Colorectal carcinoma
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.
H&E stained sections:
(A) Serrated adenocarcinoma: epithelial serrations or tufts (thick blue arrow), abundant eosinophilic or clear cytoplasm, vesicular basal nuclei with preserved polarity.
(B) Mucinous carcinoma: Presence of extracellular mucin (>50%) associated with ribbons or tubular structures of neoplastic epithelium.
(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). (D) Medullary carcinoma: Neoplastic cells with syncytial appearance (thick yellow arrow) and eosinophilic cytoplasm associated with abundant peritumoral and intratumoral lymphocytes.[3]
Differential diagnosis
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:
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 |
|
|
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.
- ↑ 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: . ISSN 2072-6694. Attribution 4.0 International (CC BY 4.0) license
- ↑ Robert V Rouse. Colorectal Adenoma Containing Invasive Adenocarcinoma. Stanford University School of Medicine.
- ↑ 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: . ISSN 00079235.
Image sources