Raul S Gonzalez1, Justin M M Cates2, Mary Kay Washington2, Robert Daniel Beauchamp3,4,5, Robert J Coffey4,6, Chanjuan Shi2. 1. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA. 2. Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN, USA. 5. Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract
AIMS: A subset of colorectal carcinomas (CRCs) architecturally and cytologically resembles adenomatous change, making them difficult to diagnose on biopsy. This subset has not been well characterized to date. METHODS AND RESULTS: For 35 carcinomas with adenomatous-like areas (cytological and surface architectural appearance that would be insufficient to warrant a diagnosis of adenocarcinoma if evaluated on biopsy), we recorded staging information, molecular data, clinical outcome, whether precursor adenoma was present and whether previous biopsy had been diagnosed as malignant. Despite advanced T-category in 23 (66%) tumours, only seven (20%) had nodal metastases, and only five patients (15%) developed distant metastases. Fifteen cases (43%) had been diagnosed as adenoma on biopsy. Twenty-one resections (60%) showed no residual associated adenoma, including nine called adenoma on biopsy. Median follow-up was 44 months. Four patients (12%) died of disease; 22 were alive at last follow-up. KRAS mutation was seen in 14 of 24 (58%) and four of 17 (24%) were microsatellite-unstable. Patients had significantly improved survival compared to a cohort of patients with conventional well-differentiated CRC after controlling for age and stage (P = 0.011). CONCLUSIONS: Adenoma-like adenocarcinoma is an uncommon variant of CRC with a low rate of metastasis and good prognosis. Biopsy diagnosis of this lesion may be challenging.
AIMS: A subset of colorectal carcinomas (CRCs) architecturally and cytologically resembles adenomatous change, making them difficult to diagnose on biopsy. This subset has not been well characterized to date. METHODS AND RESULTS: For 35 carcinomas with adenomatous-like areas (cytological and surface architectural appearance that would be insufficient to warrant a diagnosis of adenocarcinoma if evaluated on biopsy), we recorded staging information, molecular data, clinical outcome, whether precursor adenoma was present and whether previous biopsy had been diagnosed as malignant. Despite advanced T-category in 23 (66%) tumours, only seven (20%) had nodal metastases, and only five patients (15%) developed distant metastases. Fifteen cases (43%) had been diagnosed as adenoma on biopsy. Twenty-one resections (60%) showed no residual associated adenoma, including nine called adenoma on biopsy. Median follow-up was 44 months. Four patients (12%) died of disease; 22 were alive at last follow-up. KRAS mutation was seen in 14 of 24 (58%) and four of 17 (24%) were microsatellite-unstable. Patients had significantly improved survival compared to a cohort of patients with conventional well-differentiated CRC after controlling for age and stage (P = 0.011). CONCLUSIONS:Adenoma-like adenocarcinoma is an uncommon variant of CRC with a low rate of metastasis and good prognosis. Biopsy diagnosis of this lesion may be challenging.
Authors: A I Phipps; D D Buchanan; K W Makar; A K Win; J A Baron; N M Lindor; J D Potter; P A Newcomb Journal: Br J Cancer Date: 2013-03-19 Impact factor: 7.640
Authors: Anna Melissa Schlitter; Kee-Taek Jang; Günter Klöppel; Burcu Saka; Seung-Mo Hong; Hyejeong Choi; George Johan Offerhaus; Ralph H Hruban; Yoh Zen; Björn Konukiewitz; Ivonne Regel; Michael Allgäuer; Serdar Balci; Olca Basturk; Michelle D Reid; Irene Esposito; Volkan Adsay Journal: Mod Pathol Date: 2015-06-26 Impact factor: 7.842
Authors: Raul S Gonzalez; Won Jae Huh; Justin M M Cates; Kay Washington; R Daniel Beauchamp; Robert J Coffey; Chanjuan Shi Journal: Histopathology Date: 2016-10-28 Impact factor: 5.087