Flat and polypoid adenocarcinomas of the colorectum: a comparative histomorphologic analysis of 47 cases

Nasir, Aejaz; Boulware, David; Kaiser, Hans E.; Bodey, B; Siegel, Stuart E.; Crawley, Stephanie; Yeatman, Timothy J.; Marcet, Jorge; Coppola, Domenico

doi:10.1016/j.humpath.2003.11.011

Cited by 23 publications

(23 citation statements)

References 34 publications

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“…Moreover, this association suggests a higher malignant potential of de novo tumors, anticipated to the corresponding clinicopathological pattern reported for proximal tumors [higher stage and grade, worse outcome (16,27,28)]. The recorded rarity of de novo lesions in the indolent subset is also supportive of this state and consistent with previous findings (20,29). It is also potentially correlated with the proximal predilection of these tumors, considering the milder clinical manifestations and the lower efficacy of colonoscopy observed in proximal CRC, resulting in later stage presentation (16,28).…”

Section: Discussionsupporting

confidence: 88%

“…We also examined their correlation with particular clinicopathological characteristics (stage, grade and site). The study was conducted in a sample mainly comprising 'advanced' CRC (i.e., tumors invading beyond the submucosa), consistent with certain previous studies (7,12,13,20,23), although in contrast to most Japanese (5,6,10,18,19) and certain Western studies (8,11) focusing on early (T1) lesions. Consistent with the findings reported by Chen et al, the ascertained incidence of potentially de novo tumors in our series was 28.5% (12).…”

Section: Discussionmentioning

confidence: 61%

“…A limitation to our study was the relatively small sample size [although comparable to other relevant studies (10,11,13,20,25)], potentially affecting results, particularly in subset analysis. Another limitation could be the almost complete lack of small and/or T1 lesions in our samples, potentially hampering de novo identification.…”

Section: Discussionmentioning

confidence: 94%

“…The existence of polyps beyond this limit was considered coincidental (i.e., not correlated with the primary lesion) and therefore was not recorded; and iii) apparently nonpolypoid growth pattern, based on morphological and histological appearance, in particular infiltrative lesions (without overhanging edge and showing massive infiltration of tumor cells) (6), including even those with a relatively limited ulceration (7,20) but always excluding protruding exophytic tumors (with overhanging edge) (6). The latter type was also identified on the basis of tumor thickness (at least 2-fold greater than that of the adjacent normal mucosa) (20).…”

Section: Methodsmentioning

confidence: 99%

“…Clinically, de novo tumors may represent a more aggressive (fast-growing at an early stage) subtype of CRC (14,15,20). Consequently, their identification may be important in the planning of treatment and follow-up (10,12,14).…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological differences of colorectal cancers according to tumor origin: Identification of possibly de novo lesions

et al. 2012

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Abstract. Colorectal cancer (CRC) is considered to develop through the conventional adenoma-carcinoma sequence. However, the existence of de novo carcinogenesis, without any intervening precursor lesions, has been suggested for certain morphologically different tumors lacking polypoid characteristics. The presence of such tumors, along with their correlation with cardinal clinicopathological parameters, such as stage, grade and site, was retrospectively investigated in a series of 119 surgically treated CRC cases. The absence of particular polypoid characteristics (adenomatous remnants or coexisting polyps in the tumor vicinity) in combination with an infiltrative (or ulceroinfiltrative) growth pattern, were the criteria defining the nonpolypoid origin. The recorded frequencies of remnants, coexisting polyps and infiltrative tumors were 7, 5, 9 and 32%, respectively. The incidence of cases meeting the above-mentioned criteria was 28.5%. These nonpolypoid lesions exhibited a predilection for proximal anatomical site (P=0.04), probably associated with their infiltrative pattern. Most importantly, de novo lesions (unlike polypoid) were rarely found among cases with indolent tumor characteristics (stage I or grade I, P=0.008), showing a considerably different overall pattern of distribution by stage and grade as compared to that of polypoid tumors (P=0.03). The fact that nonpolypoid CRCs appeared to be clinicopathologically different from their polypoid counterparts is supportive of possible de novo origin and suggestive of a likely worse clinical behavior. The impact of these findings should be investigated to determine potential applications in the diagnosis, treatment and surveillance of these lesions.

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