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Ahmed EM, Farag AS, Abdelwahed MS, Hanbazazh M, Samman A, Ashmawy D, Abd-Elhameed NR, Tharwat M, Othman AE, Shawky TA, Attia RM, Ibrahim AA, Azzam S, Elhussiny MEA, Nasr M, Naeem SA, Abd-Elhay WM, Ali Alfaifi AM, Hasan A. The Expression of Stem Cell Marker LGR5 and Its Coexpression with Β-Catenin in Sporadic Colorectal Carcinoma and Adenoma: A Comparative Immunohistochemical Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1233. [PMID: 37512045 PMCID: PMC10383310 DOI: 10.3390/medicina59071233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background: LGR5 is one of the most important stem cell markers for colorectal cancer (CRC), as it potentiates Wnt/Β-catenin signaling. The well-characterized deregulation of Wnt/Β-catenin signaling that occurs during adenoma/carcinoma sequence in CRC renders LGR5 a hopeful therapeutic target. We assessed the immunohistochemical expression of LGR5 and Β-catenin in normal colonic and tumorous lesions with a clinicopathological correlation. Methods: Tissue blocks and clinical data of 50 selected cases were included: 8 from normal mucosa, 12 cases of adenoma, and 30 cases of CRC, where sections were cut and re-examined and the immunohistochemical technique was conducted using anti-LGR5 and anti-Β-catenin to measure the staining density. Results: There was no expression of LGR5 in normal mucosa compared to samples of adenoma and CRC samples. The association analysis showed that CRC specimens were more likely to have strong LGR5 and Β-catenin expressions than the other two groups (p = 0.048 and p < 0.001, respectively). Specimens with high-grade dysplastic adenoma were more likely to express moderate-to-strong expression of LGR5 and Β-catenin (p = 0.013 and p = 0.036, respectively). In contrast, there were no statistically significant associations between LGR5 and Β-catenin expression with grade and stage. Conclusion: These results suggest and support the possible role of LGR5 as a potential marker of cancer stem cells in sporadic colorectal carcinogenesis in addition to a prognostic value for LGR5 and Β-catenin in adenomatous lesions according to immunohistochemical expression density. A potential therapeutic role of LGR5 in CRC is suggested for future studies based on its role in pathogenesis.
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Affiliation(s)
- Eman Mohamed Ahmed
- Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo 11884, Egypt
| | - Abeer Said Farag
- Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo 11884, Egypt
| | - Mohammed S Abdelwahed
- Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
- Pathology Department, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Mehenaz Hanbazazh
- Pathology Department, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Abdulhadi Samman
- Pathology Department, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
| | - Diaa Ashmawy
- Pathology Department, Faculty of Medicine, Al-Azhar University, Damietta 34517, Egypt
| | | | - Mohamed Tharwat
- Pathology Department, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt
| | - Alyaa E Othman
- Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia 41552, Egypt
| | - Taiseer Ahmed Shawky
- Internal Medicine Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Radwa Mohamed Attia
- General Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo 11884, Egypt
| | | | - Sherif Azzam
- Clinical Oncology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | | | - Mohamed Nasr
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Suhaib Alsayed Naeem
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Wagih M Abd-Elhay
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | | | - Abdulkarim Hasan
- Pathology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
- Prince Mishari bin Saud Hospital, Ministry of Health, Albahah 22888, Saudi Arabia
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Dastych M, Hubatka F, Turanek-Knotigova P, Masek J, Kroupa R, Raška M, Turanek J, Prochazka L. Overexpression of CD44v8-10 in Colon Polyps-A Possible Key to Early Diagnosis. Pathol Oncol Res 2021; 27:614281. [PMID: 34257584 PMCID: PMC8262190 DOI: 10.3389/pore.2021.614281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/26/2021] [Indexed: 01/10/2023]
Abstract
Background and aims: The majority of colorectal cancers arise from detectable adenomatous or serrated lesions. Here we demonstrate how deregulated alternative splicing of CD44 gene in diseased colon mucosa results in downregulation of standard isoform of CD44 gene (CD44s) and upregulation of variant isoform CD44v8-10. Our aim is to show that upregulation of CD44v8-10 isoform is a possible marker of precancerous lesion in human colon. Methods: We analysed pairs of fresh biopsy specimen of large intestine in a cohort of 50 patients. We studied and compared alternative splicing profile of CD44 gene in colon polyps and adjoined healthy colon mucosa. We performed end-point and qRT PCR, western blotting, IHC staining and flow cytometry analyses. Results: We detected more than five-fold overexpression of CD44v8-10 isoform and almost twenty-fold downregulation of standard isoform CD44s in colon polyps compared to adjoined healthy tissue with p = 0.018 and p < 0.001 in a cohort of 50 patients. Our results also show that aberrant splicing of CD44 occurs in both biologically distinct subtypes of colorectal adenoma possibly in ESRP-1 specific manner. Conclusion: 92% of the colon polyp positive patients overexpressed CD44v8-10 isoform in their colon polyps while only 36% of them had positive fecal occult blood test which is currently a standard non-invasive screening technique. Impact: We believe that our results are important for further steps leading to application of CD44v8-10 isoform as a biomarker of colorectal precancerosis in non-invasive detection. Early detection of colon precancerosis means successful prevention of colorectal carcinoma.
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Affiliation(s)
- Milan Dastych
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine Masaryk University Brno, Brno, Czech Republic
| | - Frantisek Hubatka
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Brno, Czech Republic.,C2P NEXARS, Campus Science Park, Brno, Czech Republic
| | - Pavlina Turanek-Knotigova
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Brno, Czech Republic.,C2P NEXARS, Campus Science Park, Brno, Czech Republic
| | - Josef Masek
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Brno, Czech Republic
| | - Radek Kroupa
- Department of Gastroenterology and Internal Medicine, University Hospital Brno and Faculty of Medicine Masaryk University Brno, Brno, Czech Republic
| | - Milan Raška
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jaroslav Turanek
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Brno, Czech Republic.,C2P NEXARS, Campus Science Park, Brno, Czech Republic.,Faculty of Medicine in Hradec Kralove, Institute of Hygiene and Preventive Medicine, Charles University, Hradec Kralove, Czech Republic.,Institute of Physics of the Czech Academy of Sciences, Prague 8, Czech Republic
| | - Lubomir Prochazka
- Department of Pharmacology and Toxicology, Veterinary Research Institute, Brno, Czech Republic
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Nanotechnology is an important strategy for combinational innovative chemo-immunotherapies against colorectal cancer. J Control Release 2019; 307:108-138. [DOI: 10.1016/j.jconrel.2019.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
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Evaluation of Cancer-Associated DNA Copy Number Events in Colorectal (Advanced) Adenomas. Cancer Prev Res (Phila) 2018; 11:403-412. [PMID: 29685877 DOI: 10.1158/1940-6207.capr-17-0317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/04/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
Abstract
About 5% of colorectal adenomas are estimated to progress to colorectal cancer. However, it is important to identify which adenomas actually carry a high risk of progression, because these serve as intermediate endpoints, for example, in screening programs. In clinical practice, adenomas with a size of ≥10 mm, villous component and/or high-grade dysplasia, called advanced adenomas, are considered high risk, although solid evidence for this classification is lacking. Specific DNA copy number changes are associated with adenoma-to-carcinoma progression. We set out to determine the prevalence of cancer-associated events (CAE) in advanced and nonadvanced adenomas. DNA copy number analysis was performed on archival tissues from three independent series of, in total, 297 adenomas (120 nonadvanced and 177 advanced) using multiplex ligation-dependent probe amplification or low-coverage whole-genome DNA sequencing. Alterations in two or more CAEs were considered to mark adenomas as high risk. Two or more CAEs were overall present in 25% (95% CI, 19.0-31.8) of advanced adenomas; 23% (11/48), 36% (12/33), and 23% (22/96) of the advanced adenomas in series 1, 2, and 3, respectively, and 1.7% (1/58) and 4.8% (3/62) of the nonadvanced adenomas, in series 1 and 2, respectively. The majority of advanced adenomas do not show CAEs, indicating that only a subset of these lesions is to be considered high risk. Nonadvanced adenomas have very low prevalence of CAEs, although those with CAEs should be considered high risk as well. Specific DNA copy number alterations may better reflect the true progression risk than the advanced adenoma phenotype. Cancer Prev Res; 11(7); 403-12. ©2018 AACR.
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Solakoğlu T, Köseoğlu H, Özer Sarı S, Akın FE, Demirezer Bolat A, Tayfur Yürekli Ö, Büyükaşık NŞ, Ersoy O. Role of baseline adenoma characteristics for adenoma recurrencein patients with high-risk adenoma. Turk J Med Sci 2017; 47:1416-1424. [PMID: 29151312 DOI: 10.3906/sag-1502-105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: The present observational study aimed to determine the predictive value of 3-year recurrence adenoma characteristics at baseline conventional colonoscopy in patients with high-risk adenoma.Materials and methods: A total of 47 patients with high-risk adenoma at baseline colonoscopy were followed up and underwent a surveillance colonoscopy at 3 years. Correlations between adenoma recurrence and baseline adenoma characteristics (size, number, histological features, and location) were analyzed.Results: Among 135 patients with high-risk adenoma, 47 patients (35%) who underwent surveillance colonoscopy at 3 years following baseline colonoscopy were included in the study. In these 47 patients, at least one new adenoma was detected in 19 (40.4%) patients, and new advanced adenomas were detected in 5 (10.6%) patients during the surveillance colonoscopy. No significant difference was found in patients who had adenoma recurrence versus those who did not in terms of size of adenomas (P = 0.143), number of adenomas (P = 0.562), histological properties of adenomas (P = 0.658), or locations of adenomas (P = 0.567).Conclusion: Baseline adenoma characteristics were not associated with the recurrence of adenomas or advanced adenomas in patients with high-risk adenoma.
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Abstract
The human gut microbiota plays a major role in the development and maintenance of good health. Many recent studies have attempted to define links between microbiota residents, their function and the development of colorectal cancer (CRC). Gut microbiota drive the development of inflammation within the colon and such inflammation is implicated in colonic neoplastic development. Although the precise mechanisms through which the microbiota is involved in cancer development remain elusive, the message is clear: the microbiota contributes to cancer risk by influencing a number of key host processes. It is also recognized that we have the ability to influence the role of the gut microbiota by considering our nutritional intake. We have always known that 'we are what we eat' but it is also true that 'they (our gut microbiota) are what we eat'. We therefore have a huge opportunity to positively influence our health through microbial manipulation. There is now a clear need to move past defining the constituents of the gastrointestinal microbiota and to focus more on understanding the functional capabilities of the resident microbial community and how this impacts on host health. One such emerging concept is the development of microbial biofilms which can form in the gut in conjunction with CRC tissue. By better understanding of the interaction between the host and its resident microbiota, in the context of health and cancer development, we will open new therapeutic and diagnostic opportunities for reducing the CRC global health burden.
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Affiliation(s)
- Georgina L Hold
- School of Medicine and Dentistry, Aberdeen University, Aberdeen, UK
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Ghanouni A, Halligan S, Taylor SA, Boone D, Plumb A, Stoffel S, Morris S, Yao GL, Zhu S, Lilford R, Wardle J, von Wagner C. Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment. BMJ Open 2014; 4:e004327. [PMID: 24699460 PMCID: PMC3987721 DOI: 10.1136/bmjopen-2013-004327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES CT colonography (CTC) may be an acceptable test for colorectal cancer screening but bowel preparation can be a barrier to uptake. This study tested the hypothesis that prospective screening invitees would prefer full-laxative preparation with higher sensitivity and specificity for polyps, despite greater burden, over less burdensome reduced-laxative or non-laxative alternatives with lower sensitivity and specificity. DESIGN Discrete choice experiment. SETTING Online, web-based survey. PARTICIPANTS 2819 adults (45-54 years) from the UK responded to an online invitation to take part in a cancer screening study. Quota sampling ensured that the sample reflected key demographics of the target population and had no relevant bowel disease or medical qualifications. The analysis comprised 607 participants. INTERVENTIONS After receiving information about screening and CTC, participants completed 3-4 choice scenarios. Scenarios showed two hypothetical forms of CTC with different permutations of three attributes: preparation, sensitivity and specificity for polyps. PRIMARY OUTCOME MEASURES Participants considered the trade-offs in each scenario and stated their preferred test (or chose neither). RESULTS Preparation and sensitivity for polyps were both significant predictors of preferences (coefficients: -3.834 to -6.346 for preparation, 0.207-0.257 for sensitivity; p<0.0005). These attributes predicted preferences to a similar extent. Realistic specificity values were non-significant (-0.002 to 0.025; p=0.953). Contrary to our hypothesis, probabilities of selecting tests were similar for realistic forms of full-laxative, reduced-laxative and non-laxative preparations (0.362-0.421). However, they were substantially higher for hypothetical improved forms of reduced-laxative or non-laxative preparations with better sensitivity for polyps (0.584-0.837). CONCLUSIONS Uptake of CTC following non-laxative or reduced-laxative preparations is unlikely to be greater than following full-laxative preparation as perceived gains from reduced burden may be diminished by reduced sensitivity. However, both attributes are important so a more sensitive form of reduced-laxative or non-laxative preparation might improve uptake substantially.
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Affiliation(s)
- Alex Ghanouni
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Darren Boone
- Centre for Medical Imaging, University College London, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Sandro Stoffel
- Institute for Health and Consumer Protection, European Commission, Joint Research Centre, Ispra, Italy
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Guiqing Lily Yao
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Shihua Zhu
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Richard Lilford
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
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Evaluating patients' preferences for type of bowel preparation prior to screening CT colonography: convenience and comfort versus sensitivity and specificity. Clin Radiol 2013; 68:1140-5. [PMID: 23948662 DOI: 10.1016/j.crad.2013.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 01/01/2023]
Abstract
AIMS To explore the relative value patients place on comfort and convenience versus test sensitivity and specificity in the context of computed tomographic colonography (CTC) screening. MATERIALS AND METHODS Twenty semi-structured interviews were carried out with patients attending hospital for radiological tests unrelated to CTC. Preferences for CTC with different types of bowel preparation for CTC screening were examined and interviews were analysed thematically. The discussion guide included separate sections on CTC, bowel preparation methods (non-, reduced- and full-laxative), and sensitivity and specificity. Patients were given information on each topic in turn and asked about their views and preferences during each section. RESULTS Following information about the test, patients' attitudes towards CTC were positive. Following information on bowel preparation, full-laxative purgation was anticipated to cause more adverse physical and lifestyle effects than using reduced- or non-laxative preparation. However, stated preferences were approximately equally divided, largely due to patients anticipating that non-laxative preparations would reduce test accuracy (because the bowel was not thoroughly cleansed). Following information on sensitivity and specificity (which supported patients' expectations), the predominant stated preference was for full-laxative preparation. CONCLUSIONS Patients are likely to value test sensitivity and specificity over a more comfortable and convenient preparation. Future research should test this hypothesis on a larger sample.
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Kroepil F, Fluegen G, Totikov Z, Baldus SE, Vay C, Schauer M, Topp SA, Esch JSA, Knoefel WT, Stoecklein NH. Down-regulation of CDH1 is associated with expression of SNAI1 in colorectal adenomas. PLoS One 2012; 7:e46665. [PMID: 23029563 PMCID: PMC3460919 DOI: 10.1371/journal.pone.0046665] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 09/03/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Down-regulation of E-cadherin (CDH1) and epithelial-mesenchymal transition (EMT) are considered critical events for invasion and metastasis of colorectal carcinoma. Here we tested whether the important regulators of E-cadherin expression SNAI1 and TWIST1 are already detectable in human colorectal adenomas. METHODS RNA was extracted from a set of randomly selected formalin-fixed and paraffin-embedded (FFPE) colorectal adenomas (n = 41) and normal colon mucosa (n = 10). Subsequently mRNA expression of CDH1, CDH2, SNAI1 and TWIST1 was analysed by quantitative RT-PCR analysis. CDH1 as well as SNAI1 protein expression were assessed by immunohistochemistry (IHC). RESULTS SNAI1 mRNA was expressed in 78% (n = 32/41), TWIST1 mRNA in 41% (n = 17/41) and CDH2 mRNA in 41% (n = 17/41) of the colorectal adenoma tissue, while normal colon mucosa was negative for these transcription factors. We found a significant correlation between reduced CDH1 and the presence of SNAI1 mRNA expression and for combined SNAI1 and TWIST1 mRNA expression, respectively. A correlation between CDH2 mRNA expression and reduced CDH1 expression was not observed. We confirmed the relationship between SNAI1 expression and reduced E-cadherin expression on the protein level via IHC. CONCLUSION Our data show that SNAI1 and Twist1 are already expressed in benign precursor lesions of colorectal cancer and that SNAI1 expression was significantly correlated with lower expression of CDH1. Whether these findings reflect true EMT and/or are a sign of a more aggressive biology need to be investigated in further studies.
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Affiliation(s)
- Feride Kroepil
- Department of General-, Visceral- and Pediatric Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
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Baretton GB, Tannapfel A, Schmitt W. [Standardized and structured histopathological evaluation of colorectal polyps: a practical checklist against the background of the new WHO classification]. DER PATHOLOGE 2012; 32:289-96. [PMID: 21678043 DOI: 10.1007/s00292-011-1436-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Gastroenterologists removing colorectal polyps expect standardized and well-structured pathological reports, providing them with all relevant data for the further clinical management of the patient. Over the last year, a task force of clinicians and pathologists has developed a checklist to improve and harmonize endoscopic and pathological reporting of colorectal polyps. This checklist concentrates more on concrete recommendations from evidence-based guidelines and established international classifications for daily practice rather than detailed molecular pathological pathways of carcinogenesis. These recommendations are based on the current S3 guidelines for colorectal cancer (the chapter entitled "Management of colorectal polyps"), the histomorphological consensus manuscript of the GI working group of the German Society for Pathology, as well as the current WHO classification for tumors of the digestive system.
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Affiliation(s)
- G B Baretton
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Risio M. The Grand Challenges in GI Tract Cancers. Front Oncol 2011; 1:46. [PMID: 22649766 PMCID: PMC3355881 DOI: 10.3389/fonc.2011.00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 11/08/2011] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mauro Risio
- Department of Pathology, Institute for Cancer Research and Treatment Candiolo, Torino, Italy
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Abstract
The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.
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Affiliation(s)
- S Rüth
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Deutschland.
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