Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Division of Clinical Laboratory, Keio University Hospital, Tokyo, Japan.
Histopathology. 2020 Mar;76(4):603-612. doi: 10.1111/his.14022. Epub 2020 Feb 24.
Lymph node metastasis (LNM) has not been found in more than 85% of patients with early invasive colorectal adenocarcinoma (T1-CRAC) who undergo surgery after therapeutic endoscopy due to the risk for LNM. Better histological risk assessment for LNM of endoscopically resected T1-CRAC is important to avoid unnecessary additional surgery.
We evaluated cancer gland rupture (CGR), i.e. cancer glands with a discontinuous epithelial lining, at the invasive front, as a potential risk factor for LNM by histological examination of differentiated T1-CRAC from 217 patients who underwent surgery with or without therapeutic endoscopy. CGR was represented by C-shaped neoplastic glands with a variable inflammatory or stromal reaction, and was occasionally accompanied by mucus lake or abscess formation. CGR was observed in 168 (77%) cases, including all 20 cases with LNM, and the odds ratio of LNM was higher for CGR than for deep invasion (depth of submucosal invasion ≥1000 μm). All cases with LNM were found among 148 cases with deep invasion and positive CGR, whereas no LNM was detected in 29 cases with deep invasion and negative CGR, regardless of vascular invasion or tumour budding. In the 148 cases, LNM was detected in 18 (19%) of 93 cases with positive vascular invasion or high-grade tumour budding, and in two (4%) of 55 cases without either.
Our findings suggest that CGR is an easily applied and objective histological finding for predicting LNM that could be useful for assessing the risk for LNM of endoscopically resected T1-CRAC with deep invasion.
由于存在淋巴结转移（LNM）的风险，接受治疗性内镜检查后的手术治疗的早期侵袭性结直肠腺癌（T1-CRAC）患者中，超过 85%的患者未发现 LNM。更好地评估内镜切除的 T1-CRAC 中 LNM 的组织学风险对于避免不必要的额外手术非常重要。
我们评估了癌症腺体破裂（CGR），即在侵袭前沿具有不连续上皮衬里的癌腺体，作为组织学检查的潜在危险因素在 217 例接受手术治疗或不接受治疗性内镜检查的分化型 T1-CRAC 患者中。CGR 表现为 C 形肿瘤腺体，伴有不同程度的炎症或基质反应，偶尔伴有黏液湖或脓肿形成。在 168 例（77%）病例中观察到 CGR，包括所有 20 例 LNM 病例，CGR 的 LNM 比值高于深部浸润（黏膜下浸润深度≥1000μm）。所有 LNM 病例均见于 148 例深部浸润且 CGR 阳性病例中，而 29 例深部浸润且 CGR 阴性病例中未检测到 LNM，无论是否存在血管浸润或肿瘤芽生。在 148 例病例中，LNM 见于 93 例阳性血管浸润或高级别肿瘤芽生的病例中的 18 例（19%），见于 55 例无血管浸润或高级别肿瘤芽生的病例中的 2 例（4%）。
我们的研究结果表明，CGR 是一种易于应用和客观的组织学发现，可用于预测 LNM，对于评估内镜切除的深部浸润 T1-CRAC 中 LNM 的风险可能有用。
