Endoscopic diagnosis of small flat carcinoma of the colon

Hunt, David; Cherian, Maya

doi:10.1007/bf02055545

Cited by 49 publications

(19 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, however, several reports from the western world have found that small colorectal carcinomas can be detected at a similar frequency when endoscopic techniques such as those used in Japan are employed [5,18,37,42,43,44]. In 1995, our group published a series in Germany describing 155 de novo carcinomas collected between 1988 and 1994 that were no more than 1.0 cm in diameter [45].…”

Section: Controversy In the Westmentioning

confidence: 96%

Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance

2002

View full text Add to dashboard Cite

The effort to reduce colorectal adenocarcinoma mortality increasingly depends on detection and removal of precancerous adenomas by colonoscopy. Sporadic reports have described small, aggressive carcinomas that do not appear to develop from adenomas and have been called "de novo" carcinomas. These lesions seem to challenge the basis of colorectal surveillance and are therefore a controversial topic. This review presents the history of the de novo concept, the problems concerned with the histopathologic diagnosis of these lesions and what is presently known about their clinical and molecular biologic features in comparison with the more common ex adenoma type of colorectal carcinomas. This information will show that, despite their rarity, it is important for both pathologists and gastroenterologists to be aware of these lesions.

show abstract

Section: Controversy In the Westmentioning

confidence: 96%

Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance

2002

View full text Add to dashboard Cite

show abstract

“…(11) Presence or absence of perineural invasion. (12) Presence or absence of lymph node metastases. (13) Presence or absence, and grade, of dysplasia (low or high) of adjacent adenomatous epithelium, where present, as per previously published criteria.…”

Section: Pathologic Analysismentioning

confidence: 99%

“…2,3,14,39,40 Some investigators believe that de novo carcinomas arise directly from normal mucosa and develop via a distinct pathway of carcinogenesis with, possibly, a more aggressive phenotype. 2,11,27,40 These tumors have been described by a variety of names, such as ''superficial'' 11,46 (including flat, 12,25,40,42 depressed, 11,14,23 and ulcerated 20 ), ''early'' 14,25,27 (generally applied to carcinomas limited to the mucosa and/or submucosa), ''nonpolypoid,'' 3,19,22 and de novo 2,24,39 carcinomas.…”

mentioning

confidence: 99%

Clinicopathologic and Immunohistochemical Study of Small Apparently ???De Novo??? Colorectal Adenocarcinomas

Hornick

Farraye

Odze

2007

The American Journal of Surgical Pathology

View full text Add to dashboard Cite

Rarely, adenocarcinomas of the colorectum develop as small (< or =1.0 cm) rapidly invasive tumors without an obvious adenomatous or "in situ" component. These tumors have been termed "de novo" carcinomas. Although it is believed by some that these tumors are more aggressive than conventional large adenocarcinomas with an identifiable in situ component, little is known about the biologic characteristics and natural history of these lesions. The aim of this study was to evaluate and compare the pathologic features, biologic characteristics, and natural history of small apparently de novo invasive colorectal adenocarcinomas with conventional large (>1.0 cm) carcinomas. Routinely processed specimens from 20 patients (M/F ratio: 13/7; mean age: 65 y) with small apparently de novo invasive colorectal adenocarcinomas (all < or =1.0 cm in size) were evaluated for a variety of clinical and pathologic features. In addition, immunostains for p53, beta-catenin, DPC4, hMLH1, hMSH2, and MGMT were evaluated in all cases. The findings in this group of cases were compared with those from 20 control patients (M/F ratio: 8/12; mean age: 60 y) with stage-matched conventional "large" colorectal adenocarcinomas (all >1.0 cm in size). Patients were followed for a mean of 52.6 and 60.6 months, respectively, for the 2 groups. Small apparently de novo invasive adenocarcinomas were present in the left colon, transverse colon, and right colon in 85%, 10%, and 5% of cases, respectively. Their mean size was 7 mm (range: 3 to 10 mm). All cases were stage T1 and the majority were moderately differentiated (75%). Only 1 (5%) patient had lymph node metastases. Two (10%) cases were mucinous and only 1 (5%) showed prominent tumor infiltrating lymphocytes. Upon complete sectioning of the tissue blocks of tumor, residual foci of adenomatous epithelium were present in 16/20 (80%) cases, of which 75% contained foci of high-grade dysplasia. P53 and nuclear beta-catenin staining was present in 70% and 85% of cases, respectively, but only 5 cases (25%) showed loss of DPC4. Loss of MGMT expression was seen in 5 cases (25%), loss of hMSH2 in only 1 case (5%), and none showed loss of hMLH1. Only 2 patients (10%) developed visceral metastases upon follow-up. Control patients had similar demographic features, clinical outcome, anatomic distribution of tumors, degree of differentiation, and prevalence of positivity for the immunostains noted above, to the study cases. In our patient population, true small de novo colorectal adenocarcinomas, tumors that lack an identifiable adenomatous component, are exceedingly rare, because complete tissue sectioning reveals residual adenomatous tissue in the majority of cases. The biologic characteristics and natural history of small carcinomas with a minimal dysplastic component, and those with no identifiable adenomatous component, are similar to conventional large (>1 cm) adenocarcinomas, and, thus, they should probably be treated similarly.

show abstract

“…Whether depressed or not, rather few cases of non‐polypoid early colon cancers have been reported by Western researchers. 17–21 This is probably because candidate lesions are overlooked as a result of ignorance of and/or resistance to the concept or because proper diagnostic methods are not used. High‐magnification colonoscopy and chromoscopy clearly improve the detection rate of non‐polypoid neoplastic lesions.…”

Section: Detection Of Flat Adenomas and Depressed Lesionsmentioning

confidence: 99%

Early colorectal cancer: Flat or depressed type

Kudo

Kashida

Tamura

2000

J of Gastro and Hepatol

View full text Add to dashboard Cite

The present review describes the changes in views about the early forms of colorectal cancers. In 1985, a concept of 'flat adenoma' was born in Japan. At around the same time, depressed type early colorectal cancers started to be reported by Japanese colonoscopists. Neither flat adenomas nor depressed lesions have been frequently reported in Western countries, but increasing numbers of such cases are now described. The problem is that flat adenomas and depressed lesions seem to have been confused by many researchers. The biological aggressiveness of these lesions is quite different. The rate of submucosal invasion is very high in depressed lesions, but fairly low in small flat adenomas. Some adenomas may even look depressed at first, but such lesions should not be mistaken for truly depressed lesions. Ignorance or resistance to the concept may inhibit the detection of flat or depressed lesions. Differences of diagnostic criteria between Japanese and Western pathologists may influence the apparent frequency of mucosal cancers, but not that of invasive carcinomas. Many small adenomas do not grow if followed, but depressed lesions grow rapidly and invade the deeper layers and, as a result, may look elevated as a whole. Many cases in previously published papers suggest that small depressed carcinomas of the large intestine may develop without a precursory stage of an adenomatous polyp. At least two carcinogenic pathways, one through adenomatous polyps and one de novo, should be recognized. In addition, the importance of small depressed cancers should be emphasized.

show abstract

Endoscopic diagnosis of small flat carcinoma of the colon

Cited by 49 publications

References 12 publications

Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance

Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance

Clinicopathologic and Immunohistochemical Study of Small Apparently ???De Novo??? Colorectal Adenocarcinomas

Early colorectal cancer: Flat or depressed type

Contact Info

Product

Resources

About