Background and aim: Aim of the present study was to evaluate the histopathologic and clinical characteristics of colorectal carcinomas detected by means of the regional screening program in the province of Ferrara. Material and methods: The study included 92 infiltrating adenocarcinomas, 62 removed by surgery and 30 (32%) by endoscopic resection. Twenty-one patients with endoscopically removed malignant polyps subsequently underwent surgical resection with lymphadenectomy. Results: Most of the endoscopically removed malignant polyps (n=29) were localized in the distal colon (7 in the descending colon, 17 in the sigmoid colon and 5 in the rectum) and only one in the proximal colon. With regard to colorectal carcinomas removed by surgery, 16 were localized in the proximal colon (10 in the right and 6 in the transverse colon) and 46 in the distal colon (5 in the descending and 21 in the sigmoid colon and 20 in the rectum). Among the surgically removed tumors, 20 have been classified as TNM stage I, 18 as TNM stage II (all of them stage IIa), 18 as TNM stage III (6 stage IIIa, 7 IIIb and 5 IIIc) and 5 as TNM stage IV. Among the 21 carcinomas treated by endoscopic resection and subsequent surgical resection, two cases displayed metastases to lymph nodes (pN1). Analyzing all the adenocarcinomas identified by the screening program, 48 tumors (52.7%) were found to belong to the category with excellent prognosis, 26 (28.6%) to the category with good prognosis and only 17 (18.7%) to the category with poor prognosis. Most tumors were submitted to molecular analysis for microsatellite instability evaluation by means of a fluorescence-based PCR method and to immunohistochemical analysis to assess mismatch repair proteins expression (MLH1, MSH2, MSH6 and PMS2). These analyses allowed us to identify four MSI-H adenocarcinomas with loss of MMR protein expression (MLH1 in one case, MSH2 in one case and MSH6 in two cases), probably removed from patients with hereditary disease (Lynch syndrome). Conclusions: Our results indicate that the screening program allows to detect a large number of early stage colorectal carcinomas with excellent prognosis. This fact should contribute to obtain a mortality reduction for this neoplasm in the population.
Pathologic features of colorectal cancers detected by population screening in the province of Ferrara
GAFA', Roberta;LANZA, Giovanni;ANANIA, Gabriele;FEO, Carlo;
2008
Abstract
Background and aim: Aim of the present study was to evaluate the histopathologic and clinical characteristics of colorectal carcinomas detected by means of the regional screening program in the province of Ferrara. Material and methods: The study included 92 infiltrating adenocarcinomas, 62 removed by surgery and 30 (32%) by endoscopic resection. Twenty-one patients with endoscopically removed malignant polyps subsequently underwent surgical resection with lymphadenectomy. Results: Most of the endoscopically removed malignant polyps (n=29) were localized in the distal colon (7 in the descending colon, 17 in the sigmoid colon and 5 in the rectum) and only one in the proximal colon. With regard to colorectal carcinomas removed by surgery, 16 were localized in the proximal colon (10 in the right and 6 in the transverse colon) and 46 in the distal colon (5 in the descending and 21 in the sigmoid colon and 20 in the rectum). Among the surgically removed tumors, 20 have been classified as TNM stage I, 18 as TNM stage II (all of them stage IIa), 18 as TNM stage III (6 stage IIIa, 7 IIIb and 5 IIIc) and 5 as TNM stage IV. Among the 21 carcinomas treated by endoscopic resection and subsequent surgical resection, two cases displayed metastases to lymph nodes (pN1). Analyzing all the adenocarcinomas identified by the screening program, 48 tumors (52.7%) were found to belong to the category with excellent prognosis, 26 (28.6%) to the category with good prognosis and only 17 (18.7%) to the category with poor prognosis. Most tumors were submitted to molecular analysis for microsatellite instability evaluation by means of a fluorescence-based PCR method and to immunohistochemical analysis to assess mismatch repair proteins expression (MLH1, MSH2, MSH6 and PMS2). These analyses allowed us to identify four MSI-H adenocarcinomas with loss of MMR protein expression (MLH1 in one case, MSH2 in one case and MSH6 in two cases), probably removed from patients with hereditary disease (Lynch syndrome). Conclusions: Our results indicate that the screening program allows to detect a large number of early stage colorectal carcinomas with excellent prognosis. This fact should contribute to obtain a mortality reduction for this neoplasm in the population.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
