CANCER ARISING IN
INTESTINAL ADENOMA: % OF
LYMPH NODE METASTASIS
Low risk
0-7%
High risk
12- 35%
H
A
G
G
1
I
KIKUCHI ‘95
T
T
2
3
1
KUDO 2
3
Sm1: Invasion from the mucosa to 300 m: no limph node mts
RISK FACTORS FOR METASTASIS
FROM A CANCER ARISING IN
INTESTINAL ADENOMA
• SIZE: > 2.5 – 3.5 cm
(Nusco ’97)
• TUMOR/DYSPLASIA AT THE RESECTION
MARGIN <2 mm
(Cooper ’95)
• POORLY DIFFERENTIATED CARCINOMA
(CoverlizzaRisio ’89)
• LYMPHATIC INVASION: grade 1-3 (Jap Res Soc Canc ’85)
• HIGH TUMOR BUDDING
(Prall, Nizze, Barten 2005)
SEQUENZA ADENOMACARCINOMA
CANCRO CON FENOTIPO MSS
Deletions of 17p are associated with
transition from early to advanced
colorectal cancer
M. Risio 2003
• 20 adenomas with early carcinoma: 15%
• 20 advanced adenocarcinomas:
60%
SEQUENZA ADENOMACARCINOMA
MSH2
MLH1
Microsatellite instability
Mutation
TGFbeta , BAX
CANCRO CON FENOTIPO MSI
TREATMENT OF DYSPLASIA IN IBD
• SPORADIC ADENOMA
WITH EARY CANCER
Dysplasia Associated
Lesions or Masses
POLIPECTOMY
COLECTOMY
DALM
R. Odze ‘03
RISK FACTORS FOR METASTASES
FROM A CANCER ARISING IN
INTESTINAL ADENOMA
•
•
•
•
SIDE: RECTUM
SESSILE
(Nicholls_Binda ’04, Kikuchi ’95)
SIZE > 2.5-3.5 cm
(Nusco ’97)
TUMOR/DYSPLASIA AT THE RESECTION
MARGIN <2 mm
(Cooper ’95)
• POORLY DIFFERENTIATED CARCINOMA
Risio ’89)
• LYMPHATIC INVASION
• HIGH BUDDING
(Coverlizza-
(Morson ’77, Coper ’98)
(Prall, Nizze, Barten 2005)
Ca colon-retto
85 %
15 %
Instabilità Cromosomica
Instabilità Microsatelliti
perdita di eterozigosi diffusa
Aneuploidie o poliploidie
Localiz. prefer. lato sinistro colon
Aspetto istol. molto differenziato
Scarsa infiltraz. linfocitaria
Raramente “mucinoso”
Prognosi peggiore
instabilità dei microsatelliti
Diploidie
Localiz. prefer. lato destro colon
Aspetto istol. scars. differenziato
Infiltraz. linfocitaria
Spesso “mucinoso”
Prognosi migliore
5%
10 %
mutato gene
del Mismatch
Repair
inattivato
MLH1
epigeneticam.
Robert Odze, Mod Pathol
2003;16(4):347–358