Difference between revisions of "Colorectal carcinoma"
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===Subtyping=== | ===Subtyping=== | ||
[[File:Pie chart of colorectal carcinoma etiologies.svg|thumb|250px]] | [[File:Pie chart of colorectal carcinoma etiologies.svg|thumb|250px]] | ||
− | + | Determining the specific histopathologic subtype of colorectal adenocardinoma is not as important as its staging (see [[#Staging]] section below), and about half cases do not have any specific subtype. Still, it it customary to specify it where applicable. | |
===Differential diagnosis=== | ===Differential diagnosis=== |
Revision as of 08:35, 30 September 2019
Author:
Mikael Häggström [note 1]
Contents
Gross evaluation
Depending on presentation:
Microscopic evaluation
Microscopy criteria for colorectal adenocarcinoma
- A lesion at least "high grade intramucosal neoplasia" (high grade dysplasia) has:
- Severe cytologic atypia[1]
- Cribriform architecture, consisting of juxtaposed gland lumens without stroma in between, with loss of cell polarity. Rarely, they have foci of squamous differentiation (morules).[1]
- This should be distinguished from cases where piles of well-differentiated mucin-producing cells appear cribriform. In such piles, nuclei show regular polarity with apical mucin, and their nuclei are not markedly enlarged.[1]
- Invasive adenocarcinoma commonly displays:
- Varying degrees of gland formation with tall columnar cells.[1]
- Frequenty desmoplasia.[1]
- Dirty necrosis, consisting of extensive central necrosis with granular eosinophilic karyorrhectic cell detritus.[1][2] It is located within the glandular lumina,[2] or often with a garland of cribriform glands in their vicinity.[1]
It may also show lymphovascular invasion.
Subtyping
Determining the specific histopathologic subtype of colorectal adenocardinoma is not as important as its staging (see #Staging section below), and about half cases do not have any specific subtype. Still, it it customary to specify it where applicable.
Differential diagnosis
Colorectal carcinoma (mainly adenocarcinoma) is distinguished from an adenoma (mainly tubular and ⁄or villous adenomas) mainly by invasion through the muscularis mucosae.[3]
Staging
Determine depth of growth and/or infiltration. Preferably stage by the AJCC or TNM system:
AJCC stage[4] | TNM stage[4] | TNM stage criteria[4] |
---|---|---|
Stage 0 | Tis N0 M0 | Tis: Tumor confined to mucosa; cancer-in-situ |
Stage I | T1 N0 M0 | T1: Tumor invades submucosa |
T2 N0 M0 | T2: Tumor invades muscularis propria | |
Stage II-A | T3 N0 M0 | T3: Tumor invades subserosa or beyond (without other organs involved) |
Stage II-B | T4a N0 M0 | T4a: Tumor perforates the visceral peritoneum |
Stage II-C | T4b N0 M0 | T4b: Tumor invades adjacent organs |
Stage III-A |
|
|
Stage III-B |
|
|
Stage III-C |
|
|
Stage IVa | any T, any N, M1a | M1a: Metastasis to 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N. |
Stage IVb | any T, any N, M1b | M1b: Metastasis to more than 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N. |
Stage IVc | any T, any N, M1c | M1c: Metastasis to the peritoneal surface. Any T, any N. |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Robert V Rouse. Adenocarcinoma of the Colon and Rectum. Stanford University School of Medicine. Original posting/updates: 1/31/10, 7/15/11, 11/12/11
- ↑ 2.0 2.1 Li, Lianhuang; Jiang, Weizhong; Yang, Yinghong; Chen, Zhifen; Feng, Changyin; Li, Hongsheng; Guan, Guoxian; Chen, Jianxin (2014). "Identification of dirty necrosis in colorectal carcinoma based on multiphoton microscopy ". Journal of Biomedical Optics 19 (6): 066008. doi: . ISSN 1083-3668.
- ↑ Robert V Rouse. Colorectal Adenoma Containing Invasive Adenocarcinoma. Stanford University School of Medicine.
- ↑ 4.0 4.1 4.2 . Colorectal Cancer: Stages. Cancer.net (American Society of Clinical Oncology). Retrieved on 2019-09-26. Approved by the Cancer.Net Editorial Board, 11/2018. In turn citing:
Amin, Mahul B.; Greene, Frederick L.; Edge, Stephen B.; Compton, Carolyn C.; Gershenwald, Jeffrey E.; Brookland, Robert K.; Meyer, Laura; Gress, Donna M.; et al. (2017). "The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging ". CA: A Cancer Journal for Clinicians 67 (2): 93–99. doi: . ISSN 00079235.
Image sources