Sporadic Medullary Carcinoma of the Colon

Abstract

We studied 68 sporadic colorectal carcinomas (CRCs) with medullary features (MCRCs) and compared them with 35 poorly differentiated purely "enteric" CRCs (ECRCs) and 15 purely neuroendocrine carcinomas (NECs) of grades II and III, all in patients lacking a family history of CRC. Potential clinicopathologic differences between the study groups were assessed. MCRCs were significantly more common in the ascending colon than were ECRCs, but there was no significant dissimilarity to NECs. ECRCs occurred more often in the rectosigmoid than MCRCs or NECs. MCRCs arose in older patients, and a marked sex difference also was noted. Despite an infiltrative growth pattern, MCRC was less likely than ECRC to manifest with stage III or IV disease, but there was no stage-related difference from NECs. Although the histologic images of MCRCs were evocative of neuroendocrine differentiation, chromogranin positivity and synaptophysin reactivity in that group did not differ meaningfully from that of ECRCs but was dissimilar to the 100% labeling of NECs. p53 immunolabeling was similar in the 3 tumor groups. Follow-up data in the study cases showed that 5-year mortality was 40% (27/68) for MCRC, 59% (19/32) for ECRC, and 93% (14/15) for NEC. Medullary CRC seems to be a distinct clinicopathologic variant of CRC, which does not have a neuroendocrine lineage. The biologic behavior of MCRC was better than that of ECRC or NEC.

Intravascular large B-cell lymphoma as a cause of hypopituitarism: gradual and late reversal of hypopituitarism after long-term remission of lymphoma with immunochemotherapy

“…She either had hypopituitarism as a consequence of IVL or endocrine dysfunction as a consequence of critical illness. IVL associated with endocrine dysfunction has been described in less than 30 patients [3,4,8,13]. Few reports have been focused on pituitary gland involvement in IVL with consecutive hypopituitarism [8,13].…”

“…Intravascular large B-cell lymphoma (IVL) is a rare generally fatal disease characterized by massive proliferation of lymphoid cells within the small and medium blood vessels, with little or no adjacent parenchymal involvement [1][2][3]. This disorder was previously known as ''malignant angioendotheliomatosis'' or ''angiotropic large-cell lymphoma''.…”

Diagnosing colorectal medullary carcinoma: interobserver variability and clinicopathological implications

“…In both clinical and research settings, medullary carcinoma (MC) is commonly perceived as a distinct clinico-pathological entity with specific prognostic relevance and molecular pathogenesis. A number of studies have suggested that tumors with medullary histology tend to have a favorable clinical outcome and are strongly associated with DNA mismatch repair (MMR) deficiency despite their “poorly differentiated” histologic appearance [3, 4, 6, 8–10]. As such, the most recent World Health Organization (WHO) classification [11] as well as the American Joint Committee on Cancer (AJCC) [12] have incorporated MC as a distinct histologic subtype.…”

“…The number of specific features required for the diagnosis is also widely inconsistent across different studies [3, 6, 8, 9]. MMR deficiency is a stringent diagnostic requirement in some studies [4, 14], but not in others [9, 10]. At present, the only standard diagnostic guideline is that delineated in the 2010 WHO Classification of Tumours of the Digestive System [11], which states concisely that MC is composed of “sheets of malignant cells with vesicular nuclei, prominent nucleoli and abundant eosinophilic cytoplasm, and prominent infiltration by intraepithelial lymphocytes”.…”

Prognostic stratification of colorectal cancer patients: current perspectives

“…Medullary carcinomas arise frequently in the proximal colon, with an incidence increasing with age and a female predominance 22,23…”