ABSTRACT
BACKGROUND: The appropriateness of endoscopic resection in patients with T1 colorectal carcinomas is unclear. Highly precise predictors of lymph node metastasis are required to optimize the outcomes of treatments for T1 colorectal carcinomas. OBJECTIVE: The purpose of this work was to identify predictors of lymph node metastasis by examining the clinicopathologic significance of immunophenotypes found in T1 colorectal carcinomas. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at a university hospital. PATIENTS: Included were 265 patients with T1 colorectal carcinoma who underwent radical surgery. INTERVENTIONS: Patients with T1 colorectal carcinoma were managed. MAIN OUTCOME MEASURES: Immunophenotypes were associated with various clinicopathologic parameters, and CD10 expression was strongly associated with lymph node metastasis. RESULTS: The levels of MUC2, MUC5AC, and CD10 expression were individually significantly associated with tumor location, growth pattern, histologic type, invasive potential, and metastatic potential. The incidence of lymph node metastasis was significantly associated with each of the 5 following parameters: depth of submucosal invasion (p = 0.005), tumor budding (p < 0.001), lymphatic invasion (p < 0.001), MUC2 expression (p = 0.006), and CD10 expression (p < 0.001). Multivariate analysis showed that CD10 expression (OR, 9.2 [95% CI, 2.5-39.8]; p = 0.001) and lymphatic invasion (OR, 6.3 [95% CI, 2.5-17.7]; p < 0.001) were independently associated with lymph node metastasis. LIMITATIONS: This study was limited by its small sample size, intraobserver variation attributed to immunohistochemical staining, and potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens. CONCLUSIONS: We suggest that CD10 expression is closely associated with lymph node metastasis in T1 colorectal carcinoma.
Subject(s)
Colorectal Neoplasms/immunology , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Immunophenotyping , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/immunology , Endoscopy , Female , Humans , Immunohistochemistry , Lymph Node Excision , Lymphatic Metastasis/pathology , Male , Middle Aged , Mucin 5AC/immunology , Mucin-2/immunology , Neoplasm Grading , Neprilysin/immunology , Predictive Value of Tests , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: There are currently no universally accepted indications and criteria for additional gastrectomy after endoscopic resection of submucosally invasive cancer. The purpose of the present study was to establish accurate indications and criteria for such additional gastrectomy on the basis of lymph node metastasis risk. METHODS: We investigated 130 submucosally invasive gastric cancers and analyzed the pathological risk factors for lymph node metastasis. The tumors were evaluated for pathological factors in the area of invasion, and factors were compared between the cases with lymph node metastasis and those without. RESULTS: Univariate logistic regression analysis showed that tumor minor axis length, depth of invasion, histological classification of the area of submucosal invasion, absence of lymphoid infiltration, ulceration or scar in the lesion, and lymphatic and venous invasion are statistically significant risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the absence of lymphoid infiltration and the presence of lymphatic invasion are statistically significant as risk factors for lymph node metastasis. CONCLUSIONS: We present a scoring system on the basis of the pathological criteria tested in this study. Our findings enable more accurate identification of patients who should undergo additional gastrectomy after endoscopic resection.
Subject(s)
Endoscopy , Gastrectomy , Lymphocytes, Tumor-Infiltrating/pathology , Stomach Neoplasms/pathology , Aged , Female , Follow-Up Studies , Humans , Lymphatic Metastasis , Male , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Risk Factors , Sensitivity and Specificity , Stomach Neoplasms/surgeryABSTRACT
An 86-year-old man was admitted complaining of abdominal pain. A tender hard mass was palpated in the right upper abdomen. On computed tomography, intussusception was visualized with a mass about 4 cm in size. Gastrographin enema examination showed typical so-called crab finger's sign findings. The mass was suspected to be cancer of the transverse colon which had led to the intussusception. Operation was performed. Histopathologically, the tumor was type 1 and poorly differentiated adenocarcinoma. Intussusception in adults is rarely caused by transverse colon cancer, with only 18 cases reported in Japan. We discuss our case in light of our review of the literature.