Histopathological aspects of peritoneal malignancy
Tom Cecil, John Bunni, Akash Mehta in A Practical Guide to Peritoneal Malignancy, 2019
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].
Appendiceal Cancer
Dongyou Liu in Tumors and Cancers, 2017
Although adenoma is often limited to the mucosa of the appendix and does not produce murin, some neoplasms show adenomatous growths with mucin dissection beyond the muscularis mucosa (so-called broad front invasion), mural perforation, or even peritoneal dissemination (as in the case of pseudomyxoma peritonei, PMP). The 2010 WHO classification recognizes three categories of mucinous neoplasms: mucinous adenoma (restricted to mucosa, no extra-appendiceal mucin, not associated with PMP, nonrecurrent), low-grade appendiceal mucinous neoplasm (LAMN; non-invasive glands beyond appendix, extra-appendiceal mucin, associated with low-grade PMP, recurrent), and appendiceal adenocarcinoma (invasive glands beyond appendix, extra-appendiceal mucin, associated with high-grade PMP, 10-year survival <10%) [1,2].
Malignant Neoplasms of the Colon
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Tanaka et al. (595) reported on 39 consecutive patients with synchronous colorectal carcinoma metastases to the liver who underwent curative simultaneous “one-stage” hepatectomy and resection of the colorectal primary. Only the volume of the resected liver was selected as a risk factor for postoperative complications (350 g mean resected liver volume in patients with postoperative complications vs. 150 g in those without complications). Patient age of 70 years or older and poorly differentiated mucinous adenocarcinoma as the primary lesion predicted decreased overall survival. They concluded, a one-stage procedure appears desirable for synchronous colorectal hepatic metastases except for patients requiring resection of more than one hepatic section, patients aged 70 years or older, and those with poorly differentiated or mucinous adenocarcinomas as primary lesions.
Immunohistochemistry as a Surrogate Marker of Underlying Molecular Derangements in Sporadic Colorectal Carcinoma in Children – A Series of Three Cases
Published in Fetal and Pediatric Pathology, 2022
Priyanka Maity, Aniket Halder, Ranajoy Ghosh, Uttara Chatterjee, Shibsankar Barman, Ruchirendra Sarkar
Histopathological examination of the colonoscopic biopsies revealed gland forming dysplastic cells including signet ring cells (Fig. 3e) floating in pools of extracellular mucin. A diagnosis of mucinous adenocarcinoma was made. Like the previous two cases, this case also showed diffuse BRAF positivity (Fig. 3f). However, the tumor cells were negative for p53 and β-catenin. The tumor cells in this case were positive for MSH2, MSH6, and MLH1 (Fig. 4a–c) but showed negative immunostaining for PMS2 (Fig. 4d), thus suggesting microsatellite instability. Genetic analysis in this patient showed BRAF-V600E mutation but did not show any germline mutation in mismatch repair genes. In addition, this patient had CpG island hypermethylation in the MLH1-promoter region.
Survival difference between mucinous vs. non-mucinous colorectal cancer following cytoreductive surgery and intraperitoneal chemotherapy
Published in International Journal of Hyperthermia, 2018
Yeqian Huang, Nayef A. Alzahrani, Winston Liauw, Arief Arrowaili, David L. Morris
In our study, there was no significant difference in OS outcomes between MC and NMC, including rectal subgroup. Thus in patients with PM who underwent CRS and IPC, MC might not necessarily indicate a poor prognosis and at the current time should not be considered a contraindication to treatment. The observation in our sample that synchronous liver metastasis was more likely in the mucinous tumors warrants further investigation. Mucinous tumors may have molecular characteristics that make liver metastasis less likely however our observation could also reflect bias introduced by our local selection criteria for simultaneous liver resection an cytoreduction being four or fewer liver metastasis and PCI less than or equal to 10. Mucinous tumors tended to have higher PCI. Kermanshahi et al. have demonstrated previously that mucinous tumors are less likely to develop liver metastasis and more likely to develop peritoneal disease [25]. A recent study of a Dutch cohort has shown colorectal cancer peritoneal metastases to be enriched for the consensus molecular subtype (CMS) four or the mesenchymal subtype. Eight of twenty-four of these patients had mucinous adenocarcinoma [26]. In a review of clinical, morphological and molecular classification of colorectal cancer, Jass notes that mucinous differentiation is not specific to clinicopathological subtypes [27]. Therefore, given the distribution of adverse molecular prognostic markers, there are many variables that would potentially abrogate any effect of mucinous differentiation.
Lynch syndrome and sextuple primary malignancies
Published in Acta Chirurgica Belgica, 2018
Donatas Danys, Eugenijus Stratilatovas, Vaidas Cereska, Tomas Poskus
In August 2014, patient was admitted to abdominal surgery department in Vilnius University Hospital Santariškiu Clinics. Abdominal and pelvic CT was performed, which showed infiltrated segment of ascending colon, without infiltration of pericolic tissue. After that, a colonoscopy with biopsy from cecum and ascending colon was carried out. Biopsy results were moderately differentiated adenocarcinoma G2 and mucinous adenocarcinoma G3, respectively. Right hemicolectomy was performed. Imunohistochemical (IH) analysis revealed absence of MSH2 and MSH6 proteins. Reaction to MLH1 and PMS2 was positive. In addition, IH test was performed on a specimen from 2003 of poorly differentiated stomach adenocarcinoma (G3; pT2N1). It was negative for MsH2/MsH6 and positive for MLH1 and PMS2. Molecular genetic analysis was performed. Pathological MSH2 gene mutation in 12th exon was found. Molecular genetic testing confirmed Lynch syndrome II diagnosis. Genetic consulting was recommended for her relatives.
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