| Theme |
Vessel invasion and metastasis in colorectal submucosal cancer |
| Title |
Clinicopathological study on submucosal invasive colorectal carcinoma with special reference to relationship between risk factors for hepatic and lymphnodal metastasis and vessel permeation |
| Author |
Masahiro Ikegami |
Department of Pathology, Jikei University School of Medicine |
| Author |
Tiecheng Liu |
Department of Pathology, Jikei University School of Medicine |
| Author |
Nobuko Yamashita |
Department of Pathology, Jikei University School of Medicine |
| Author |
Hiroshi Hano |
Department of Pathology, Jikei University School of Medicine |
| [ Summary ] |
One hundred fifty nine surgically resected cases of submucosal invasive colorectal carcinoma were clinicopathologically reviewed in order to clarify risk factors associated with hepatic and lymphnodal metastases. All tumors were classified into two groups: those with or without hepatic and lymphnodal metastases. Metastatic involvement was seen in 12 cases (7.5%). Seven factors were compared between the two groups: 1. mode of intramucosal growth (polypoid or non polypoid); 2. degree of submucosal invasion (sm1, 2 and 3 by the depth of invasion and sm1a and sm1b, determined by the volume of the carcinomal component); 3. histological type 4. the presence or absence of bud-like structures in submucosal invasion; 5. the presence or absence of lymphatic permeations in the colorectal wall; 6. the presence or absence of venous permeations in the colorectal wall; and 7. macroscopic features. In multivariate analysis of these seven factors, the only variable consideration in the basis of a logistic model in stepwise variable selections was the presence of lymphatic permeation. In addition, histologic differentiation and the degree of submucosal invasion were seen as being statistically significant as risk factors. Consequently, the most significant risk factors for metastasis in submucosal invasive colorectal carcinomas were lymphatic permeation, submucosal invasion (deeper than sm1b), and poor histologic differentiation. With submucosal invasive carcinoma, there were a few cases showing venous permeations. However, venous permeation with submucosal invasive carcinoma was considered to be important histological view for metastasis.
These results suggest that the histologic evaluation of these risk factors in endoscopically resected specimens is important for making the decision, whether endoscopic resection or surgical resection should be performed. |