Pragmatic classification of superficial neoplastic colorectal lesions

Lambert, René; Kudo, Shin Ei; Vieth, Michael; Allen, John I.; Fujii, Hiroaki; Fujii, Takeshi; Kashida, Hiroshi; Matsuda, Takahisa; Mori, Masaki; Saitō, Hiroshi; Shimoda, Tadakazu; Tanaka, Shinji; Watanabe, Hidenobu; Sung, Joseph J.Y.; Feld, Andrew D.; Inadomi, John M.; O’Brien, Michael; Lieberman, David A.; Ransohoff, David F.; Soetikno, Roy; Zauber, Ann G.; Teixeira, Cláudio Rolim; Rey, Jean François; Jaramillo, Edgar; Rubio, Carlos A.; Gossum, A. Van; Jung, Michael; Jass, Jeremy R.; Triadafilopoulos, George

doi:10.1016/j.gie.2009.09.015

Cited by 110 publications

(75 citation statements)

References 62 publications

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“…Although the designation intramucosal carcinoma is currently discouraged by the WHO, it has recently been included in the pragmatic classification of superficial neoplastic colorectal lesions [3,4]. In conclusion, we report the first case of an intramucosal colorectal mucinous adenocarcinoma, which was successfully removed endoscopically.…”

mentioning

confidence: 77%

Early mucinous colorectal adenocarcinoma – mucosal type

et al. 2010

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confidence: 77%

Early mucinous colorectal adenocarcinoma – mucosal type

et al. 2010

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“…[5][6][7] The APC and KRAS mutations, which are common in polypoid adenoma, are found less frequently in nonpolypoid and depressed lesions. [18][19][20] Colorectal adenoma has a range of growth patterns from flat or slightly elevated lesion to large sessile or pedunculated polyps. The growth patterns of superficial, neoplastic mucosal lesions of the colorectum are divided into polypoid and nonpolypoid subtypes in the Paris classification.…”

Section: Tumoral Intraepithelial Neoplasm In the Colorectum Polypoid mentioning

confidence: 99%

“…In addition to simple comparisons of polypoid versus nonpolypoid adenoma-carcinoma sequence, serrated polyps have been reported to have a different genomic profiles when compared with nonserrated adenoma-carcinoma sequence. 22 Lambert el al 19 suggested a pragmatic classification of superficial, neoplastic colorectal lesions based on the presence or absence of serrated lesions, with additional mutation and genomic profiles that include chromosomal instability, microsatellite stability or instability, and CpG island methylator phenotype. In their pragmatic classification, nonserrated lesions were composed of polypoid adenoma, nonpolypoid and nondepressed adenomas, lateral spreading tumor adenomas, and nonpolypoid and depressed adenomas; polypoid adenomas showed a high proportion of APC and KRAS mutations, lateral spreading tumor adenomas showed a high frequency of KRAS and p53 mutation, 23 and nonpolypoid and depressed adenomas showed a much higher proportion of submucosal invasion than other subtypes.…”

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confidence: 99%

Tumoral Versus Flat Intraepithelial Neoplasia of Pancreatobiliary Tract, Gallbladder, and Ampulla of Vater

Jang

Ahn

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-The identification of a precursor lesion is important to understanding the histopathologic and genetic alterations in carcinogenesis. There are a plethora of terminologies that describe precursor lesions of the pancreatobiliary tract, ampulla of Vater, and gallbladder. The current terminologies for precursor lesions may make it difficult to understand the tumor biology. Here, we propose the concept of tumoral and flat intraepithelial neoplasia to improve our understanding of precursor lesions of many epithelial organs, including the pancreatobiliary tract, ampulla of Vater, and gallbladder.Objective.-To understand the dichotomous pattern of tumoral and flat intraepithelial neoplasia in carcinogenesis of pancreatobiliary tract, ampulla of Vater, and gallbladder.Data Sources.-Review of relevant literatures indexed in PubMed.Conclusions.-Tumoral intraepithelial neoplasia presents as an intraluminal or intraductal, mass-forming, polypoid lesion or a macroscopic, visible, cystic lesion without intracystic papillae. Microscopically, tumoral intraepithelial neoplasia shows various proportions of papillary and tubular architecture, often with a mixed pattern, such as papillary, tubular, and papillary-tubular. The malignant potential depends on the degree of dysplasia and the cell phenotype of the epithelium. Flat intraepithelial neoplasia presents as a flat or superficial, spreading, mucosal lesion that is frequently accompanied by an invasive carcinoma. Tumoral and flat intraepithelial neoplasias are not homogeneous entities and may exhibit histopathologic spectrum changes and different genetic profiles. Although intraepithelial neoplasia showed a dichotomous pattern in the tumoral versus flat types, they can coexist. Tumoral and flat intraepithelial neoplasia can be interpreted as part of a spectrum of changes in the carcinogenesis pathway of each organ. A denoma is the prototype precursor lesion in carcinogenesis. The adenoma-carcinoma sequence is one of the well-characterized models of the carcinogenesis pathway. Through the adenoma-carcinoma sequence, many histopathologic and genetic alterations have been characterized in colorectal carcinogenesis.1,2 Another prototype precursor lesion is uterine cervix dysplasia, which also progresses to invasive squamous cell carcinoma of the uterine cervix through multistep carcinogenesis. Both colon adenoma and uterine cervix dysplasia correspond to intraepithelial neoplasia (IN), which can lead to invasive carcinoma. Most colorectal adenomas present as a polypoid lesion, whereas uterine cervix dysplasia presents as a nonpolypoid, flat, mucosal lesion. We think colon adenoma and uterine cervix dysplasia represent a mass-forming tumoral IN and a nonmass-forming, flat IN, respectively. In general, tumoral IN corresponds to a macroscopic or mass-forming lesion, and flat IN presents as invisible or microscopic lesions. Flat adenomas have been reported in the colorectum, which is much closer to a flat IN, and papillary squamous cell carcinoma of the uterine cervix, which is...

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“…The neoplastic lesions are classified in categories of low, mid and high grade dysplasia and of carcinoma with estimation of the depth of invasion in the mucosa or extension in the submucosa. Characterization is based on analysis of the micro-architecture with the pit pattern of the mucosa and on the vascular pattern of sub-epithelial capillaries, visible in endoscopy [13][14][15]. After characterization, the treatment decision is taken between abstention with a simple diagnostic biopsy, resection by endoscopy, or direct surgery.…”

Section: Strategy Of Endoscopic Diagnosismentioning

confidence: 99%

“…The pit pattern of the colonic mucosa is then described in multiple categories [13][14][15]: In type I, the normal columnar epithelium shows small and regular pit openings surrounded by sub-epithelial capillaries. The type II corresponds to non-neoplastic, hyperplastic lesions with regular and large pit openings which are less contrasted.…”

Section: Endoscopic Diagnosis Of Colonic and Rectal Lesionsmentioning

confidence: 99%

Role of Endoscopy in Screening and Treatment of Gastrointestinal Cancer

Lambert¹

2013

J Gastrointest Dig Syst

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Gastrointestinal cancer includes tumors of the proximal and distal stomach which are explored by upper GI endoscopy, using a flexible endoscope. It includes also tumors of the large bowel (colon and rectum), explored with flexible endoscopes by a complete colonoscopy or by a simple sigmoidoscopy. In 2008 the number of incident cases occurring in the World is estimated at 988 602 for gastric cancer and at 1 235 108 for colorectal cancer. A trigger role is played by Helicobacter pylori infection in gastric cancer, and by Diet, Nutrition and physical activity, in colorectal cancer. Gastric cancer is more frequent in developing countries of Asia and Latin America; colorectal cancer is more frequent in more developed countries of North America and Europe. For both tumors, endoscopic diagnosis is based on a 2 steps analysis, with detection followed by charaterization and prediction of histology, before decision of endoscopic resection. Techniques of endoscopic resection include polypectomy with a ligating snare, and modalities of resection called EMR and ESD. Endoscopic diagnosis with eventual treatment is the final step of all screening strategies, either in organized mass screening under the control of Health Authorities, or in Opportunistic screening in individual cases. In mass screening, endoscopy is performed only in persons with a positive filter test. In opportunistic screening endoscopy is a primary procedure. In secondary prevention of cancer, the early treatment of the tumor has a positive impact on survival and mortality. In the colorectum the treatment of premalignant adenomatous polyps has an impact on the reduction of incidence and could be considered as a primary prevention. Terminology and Definition of ScreeningIn clinical practice gastrointestinal cancer concerns tumors located in the stomach and in the large bowel, with colon and rectum. The occurrence of tumors in the long segment of the small intestine is relatively rare, and as a rule, these are considered separately. Gastric cancer is located in the distal stomach and antrum, or in the proximal stomach or cardia. The cardia includes the esophago-gastric junction, where tumors develop either from the squamous epithelium of the distal esophagus or from the gastric epithelium of the cardia. In synthesis for clinical practice, the term gastrointestinal cancer includes tumors of the distal esophagus and of the stomach, explored by upper GI endoscopy and tumors of the large bowel, explored by colonoscopy.In clinical practice persons complaining from appealing digestive symptoms consult their doctor; then an advanced cancer can be detected by radiology or endoscopy. On the other hand, at each tumor site, and in usually asymptomatic persons, screening corresponds to early detection of cancer at a completely curable stage, and will increase the overall 5 years survival from the disease, with a reduction in the mortality rate. In addition, the detection and treatment of premalignant neoplastic precursors will decrease the incidence rate of cance...

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Pragmatic classification of superficial neoplastic colorectal lesions

Cited by 110 publications

References 62 publications

Early mucinous colorectal adenocarcinoma – mucosal type

Early mucinous colorectal adenocarcinoma – mucosal type

Tumoral Versus Flat Intraepithelial Neoplasia of Pancreatobiliary Tract, Gallbladder, and Ampulla of Vater

Role of Endoscopy in Screening and Treatment of Gastrointestinal Cancer

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