Difference between revisions of "Colorectal carcinoma"

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File:Micrograph of serrated adenocarcinoma, mucinous carcinoma, signet ring carcinoma and medullary carcinoma.jpg|H&E stained sections: <br>'''(A) Serrated adenocarcinoma''': epithelial serrations or tufts (thick blue arrow), abundant eosinophilic or clear cytoplasm, vesicular basal nuclei with preserved polarity.<br>'''(B) Mucinous carcinoma:''' Presence of extracellular mucin (>50%) associated with ribbons or tubular structures of neoplastic epithelium.<br>'''(C) Signet ring carcinoma''': More than 50% of signet cells with infiltrative growth pattern (thin red arrow) or floating in large pools of mucin (thick red arrow).<br>'''(D) Medullary carcinoma:''' Neoplastic cells with syncytial appearance (thick yellow arrow) and eosinophilic cytoplasm associated with abundant peritumoral and intratumoral lymphocytes.<ref>Initially copied from: {{cite journal|last1=Remo|first1=Andrea|last2=Fassan|first2=Matteo|last3=Vanoli|first3=Alessandro|last4=Bonetti|first4=Luca Reggiani|last5=Barresi|first5=Valeria|last6=Tatangelo|first6=Fabiana|last7=Gafà|first7=Roberta|last8=Giordano|first8=Guido|last9=Pancione|first9=Massimo|last10=Grillo|first10=Federica|last11=Mastracci|first11=Luca|title=Morphology and Molecular Features of Rare Colorectal Carcinoma Histotypes|journal=Cancers|volume=11|issue=7|year=2019|pages=1036|issn=2072-6694|doi=10.3390/cancers11071036}} [https://creativecommons.org/licenses/by/4.0/ Attribution 4.0 International (CC BY 4.0) license]</ref>
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File:Micrograph of serrated adenocarcinoma, mucinous carcinoma, signet ring carcinoma and medullary carcinoma.jpg|H&E stained sections: <br>'''(A) Serrated adenocarcinoma''': epithelial serrations or tufts (thick blue arrow), abundant eosinophilic or clear cytoplasm, vesicular basal nuclei with preserved polarity.<br>'''(B) Mucinous carcinoma:''' Presence of extracellular mucin (>50%) associated with ribbons or tubular structures of neoplastic epithelium.<br>'''(C) Signet ring carcinoma''': More than 50% of signet cells with infiltrative growth pattern (thin red arrow) or floating in large pools of mucin (thick red arrow).<br>'''(D) Medullary carcinoma:''' Neoplastic cells with syncytial appearance (thick yellow arrow) and eosinophilic cytoplasm associated with abundant peritumoral and intratumoral lymphocytes.<ref name=Remo2019>Initially copied from: {{cite journal|last1=Remo|first1=Andrea|last2=Fassan|first2=Matteo|last3=Vanoli|first3=Alessandro|last4=Bonetti|first4=Luca Reggiani|last5=Barresi|first5=Valeria|last6=Tatangelo|first6=Fabiana|last7=Gafà|first7=Roberta|last8=Giordano|first8=Guido|last9=Pancione|first9=Massimo|last10=Grillo|first10=Federica|last11=Mastracci|first11=Luca|title=Morphology and Molecular Features of Rare Colorectal Carcinoma Histotypes|journal=Cancers|volume=11|issue=7|year=2019|pages=1036|issn=2072-6694|doi=10.3390/cancers11071036}} [https://creativecommons.org/licenses/by/4.0/ Attribution 4.0 International (CC BY 4.0) license]</ref>
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File:Micrograph of lymphoepitelioma-like carcinoma, cribiform comedo-type carcinoma, micropapillary carcinoma and low grade tubulo-glandular carcinoma.jpg|H&E stained sections:<br>'''(A)Lymphoepitelioma-like carcinoma''': Poorly differentiated cells (red arrow) arranged in solid nests, tubules and trabeculae with poorly demarcated, infiltrative margins; intratumoral lymphoid infiltrate is extremely abundant.'''(B) Cribiform comedo-type carcinoma''': Cribriform gland (yellow arrow) with central necrosis comedo-like (yellow asterisk).<br>'''(C) Micropapillary carcinoma''': Small, tight round to oval cohesive clusters of neoplastic cells (>5 cells) floating in clear spaces (double circle red-black), without endothelial lining and with no evidence of inflammatory cells. '''(D) Low grade tubulo-glandular carcinoma''': Very well-differentiated invasive glands with uniform circular or tubular profiles (blue arrow) with bland cytologic atypia.<ref name=Remo2019/>
 
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Revision as of 09:12, 30 September 2019

Author: Mikael Häggström [note 1]

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

Relative incidences of subtypes of colorectal carcinomas.
Colorectal adenocarcinoma, not otherwise specified

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

edit
Colorectal carcinoma (mainly adenocarcinoma) is distinguished from an adenoma (mainly tubular and ⁄or villous adenomas) mainly by invasion through the muscularis mucosae.[4]

Staging

Determine depth of growth and/or infiltration. Preferably stage by the AJCC or TNM system:

Colorectal cancer staging   edit
AJCC stage[5] TNM stage[5] TNM stage criteria[5]
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
  • T1-2 N1 M0 or
  • T1, N2a, M0
  • N1: Tumor cells in 1 to 3 regional lymph nodes. T1 or T2.
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T1
Stage III-B
  • T3-4a, N1 M0 or
  • T2-3, N2a, M0 or
  • T1-2 N2b M0
  • N1: Tumor cells in 1 to 3 regional lymph nodes. T3 or T4
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T2 or T3
  • N2b: Tumor cells in 7 or more regional lymph nodes. T1 or 2
Stage III-C
  • T4a N2a M0 or
  • T3-4a N2b M0 or
  • T4b N1-2, M0
  • N2a: Tumor cells in 4 to 6 regional lymph nodes. T4a
  • N2b: Tumor cells in 7 or more regional lymph nodes. T3-4a
  • N1-2: Tumor cells in at least one regional lymph node. T4b
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

  1. 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. 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. 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:10.1117/1.JBO.19.6.066008. ISSN 1083-3668. 
  3. 3.0 3.1 Initially copied from: Remo, Andrea; Fassan, Matteo; Vanoli, Alessandro; Bonetti, Luca Reggiani; Barresi, Valeria; Tatangelo, Fabiana; Gafà, Roberta; Giordano, Guido; et al. (2019). "Morphology and Molecular Features of Rare Colorectal Carcinoma Histotypes ". Cancers 11 (7): 1036. doi:10.3390/cancers11071036. ISSN 2072-6694.  Attribution 4.0 International (CC BY 4.0) license
  4. Robert V Rouse. Colorectal Adenoma Containing Invasive Adenocarcinoma. Stanford University School of Medicine.
  5. 5.0 5.1 5.2 . 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:10.3322/caac.21388. ISSN 00079235. 

Image sources