Pathology of the malignant colorectal polyp

Cooper, Harry S.; Deppisch, Ludwig M.; Kahn, Ellen; Lev, Robert; Manley, Paul; Pascal, Robert; Qizilbash, Ali H.; Rickert, Robert R.; Silverman, Jan F.; Wirman, John A.

doi:10.1016/s0046-8177(98)90385-9

Cited by 61 publications

(37 citation statements)

References 26 publications

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“…It seems reasonable to refer to the clearance of the endoscopic resection margin of pedunculated adenomas containing cancer, considering that the presence of cancer cells at or near the resection margin is a reliable histologic marker of adverse outcome. Here, a negative margin is reported in the absence of cancer within the diathermy burn or more than 1mm from the actual margin of resection [65], even if higher distances (up to 3 mm) have been suggested. The precise measurement has to consider the possible artifacts induced by endoscopic resection or surgery (e.g.…”

Section: Bmentioning

confidence: 78%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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Section: Bmentioning

confidence: 78%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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“…49 Such limitation could be overcome by the identification of biomarkers predictive of an invasive/metastatic behavior in the early stage of colorectal cancer. Unfortunately, differently from advanced colorectal cancer, no significant relationship between proliferative index or DNA ploidy and the metastatic potential of malignant polyps has been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

Hassan

Zullo

Risio

et al. 2005

Diseases of the Colon &Amp; Rectum

192

186

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PURPOSE:The malignant polyp carries a significant risk of lymphohematic metastasis and mortality. Clinical usefulness of histologic risk factors is still controversial. The study was designed to compute the association between the main histologic risk factors and the occurrence of unfavorable outcomes in patients with malignant polyps. METHODS: A MEDLINE search regarding malignant polyps was performed. Three histologic risk factors (positive resection margin, poor differentiation of carcinoma, vascular invasion) and five (residual disease, recurrent disease, lymph node metastasis, hematogenous metastasis, mortality) unfavorable clinical outcomes were evaluated. Further analysis was performed by subgrouping polyps in high-risk and lowrisk groups. RESULTS: Thirty-one studies enrolling 1,900 patients with malignant polyp were selected. Positivity of resection margin was significantly predictive of the presence of residual disease (odds ratio, 22; P < 0.0001), poorly differentiated carcinoma was associated with an increased mortality (odds ratio, 9.2; P < 0.05), and vascular invasion with a higher lymph node metastasis risk (odds ratio, 7; P < 0.05). Patients with high-risk polyps showed a significantly worse outcome than those with low-risk, especially for mortality (odds ratio, 11; P < 0.05). Surgical-related death was as low as 0.8 percent. CONCLUSIONS: All three histologic risk factors are significantly associated with the clinical outcome. Classification in low-risk and high-risk patients may be regarded as a meaningful staging procedure. T he malignant polyp, namely an adenoma containing a carcinoma invading the submucosa but not the muscular layer, represents the vast majority of early colorectal cancer, carrying a small but significant risk of both lymphohematic metastasis and mortality. 1

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“…Since the early 1980s, endoscopic resection (ER) techniques using electrothermal devices, such as polypectomy, strip biopsy and endoscopic mucosal resection (EMR), have been developed as diagnostic and curative procedures for gastrointestinal mucosal lesions (1)(2)(3)(4)(5)(6). The latest modality using specialized electrosurgical knives, referred to as endoscopic submucosal dissection (ESD), has enabled more complete removal of gastric lesions and is currently accepted as a standard treatment of early gastric adenocarcinoma (EGA) (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…The latest modality using specialized electrosurgical knives, referred to as endoscopic submucosal dissection (ESD), has enabled more complete removal of gastric lesions and is currently accepted as a standard treatment of early gastric adenocarcinoma (EGA) (6)(7)(8). The precise histological assessment of ER specimens, such as pathological diagnosis, the depth of cancerous invasion, lymphovascular permeation and the status of the surgical margin, is crucial for the subsequent management of the patients (1,3,4,(6)(7)(8)(9). Therapeutic procedures using electrothermal devices may induce varying artifacts disturbing the histological evaluation in gastrointestinal and other specimens (1,3,4,(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

“…The precise histological assessment of ER specimens, such as pathological diagnosis, the depth of cancerous invasion, lymphovascular permeation and the status of the surgical margin, is crucial for the subsequent management of the patients (1,3,4,(6)(7)(8)(9). Therapeutic procedures using electrothermal devices may induce varying artifacts disturbing the histological evaluation in gastrointestinal and other specimens (1,3,4,(9)(10)(11)(12)(13)(14). However, histological artifacts in newly developed ESD specimens remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study

Matsukuma

Takeo

Sato

2014

Molecular and Clinical Oncology

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Abstract.To delineate the characteristics of nuclear artifacts associated with endoscopic submucosal dissection (ESD), we examined 97 gastric ESD specimens from 79 patients. In 69 of the specimens (71%), multinucleated figures and̸or atypical mitotic-like figures, including tripolar-like and bizarre spindles, were found in the peripheral portions close to the marking areas. These nuclear figures were mostly recognizable as artifacts, but were infrequently (13 specimens) accompanied by other nuclear alterations and/or architectural abnormalities, mimicking dysplasia. However, in the deep cut sections, the dysplastic characteristics tended to disappear and coagulative or degenerative findings became more prominent. These nuclear artifacts were not found in 69 age-and gender-matched control gastrectomy specimens without ESD. Multinucleated artifacts were associated with the size of the ESD specimens (P=0.003), frequency of marking (P<0.001) and a history of 'previous' marking 1-6 days prior to ESD (P<0.001); however, they were not associated with age, ESD procedure time, or 'fresh' marking on the day of the ESD. Atypical mitosis-like characteristics were associated with a history of 'fresh' (P=0.007) as well as 'previous' (P=0.002) marking, but not with other variables. Dysplasia-like artifacts were associated with older age only (P=0.031). Follow-up data of all the patients with nuclear artifacts showed no aggressive behavior. Therefore, we concluded that these nuclear changes were ESD-related artifacts. Particularly in older patients, these changes may simulate dysplasia and must be distinguished from true dysplasia or neoplasia.

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Pathology of the malignant colorectal polyp

Cited by 61 publications

References 26 publications

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Histologic Risk Factors and Clinical Outcome in Colorectal Malignant Polyp: A Pooled-Data Analysis

Nuclear artifacts in gastric endoscopic submucosal dissection specimens: A clinicopathological study

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