Peritoneal elastic lamina invasion: limitations in its use as a prognostic marker in stage II colorectal cancer

Grin, Andrea; Messenger, David E.; Cook, M. C.; O’Connor, Brenda I.; Hafezi, Sara; El‐Zimaity, Hala; Kirsch, Richard

doi:10.1016/j.humpath.2013.07.013

Cited by 25 publications

(42 citation statements)

References 16 publications

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“…Evaluation for tumor invasion of the elastic lamina can also be challenging due to anatomic variations in its composition, its displacement from the peritoneal surface, splaying, attenuation, and destruction of its elastic fibers, and variation in the technical quality of the elastic stain [10–12,21,24,25]. In fact, the elastic lamina, when invaded by tumor, can be undetected in as high as 59% of deeply invasive colorectal carcinoma, or inapparent even in tumors that penetrate the visceral peritoneal surface [9,11,12]. …”

Section: Discussionmentioning

confidence: 99%

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Histopathology and enhanced detection of tumor invasion of peritoneal membranes

Chen

Melissa²

2017

PLoS ONE

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Tumor invasion of the peritoneal membrane may have an adverse prognostic significance, but its histopathologic features can be diagnostically difficult to recognize. We observed that local peritoneal injury associated with tumor invasion is characterized by activation and proliferation of serosal stromal cells that express cytokeratin, a characteristic property of injured serosal membranes that may have diagnostic utility. To explore this, we examined 120 primary tumors of the gastrointestinal tract and pancreaticobiliary system using cytokeratin and elastic stains to assess for tumor invasion of peritoneal membranes. Peritoneal invasion by tumor was associated with retraction, splaying, and destruction of the elastic lamina and proliferation of keratin-expressing stromal cells of serosal membranes. All 82 peritoneal invasive tumors were characterized by neoplastic cells that invaded the elastic lamina and the serosal connective tissue with neoplastic cells that abutted or were surrounded by keratin-positive stromal cells, whereas all 38 tumors limited to the subserosa showed none of these features. The diagnosis of tumor invasion of peritoneal membranes is enhanced by the combined use of cytokeratin and elastic stains, which in turn would enable better histopathologic correlation with patient treatment and outcome.

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Section: Discussionmentioning

confidence: 99%

“…Recognizing tumor invasion of peritoneal membranes can be diagnostically challenging. Invasion of the elastic lamina characterizes tumor invasion of the peritoneal membrane, but the elastic lamina can be difficult to detect due to its displacement, splaying, and fragmentation when invaded by tumor [9,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Histopathology and enhanced detection of tumor invasion of peritoneal membranes

Chen

Melissa²

2017

PLoS ONE

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“…Shepherd et al 22,27 originally considered this finding to be negative for serosal involvement, which was subsequently supported by studies from other groups. 23,28,29 However, a study of 120 CRC resection specimens 30 reported that 46% of pT3 cancers with tumor cells less than 1 mm from the serosal surface and overlying tissue reaction (ie, fibroinflammatory reaction, hemorrhage/fibrin deposition, and/or mesothelial reaction) had tumor cells in cytologic preparations from the serosa, comparable with the rate for pT4a tumors (55%). None of the pT3 tumors more than 1 mm from the serosal surface had positive cytologic smears.…”

Section: Histologic Assessment Of Pt3 Versus Pt4 Crcmentioning

confidence: 97%

A Review of Current Challenges in Colorectal Cancer Reporting

Dawson

Kirsch

Messenger

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Pathologic assessment of colorectal cancer resection specimens plays an important role in postsurgical management and prognostication in patients with colorectal cancer. Challenges exist in the evaluation and reporting of these specimens, either because of difficulties in applying existing guidelines or related to newer concepts.Objective.-To address challenging areas in colorectal cancer pathology and to provide an overview of the literature, current guidelines, and expert recommendations for the handling of colorectal cancer resection specimens in everyday practice.

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“…[17][18][19] In some cases, clear-cut invasion by tumor cells can be identified (Figures 4a and b). The elastic lamina is not present in all cases, particularly in the right colon, and can be difficult to interpret in some cases 14 (Figures 4c and d). It is frequently incomplete or retracted toward tumor in cases with a reaction where its use may be most necessary.…”

Section: Elastic Stain To Identify Elastic Lamina Invasionmentioning

confidence: 99%

“…[13][14][15][16] The elastic stain is useful in assessing involvement of the visceral peritoneum in lung cancers, and is used in AJCC TNM 7th edition to help stage lung cancers. The subserosal elastic lamina is located just deep to the peritoneum in the colon.…”

Section: Elastic Stain To Identify Elastic Lamina Invasionmentioning

confidence: 99%

Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

Frankel

Jin

2015

Modern Pathology

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Colorectal carcinoma is the third most common cancer in the United States. Proper and standardized pathologic staging is vital for prognostic assessment and impacts therapeutic decisions. The Tumor Node Metastasis (TNM) staging system was developed by the American Joint Committee on Cancer (AJCC) to be a data-driven, evidence-based staging system providing an accurate prediction of outcome. The AJCC 7th edition (2010) included several changes clarifying some issues and leading to new controversies. We aim to address selected challenging issues in tumor T staging, neoadjuvant treatment effects in rectal cancer, and definition of lymph node vs tumor deposit. Serosal involvement in colorectal cancer is staged as T4, which is associated with decreased survival and may impact additional therapy decisions. Although careful sampling and sectioning are helpful, challenges remain in interpretation of tumor within 1 mm of serosal surface with a reaction. Elastic stain as a surrogate marker for serosal invasion has been studied, but its usefulness remains unclear. Some unique issues in rectal cancer include the presence of serosa in proximal but not in distal tumors and post-neoadjuvant effects. Tumor should be staged based on tumor cells rather than acellular mucin pools. Additionally, tumor response should be graded only in primary tumor but not in lymph nodes or metastatic sites. The distinction between tumor deposits and lymph nodes has been modified in AJCC TNM from using size in the 5th edition, to the round contour in the 6th edition, to only features of residual lymph node architecture in the 7th edition. Interobserver variability remains but tumor deposits should be documented when present. The number of deposits should not be added to the total number of positive lymph nodes, and the N1c designation should only be used in cases without any positive lymph nodes. Future clarification will likely evolve as more data become available.

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Peritoneal elastic lamina invasion: limitations in its use as a prognostic marker in stage II colorectal cancer

Cited by 25 publications

References 16 publications

Histopathology and enhanced detection of tumor invasion of peritoneal membranes

Histopathology and enhanced detection of tumor invasion of peritoneal membranes

A Review of Current Challenges in Colorectal Cancer Reporting

Serosal surfaces, mucin pools, and deposits, Oh my: challenges in staging colorectal carcinoma

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