Pathology Field, Research Center for Innovative Oncology, National Cancer Center Hospital East Kashiwa, Chiba, Japan.
Front Oncol. 2012 Dec 11;2:179. doi: 10.3389/fonc.2012.00179. eCollection 2012.
Primary tumors of the colorectal cancers are assessed pathologically based on the tumor spread into the bowel wall. The assessment of serosal involvement, which may be relevant to pT4, can be challenging for pathologists, making the consistency of diagnoses questionable. As solutions to this problem, the following two strategies could be adopted. One would be to use special staining or immunohistochemical staining techniques for diagnostic assistance. The other would be to construct recommendations for the assessment of tumor spreading and to obtain a world-wide consensus on the criteria used to assess tumor spreading. Using elastic staining, we previously reported that peritoneal elastic laminal invasion (ELI) could be objectively determined and would likely contribute to a simplified and more objective stratification of deep tumor invasion around the peritoneal surface. We also noted the importance of sampling, staining, and histo-anatomical knowledge in the application of elastic staining during routine pathological diagnosis. Here we review the history of primary tumor stratification leading to the present TNM classification and report on the current status of pathological assessments made at our hospital to summarize what has been established and what is further required for the pathological diagnosis of tumor spreading in patients with colorectal cancer.
结直肠癌的原发肿瘤主要根据肿瘤向肠壁的侵袭程度进行病理评估。浆膜浸润的评估（可能与 pT4 相关）对病理学家来说具有挑战性，这使得诊断的一致性值得怀疑。针对这个问题，我们可以采用以下两种策略。一种是使用特殊的染色或免疫组织化学染色技术来辅助诊断。另一种是制定评估肿瘤扩散的建议，并就评估肿瘤扩散所使用的标准达成全球共识。我们之前曾使用弹性染色报告过，腹膜弹性层侵犯（ELI）可以客观地确定，并可能有助于简化和更客观地分层腹膜表面周围的深层肿瘤侵袭。我们还注意到在常规病理诊断中应用弹性染色时采样、染色和组织解剖学知识的重要性。在这里，我们回顾了导致目前 TNM 分类的原发肿瘤分层的历史，并报告了我们医院目前的病理评估现状，以总结已经确立的内容以及对结直肠癌患者肿瘤扩散的病理诊断进一步的要求。
