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Oesophageal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Nyree Griffin, Jason Dunn, Lee Alexander Grant
Histological grade also markedly affects survival of patients with cT1-2N0M0 adenocarcinomas and cT2N0M0 squamous cell carcinomas (46). Poorer outcomes are associated with poorly differentiated cancers and signet ring cell morphology (48).
Histopathological aspects of peritoneal malignancy
Published in Tom Cecil, John Bunni, Akash Mehta, A Practical Guide to Peritoneal Malignancy, 2019
Babatunde Rowaiye, Norman Carr
Mucinous adenocarcinomas of the appendix are defined by infiltrative invasion. Histologically, this manifests as irregular angulated glands, tumour budding small pools of mucin containing malignant epithelium, and/or a desmoplastic stroma (Figure 12.3). According to the WHO definition, the term ‘mucinous adenocarcinoma’ is used when more than 50% of the tumour consists of extracellular mucin. Mucinous adenocarcinomas can be well, moderately or poorly differentiated. The presence of signet ring cells confers a worse prognosis [11–13], and tumours with these cells are classified separately in the PSOGI classification (Table 12.2) (Figure 12.4) [10]. True signet ring cells need to be distinguished from degenerative cells within mucus pools. All appendiceal adenocarcinomas, irrespective of the presence of signet ring cells, exhibit a high propensity for peritoneal metastasis [14].
Gastrointestinal Tract
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
A 62-year-old black man was admitted to the hospital complaining of dull pain in the gastric area which was relieved by food intake. He had lost 30 lbs in the last few months. The patient was noted to have indigestion, loss of appetite, and heartburn for more than a year. The day before admission he vomited twice, and the vomited material had a coffee-ground appearance. Radiologically, the stomach was markedly diminished in size. It was rigid without visible peristalsis. Barium passed rapidly from the esophagus into the duodenum. A biopsy taken through the flexible fiberoptic gastroscope demonstrated carcinoma. At laparatomy, no perigastric lymphadenopathy was found, a distal subtotal resection of the stomach was performed, and a portion of the proximal line of resection was submitted for frozen section study. Microscopically, the mucosa, submucosa, the muscular layer, and the subserosal area were diffusely infiltrated by small neoplastic cells. The individual cells were round or polygonal and many contained intracellular vacuoles which appeared to compress the nuclei to the cytoplasmic membrane. These cells were characteristic so-called “signet ring” cells (Figures 3 and 4).
Nutritional Indexes as Predictors of Survival and Their Genomic Implications in Gastric Cancer Patients
Published in Nutrition and Cancer, 2021
Yesennia Sánchez, Felipe Vaca-Paniagua, Luis Herrera, Luis Oñate, Roberto Herrera-Goepfert, Guiselle Navarro-Martínez, Dennis Cerrato, Clara Díaz-Velázquez, Ericka Marel Quezada, Claudia García-Cuellar, Diddier Prada
A total of 940 GC patients treated from 2005 to 2018 were included in this study. They had a mean age of 55.42 years (standard deviation [SD]: 13.92 years) at diagnosis. Most patients were male (57.56%) and had a very low socioeconomic status (49.89%). Most patients were also diagnosed in advanced stages (III and IV, 84.78%). The fundus and body of the stomach (33.82%) were the most affected areas, and adenocarcinoma was the most frequent histologic type (87.02%). Most subsets were positive for signet-ring cell formation (54.25%). Regarding the nutritional status, most patients were normal weight, based on the WHO classification (52.02% with BMI between 18.5 and 24.9 kg/m2) and had a mean PNI of 33.14 (SD: 0.83) at diagnosis; many of them had values higher than 34 (47.76%) (Table 1).
Immunohistochemistry features and molecular pathology of appendiceal neoplasms
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Reger R. Mikaeel, Joanne P. Young, Gonzalo Tapia Rico, Peter J. Hewett, Jennifer E. Hardingham, Wendy Uylaki, Mehgan Horsnell, Timothy J. Price
MACs refer to tumors in which histologically extracellular mucin comprises >50% of the cross-sectional area. According to the PSOGI, primary appendiceal mucinous adenocarcinoma can be classified into well-differentiated, moderately differentiated, and poorly differentiated MACs. Well-differentiated MACs often consist of neoplastic epithelium with minimal nuclear atypia lining the cystic mucin pools, while poorly differentiated MACs show no or little gland formation [14]. However, the diagnostic criteria for these three descriptive terms are not provided by the PSOGI. Poorly differentiated (mucinous) adenocarcinoma with signet ring cells are defined as neoplasms in which signet ring cells are present in <50% of the cells. PMP patients with signet ring cells tend to be associated with poor prognosis, and therefore, this group of patients are classified separately [52–54]. Signet ring cell carcinoma refers to neoplasms in which signet ring cells are present in >50% of the cells in adenocarcinoma. In addition, primary appendiceal adenocarcinoma, which can be non-mucinous, resembles colorectal adenocarcinoma radiologically and histologically and is further classified into well-differentiated, moderately differentiated, and poorly differentiated non-mucinous adenocarcinoma. Most appendiceal adenocarcinomas are of the AMN subtype and frequently arise from LAMNs. However, these carcinomas have also been reported to arise from adenomatous polyps or/and serrated adenomas [1,55,56].
Incidentally found mucinous epithelial tumors of the appendix with or without pseudomyxoma peritonei: diagnostic and therapeutic algorithms based on current evidence
Published in Acta Chirurgica Belgica, 2021
Wim Ceelen, Marc De Man, Wouter Willaert, Gabrielle H. van Ramshorst, Karen Geboes, Anne Hoorens
Low-grade appendiceal mucinous neoplasms (LAMN) are characterized by a cytologically bland, usually single-layer epithelium, which may extend into the appendiceal wall by either broad-front pushing invasion or by dissection by acellular mucin into the wall (Table 1). Both result in perforation and intra-abdominal spread, giving rise to the PMP syndrome. High-grade appendiceal mucinous neoplasms (HAMN) behave similarly and do not exhibit infiltrative growth, but the neoplastic epithelium has unequivocal high-grade features such as cribriform growth, loss of polarity with full-thickness nuclear stratification, enlarged or hyperchromatic nuclei, and numerous or atypical mitotic figures. Adenocarcinomas of the appendix show infiltrative invasive growth and malignant behavior, including lymphatic and distant metastasis (Table 2). They can be mucinous (extracellular mucin comprising >50% of the tumor), mucinous with signet ring cells, or non-mucinous. If >50% of cells show signet ring morphology, the tumor is designated ‘signet ring cell adenocarcinoma’. Mucinous tumors of the appendix are graded according to a three-tiered grading system. Grade 1 tumors are LAMNs. HAMNs and conventional mucinous adenocarcinomas qualify as grade 2. Tumors with unequivocal signet-ring cells qualify as grade 3. Non-mucinous adenocarcinomas are graded using a two-tiered grading system, low-grade (formerly well- to moderately differentiated) and high-grade (formerly poorly differentiated), similar to non-appendiceal colorectal cancer.