ABSTRACT: In 1991 this journal published the report of an international working party to the World Congress of Gastroenterology regarding the clinicopathological staging of colorectal cancer. Since that time staging has continued to evolve as further prognostic factors in colorectal cancer have been elucidated in studies of increasingly large databases in several countries. This review summarizes several of the key issues that have arisen during this evolutionary process and raises matters which still remain controversial in staging at the present time.
    Journal of Gastroenterology and Hepatology 01/2011; 26 Suppl 1(Suppl. 1):58-64. DOI:10.1111/j.1440-1746.2010.06538.x · 3.63 Impact Factor
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    ABSTRACT: Die neue WHO-Klassifikation der Tumoren des Gastrointestinaltrakts beinhaltet nicht nur eine neue Definition diagnostischer Termini wie „intraepitheliale Neoplasie“ und „Dysplasie“, sondern auch Änderungen der Nomenklatur und Diagnostik, die für die tägliche Routine hoch relevant sind. Serratierte Adenokarzinome, kribriforme Adenokarzinome vom Komedotyp und mikropapilläre Adenokarzinome werden als neue histologische Subtypen des kolorektalen Karzinoms eingeführt. Die Graduierung muzinöser und siegelringzelliger Adenokarzinome des Kolorektums, die bislang definitionsgemäß immer als G3 (schlecht differenziert) klassifiziert wurden, ist jetzt vom Mikrosatellitenstatus der Karzinome abhängig. Eine hohe Mikrosatelliteninstabilität (MSI-H) ist mit einer besseren Prognose assoziiert. Daher werden MSI-H-Karzinome als „low grade“ eingeordnet, während Karzinome ohne (Mikrosatellitenstabilität, MSS) oder mit nur geringer Mikrosatelliteninstabilität (MSI-L) aufgrund ihrer schlechteren Prognose als „high grade“ klassifiziert werden. Daher muss die Bestimmung der MSI mithilfe immunhistologischer Methoden bzw. der Fragmentlängenanalyse als integraler Bestandteil der pathomorphologischen Befundung dieser Karzinome angesehen werden. Serratierte Polypen/Adenome und ihr Progressionspotenzial zum kolorektalen Karzinom über den sog. alternativen, serratierten Signalweg sollen ebenso besprochen werden wie die Erkenntnisse hinsichtlich neuer prognostischer bzw. prädiktiver Marker. Damit liefert dieser Beitrag einen Überblick über die wichtigsten Veränderungen dieser neuen WHO-Klassifikation kolorektaler Karzinome.
    Der Pathologe 11/2011; 32(2). DOI:10.1007/s00292-011-1505-4 · 0.64 Impact Factor
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