Invasion of veins by carcinoma of rectum: method of detection, histological features and significance

Abstract

Histopathological material from operation specimens of rectal adenocarcinoma was reviewed and invasion of veins identified in 51.9% of 703 cases. The extent of venous invasion, thickness of the walls of invaded veins and various other histological features were examined in detail. By follow-up studies recurrence rates, incidence of distant metastases and corrected 5-year survival rates were obtained; correlation with the histopathological results showed that invasion of extramural and thick-walled veins is associated with a poor prognosis independent of the degree of differentiation of the adenocarcinoma. Prognosis is not significantly related to the presence of necrosis of intravenous tumour and a clearly defined stroma in the intravenous growth all appear to exert a protective influence on patient survival. Whereas permeation of capillaries in vein walls, the presence of loose clumps of tumour cells in veins and direct contact between tumour cells and venous blood appear to adversely affect survival. Venous invasion is shown to be related to local invasiveness of rectal carcinoma. Suggested modes of venous spread and interaction with host tissues are proposed, with implications for general attitudes to the spread of cancer and metastasis.

Conclusions from a study of venous invasion in stage IV colorectal adenocarcinoma

“…Although the number of cases is small, our data indicate that the addition of an elastic fibre stain to staining with H+E triples the rate of detection of intermediate venous invasion, whereas the rate of detection of massive venous invasion decreases. Neither Talbot et al, [10][11][12] Dirschmid et al, 20 Inoue et al, 18 Horn et al, 16 17 nor Minsky and colleagues 14 15 refer to the extent of venous invasion. Our present study cannot indicate whether the extent of venous invasion has an effect on the chances of development of clinically relevant distant metastases; therefore, we cannot state whether the extent of venous invasion should be regarded as an indicator of prognosis and reported routinely.…”

“…According to the those authors, Talbot et al, [10][11][12] and Dirschmid et al, 20 extramural venous invasion is predominant in other stages of colorectal cancer also. Conversely, Minsky et al found a predominance of intramural venous invasion.…”

“…Conversely, Minsky et al found a predominance of intramural venous invasion. 14 15 Inoue et al, 18 like Talbot et al, [10][11][12] conclude that extramural venous invasion is an indicator of poor prognosis. Because only intramural venous invasion was demonstrable in about a third of our patients (all with synchronous distant metastases), intramural venous invasion may also seed clinically relevant haematogenous metastases, and should therefore also be regarded as an indicator of poor prognosis.…”

“…The reported incidence of venous invasion in CRC specimens varies between 10% and 89.5%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] To a certain extent, this variance may indicate currently unidentified inherent differences between patient populations, and it obviously reflects differences in tumour differentiation and stage among the reported cohorts. Owing to the focal nature of vein invasion and to the non-continuous nature of the process of tumour embolism, it appears that pure chance also influences the identification of venous invasion.…”

Expression of the ets-1 Proto-Oncogene in Human Colorectal Carcinoma

“…In addition to hematoxylin and eosin staining, we also used Elastica van Gieson stain in all cases. Each parameter was defined as "present" when invasion was identified with certainty, but defined as "absent" when either not observed at all or not observed with certainty (16,17). Lymph node metastasis was defined as "present" only when histologically proven.…”