Washington MK, Berlin J, Branton P, et al.. 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: 2.84). 10/2009; 133(10):1539-51. DOI: 10.1043/1543-2165-133.10.1539
Source: PubMed
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    • "These bodies stress that invasion of extramural veins is an independent predictor of unfavorable outcome and increased risk of hepatic metastasis, while the significance of intramural venous (as well as lymphatic) invasion is less clear. It is of note that in the most recent College of American Pathologists’ cancer-reporting protocol,39 venous invasion is not recorded separately from lymphovascular or “small vessel” invasion, which may not be appropriate, because these features confer differing prognostic information.40 "
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    ABSTRACT: Tumor staging according to the American Joint Committee on Cancer/Union for International Cancer Control tumor, node, metastasis (TNM) system is currently regarded as the standard for staging of patients with colorectal cancer. This system provides the strongest prognostic information for patients with early stage disease and those with advanced disease. For patients with intermediate levels of disease, it is less able to predict disease outcome. Therefore, additional prognostic markers are needed to improve the management of affected patients. Ideal markers are readily assessable on hematoxylin and eosin-stained tumor slides, and in this way are easily applicable worldwide. This review summarizes the histological features of colorectal cancer that can be used for prognostic stratification. Specifically, we refer to the different histological variants of colorectal cancer that have been identified, each of these variants carrying distinct prognostic significance. Established markers of adverse outcomes are lymphatic and venous invasion, as well as perineural invasion, but underreporting still occurs in the routine setting. Tumor budding and tumor necrosis are recent advances that may help to identify patients at high risk for recurrence. The prognostic significance of the antitumor inflammatory response has been known for quite a long time, but a lack of standardization prevented its application in routine pathology. However, scales to assess intra- and peritumoral inflammation have recently emerged, and can be expected to strengthen the prognostic significance of the pathology report.
    Cancer Management and Research 07/2014; 6(1):291-300. DOI:10.2147/CMAR.S38827
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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 · 2.77 Impact Factor
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    • "By contrast, the colorectal serosal surface itself should not be considered as a CRM. Therefore, instead of only specimens from operations for mid-low rectal cancers, specimens from all colorectal cancer operations involve CRMs [17]. The various sections of the bowel can be classified as intra-peritoneal, inter-peritoneal and extra-peritoneal organs according to their patterns of coverage by the peritoneum. "
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    ABSTRACT: The standardization of colon cancer surgery has been an area of intense interest. The recent establishment of the complete mesocolic excision (CME) technique has defined the operative approach for colon cancer surgeries and enabled the collection of high-quality oncological specimens for histopathological evaluation. Standard for the Diagnosis and Treatment of Colorectal Cancer (2010), issued by the Ministry of Health of China, has provided legal bases for the treatment of colorectal cancers. However, certain confusions remain due to lack of detailed guidelines for operations. This raised the key question: "What is the standardized colon cancer surgery?" The present study re-examined the core ideas of General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus (seventh edition) published by the Japanese Society for Cancer of the Colon and Rectum. CME-related studies published in English academic journals between April 2009 and July 2012 were surveyed and analysed. Several technical issues related to the requirement of R0 resection were analysed, including the theoretical basis for the safety range of bowel resection and the rational determination of the range of regional lymph node dissection.
    09/2013; 1(2):113-8. DOI:10.1093/gastro/got020
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