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In addition to adenocarcinomas, endocrine tumors can also arise within the colorectal mucosa. Squamous and adenosquamous tumors are exceedingly rare. In addition to the diagnostic procedure, which is based on microscopical examination of a tumor specimen, immunohistochemistry can be used to determine a colorectal origin of a metastasis or to visualize the spread of tumor cells in surrounding tissues. Chromogranin-A antibodies can be used to distinguish endocrine tumors in the bowel from common adenocarcinomas.
Targeted drugs have been implemented into the treatment of patients with advanced colorectal cancer. Epidermal growth factor receptor EGFR is commonly expressed in colorectal tumors and monoclonal antibodies inhibiting EGFR demonstrate clinical efficacy in patients with tumors that do not harbor downstream activating KRAS mutations. Colon , Rectum Contact. We use cookies to enhance the usability of our website. If you continue, we'll assume that you are happy to receive all cookies.
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Histopathology
Male, 77 years, moderately differentiated adenocarcinoma, Stage I T1, N0, M0 , adenomatous colon mucosa left lower part of image. Colorectal cancer Colorectal cancer CRC is the second most common cancer in the industrialized world, accounting for approximately one million new cases each year. Column gene position tissue specific score prognostic. These studies greatly increased the knowledge on the extent and distribution of DCIS, as they demonstrated that DCIS is frequently a multifocal process and that multifocality is a typical feature of low grade rather than high grade DCIS.
Along this line were the results obtained on multifocality and multicentricity by Tot et al. In the last decade, LS were demonstrated to be useful to correlate radiological findings and pathology as it is simple to compare radiological images to the large histological sections [ 22 ].
Specifically the widespread use of mammographic screening for early detection of breast cancer identifies numerous benign lesions that can be difficult to interpret on the mammogram.
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- Colorectal Tumors: Atlas of Large Section Histopathology - Tibor Tot - Google Книги;
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This was mostly done by Tot et al. In spite of their utility in diagnostic pathology, LS are still used in a relatively few laboratories, mainly as a consequence of the fact that their preparation is perceived as more timeconsuming and expensive than conventional blocks.
This difference is only apparent as in LS a large portion of tissue is examined that is far superior to the conventional small blocks. Tot [ 25 ] calculated the costs of LS in daily practice and compared them with those obtained from conventional blocks, demonstrating that LS costs do not substantially differ from those of accurate conventional blocking. Tucker [ 26 ] calculated the cost of LS in a breast care centre and concluded that the LS costs increase from 6. As a consequence additional surgical procedures were lowered in number, which led to a decrease of the overall cost of each single patient's treatment [ 26 ].
The method to obtain LS has been previously described in several papers [ 27 ], as well as it is described by Tucker [ 26 ] in the present issue. One to three LS are obtained from each case and in addition the of rest of the surgical specimen is embedded using traditional small blocks. Additional automatic processor is used to work overnight. This last procedure is less time consuming with a shorter turn-around time to obtain the LS. Paraffin blocks from paraffin embedded LS [ 26 , 27 , 29 ] are then cut with a dedicated macrotome.
Finally haematoxylin-eosin large slide is obtained. Orientation is maintained during the whole embedding process and reported in the final slide. When immunohistochemistry or molecular studies are needed, areas of interest are selected from the LS and cut to obtain small conventional blocks [ 30 ]. LS can be used also for 3-dimensional reconstructions as previously shown [ 19 , 29 ] and summarized as follows. Tissues are then rehydrated as follows: Finally tissues are dehydrated, through a graded series of alcohol to xylene, and finally immersed in methyl salicylate for one night.
LS are useful during the everyday breast routine practice to better evaluate the tumour dimension, the in situ carcinoma extension, and the resection margins. In the series studied by Foster et al. Correct evaluation of resection margins has become an increasingly important issue especially in cases treated with quadrantectomy.
LS are cut and oriented according to the radiological images and the indications given by the surgeon, and orientation is maintained during the paraffin embedding procedures. This allows the exact evaluation of the relationship between invasive or in situ carcinoma and the adjacent surgical margin. By contrast conventional blocking is based on gross inspection at naked eye of the lesions and on palpation of the tissues; therefore, minute cancer foci, immersed within the fatty breast stroma can escape from examination Figure 1. In addition having the possibility to visualize the whole section of the breast specimen, it is easier to distinguish the real inked margin from ink migration through tissue fissures frequently present in breast tissues as also stated by Tucker [ 26 ] Figure 2.
Exact evaluation of tumour dimension is at the basis of a correct staging. We compared the tumour size on a series of consecutive quadrantectomies evaluated with both LS and conventional blocks. In addition the widely spread breast cancer screening programs lead to the detection of a high rate of in situ carcinomas and of microscopic foci of invasive carcinomas.
Due to the use of LS, it is becoming evident that breast cancer often presents with multiple foci and unifocal, multifocal and multicentric in situ, or invasive carcinomas [ 16 , 17 , 21 ] appear better demonstrated. The prognostic value of multifocality in breast cancer has been widely debated in the literature. Similar results were obtained at our institution, when LS were compared to conventional small blocks in a series of consecutive cases diagnosed during the year These data confirm that multifocality can be useful in the evaluation of the risk of axillary involvement by breast cancer metastases and confirm that the detection of multiple breast cancer foci has a great prognostic impact and therefore should be carefully searched in all cases of breast cancer.
In cases of breast cancer diagnosed in advanced stages, surgery is preceded by neoadjuvant chemotherapy with the aim of reducing the tumour mass. In order to correctly stage breast cancers treated by neoadjuvant chemotherapy, it is of vital importance to evaluate the presence of residual tumour and the degree of tumour regression [ 35 ]. In cases showing good response to neoadjuvant chemotherapy the tumour mass greatly decreases and sometimes is difficult to evaluate on macroscopy. Therefore, when histology is performed on conventional blocks, small residual tumour foci frequently escape detection.
Materials and Methods
To this purpose the use of LS improves the correct evaluation of the resection specimen Figure 3. Embedding the whole area previously occupied by the tumour can improve the chance to detect even small residual neoplastic foci. LS performed on a case treated with neoadjuvant chemotherapy evidence small foci of residual invasive breast carcinoma arrows. Finally LS are of use also in the evaluation of other prognostic parameters, such as vascular invasion, which is used to plan chemotherapy. Similarly to breast pathology, during the last century, LS have been used to shed light on different pathological processes of various organs.
Since LS have been proven to be useful to study the extension and distribution of lung diseases as emphysema [ 36 ] and, more recently the size of the tumours, to plan radiotherapy in cases of nonsmall lung cancer [ 37 ].
In current practice, LS are useful in staging cases of lung cancer Figure 4 as the relationship between the tumour mass and the adjacent obstructive pneumonia is difficult to establish at macroscopic level Figure 5. In addition the assessment of pleural invasion or resection margins that may be problematic on macroscopic examination, are readily evaluated on LS. LS clearly visualizes the relationship between lung cancer indicated by the arrows and the surrounding obstructive pneumonia.
Lung cancer is easily staged using LS that evidence pleural invasion and distance from the bronchial margin. LS have been widely used in bone pathology to compare the radiological images to the different pathological aspects of benign and malignant bone tumours [ 38 — 40 ].
Histopathology (Guy Orchard, Brian Nation)
Specifically, type of growth and extension of osteosarcoma and chondrosarcoma were elucidated comparing radiological imaging and LS from surgical resection specimens. LS have also occasionally been used to study the inner ear anatomy [ 42 ], but have been largely used to study normal brain anatomy [ 43 ] and degenerative brain diseases.
LS of brain tissue are stained using several histochemical methods that help to evidence grey and white matter Figure 6 and the related lesions and, as recently demonstrated by Howell et al. Large format section of brain, stained with the Luxol-fast blue technique, evidence the normal brain anatomical structures. In practice, in the daily practice, LS are potentially useful to understand, diagnose, and manage the pathological lesions from all organs.
Accordingly, Slootweg and Grot [ 45 ] applied LS to stage the neoplastic lesions of the head and neck district, comprising the different areas of the oral cavity and the larynx. Tumours arising in the head and neck region often involve mandibular and maxillary bones and the surrounding soft tissues. Evaluation of the extent of the tumoural growth and tissue involvement, especially in this district, is of crucial importance to perform a correct staging.
As tissues from head and neck region have different consistency. Slootweg and Grot [ 45 ] proposed to cut the surgical specimens using an engine driven water-cooled diamond saw and to obtain LS inclusive of bone and surrounding tissues. These LS are optimal for all types of neoplastic lesions affecting the head and neck region and can easily and unequivocally demonstrate the type and extension of tumoral growth.
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Tot Tibor (ed.) Colorectal Tumors: Atlas of Large Section Histopathology
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