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Ono Y, Yilmaz O. Emerging and under-recognised patterns of colorectal carcinoma morphologies: a comprehensive review. J Clin Pathol 2024; 77:439-451. [PMID: 38448211 DOI: 10.1136/jcp-2023-208816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
While the overwhelming majority of colorectal carcinomas (CRC) are diagnosed as adenocarcinoma not otherwise specified, there are numerous under-recognised morphologic patterns of CRC. These patterns are recognised by the WHO, appear in reporting manuals for the American Joint Committee of Cancer, and/or are listed on synoptic reports, while many other variants have either fallen out of favour or are emerging as future bona fide patterns. Herein, we discuss 13 variants: serrated adenocarcinoma, micropapillary adenocarcinoma, medullary carcinoma, neuroendocrine carcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma, adenosquamous carcinoma, adenoma-like adenocarcinoma, lymphoglandular complex-like CRC, carcinoma with sarcomatoid components, cribriform-comedo-type adenocarcinoma, undifferentiated carcinoma and low-grade tubuloglandular adenocarcinoma. The purpose of this review is to scrutinise these variants by assessing their clinical characteristics, morphologic cues, as well as pitfalls, and address their prognostic significance. Our analysis aims to bring clarity and updated understanding to these variants, offering valuable insights for pathologists. This contributes to more nuanced CRC diagnosis and treatment strategies, highlighting the importance of recognising a broad spectrum of morphologic patterns in CRC.
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Affiliation(s)
- Yuho Ono
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Osman Yilmaz
- Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Boylan KE, Kanth P, Delker D, Hazel MW, Boucher KM, Affolter K, Clayton F, Evason KJ, Jedrzkiewicz J, Pletneva M, Samowitz W, Swanson E, Bronner MP. Three pathologic criteria for reproducible diagnosis of colonic sessile serrated lesion versus hyperplastic polyp. Hum Pathol 2023; 137:25-35. [PMID: 37044202 PMCID: PMC10330587 DOI: 10.1016/j.humpath.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Abstract
Colonic SSLs are thought to predispose to ∼30% of colonic adenocarcinomas. This increased risk, compared to benign HPs, makes their distinction vitally important. However, no gold standard exists to differentiate them, and wide observer variability is reported. To better distinguish these polyps, we investigated 94 serrated polyps (53 SSLs and 41 HPs) using an easy-to-apply pathologic scoring system that combines, for the first time, three established distinguishing features: polyp morphology, location, and size. As an additional novel approach, polyp size was assessed by serrated biopsy number compared to endoscopic size. RNA expression profiling served as an additional biomarker. The considerable morphologic overlap across serrated polyps was quantitated for the first time. Interobserver variability was assessed by 8 expert gastrointestinal pathologists. By ROC analysis, polyp size by biopsy number performed best, followed by polyp location and morphology (areas under the curves [AUCs] = 85.9%, 81.2%, and 65.9%, respectively). Optimal discrimination combined all 3 features (AUC = 92.9%). For polyp size, the biopsy number proved superior to endoscopic size (AUC = 85.9% versus 55.2%, P = .001). Interobserver variability analysis yielded the highest reported Fleiss and Kappa statistics (0.879) and percent agreement (96.8%), showing great promise toward improved diagnosis. The proposed 3-criteria pathologic system, combining size by biopsy number, location, and morphology, yields an improved, easy-to-use, and highly reproducible diagnostic approach for differentiating SSLs and HPs.
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Affiliation(s)
| | | | - Don Delker
- Division of Gastroenterology, 84112, USA
| | | | - Kenneth M Boucher
- Division of Epidemiology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kajsa Affolter
- Department of Pathology and ARUP Laboratories, 84112, USA
| | - Fred Clayton
- Department of Pathology and ARUP Laboratories, 84112, USA
| | | | | | - Maria Pletneva
- Department of Pathology and ARUP Laboratories, 84112, USA
| | - Wade Samowitz
- Department of Pathology and ARUP Laboratories, 84112, USA
| | - Eric Swanson
- Department of Pathology and ARUP Laboratories, 84112, USA
| | - Mary P Bronner
- Department of Pathology and ARUP Laboratories, 84112, USA
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Tringali A, Milluzzo SM, Ardito F, Laurenzi A, Ettorre GM, Barbaro B, Ricci R, Giuliante F, Boškoski I, Costamagna G. Peroral-cholangioscopy to plan surgery for protruding biliary lesions: report of four cases. Ther Adv Gastrointest Endosc 2022; 15:26317745221139735. [PMID: 36465430 PMCID: PMC9709184 DOI: 10.1177/26317745221139735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2024] Open
Abstract
Intraductal biliary lesions can involve the main hepatic confluence. Assessment of the extension of pedunculated biliary lesions during per-oral cholangioscopy (POCS) can optimize and personalize the surgical strategy. Four consecutive cases of pedunculated biliary lesions were analysed. Cholangioscopy was performed with a disposable single-operator cholangioscope. POSC was successfully performed in four patients (three female, mean age 50 years), showing involvement of the main biliary confluence in three of four pedunculated biliary lesions; direct biopsy sampling was diagnostic in two of three cases (in one patient, biopsy were not performed due to the smooth appearance of the intrabiliary lesion). No adverse events occurred after POCS. Surgery required excision of the main hepatic confluence in two of three cases (one patient was not resectable). POCS can diagnose intrabiliary extension of protruding biliary lesions, providing important information to plan the surgical intervention.
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Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Ardito
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Laurenzi
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Giuseppe Maria Ettorre
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Ricci
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Kuroki Y, Endo T, Iwahashi K, Miyao N, Suzuki R, Asonuma K, Yamamoto Y, Nagahama M. Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions. Endosc Int Open 2020; 8:E1832-E1839. [PMID: 33269317 PMCID: PMC7671765 DOI: 10.1055/a-1268-7353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm 2 /h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.
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Affiliation(s)
- Yuichiro Kuroki
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Toshiyuki Endo
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Kenta Iwahashi
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Naoki Miyao
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Reika Suzuki
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Kunio Asonuma
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Masatsugu Nagahama
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
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de Lima RDAL, Parra RS, Feitosa MR, Feres O, da Rocha JJR. Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope. Acta Cir Bras 2020; 35:e202000807. [PMID: 32965304 PMCID: PMC7518222 DOI: 10.1590/s0102-865020200080000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. METHODS We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. RESULTS This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. CONCLUSIONS The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.
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Affiliation(s)
- Roberta Denise Alkmin Lopes de Lima
- Fellow PhD degree, Postgraduate Program in Surgical Clinic, Division of Coloproctology, Department of Anatomy and Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; manuscript preparation, final approval
| | - Rogério Serafim Parra
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, manuscript writing, critical revision, final approval
| | - Marley Ribeiro Feitosa
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, statistics analysis, final approval
| | - Omar Feres
- PhD, Associated Professor, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, critical revision, final approval
| | - José Joaquim Ribeiro da Rocha
- PhD, Associated Professor, Head, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; critical revision, final approval
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First Long-term Oncologic Results of the ALPPS Procedure in a Large Cohort of Patients With Colorectal Liver Metastases. Ann Surg 2020; 272:793-800. [DOI: 10.1097/sla.0000000000004330] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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