Pathological Analysis of the Carcinogenetic and Progressive Pathway of Colorectal Tumors, Especially from the Phenotypic Point of View Takashi Yao 1 1Department of Human Pathology, Juntendo University School of Medicine, Tokyo Keyword: 大腸癌 , 発育進展様式 , 形質発現 , polypoid growth , non-polypoid growth pp.1957-1964
Published Date 2008/12/25
DOI https://doi.org/10.11477/mf.1403101541
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 The carcinogenetic and progressive pathway of colorectal adenocarcinoma was analyzed from the point of view of the phenotypic expression. The phenotypes were divided into five (large intestinal-, small intestinal-, gastric-, mixed-, and unclassified-phenotypes). The growth patterns were divided into two (polypoid growth : PG, non-polypoid growth : NPG). In all,236 lesions were selected for this study, including 100 PG-type tumors (15 low-grade adenomas,25 high-grade adenomas,44 submucosal invasive carcinomas : SM-Ca,4 advanced carcinomas less than 2cm in diameter : Ad-Ca≦2cm, and 12 advanced carcinomas larger than 2cm : Ad-Ca>2cm) and 136 NPG-type tumors (0 low-grade adenomas,9 high-grade adenomas,26 SM-Ca,32 Ad-Ca≦2cm, and 69 Ad-Ca>2cm).

 The phenotypic expression tended to change during progression from adenoma to carcinoma, however, it tended not to change after invading the submucosa. The ratio of phenotypic types in SM-Ca was almost the same as that in Ad-Ca>2cm among NPG-type tumors, which suggested that NPG-type SM-Ca just shift to the NPG-type Ad-Ca>2cm. In contrast, the small intestinal-phenotype seen in PG-type SM-Ca was lost in the PG-type Ad-Ca>2cm, which suggested that the PG-type SM-Ca of small intestinal-phenotype might shift to the NPG-type Ad-Ca>2cm during its progression. This might be supported by the high-grade malignancy of small intestinal-phenotype in which the PG component in SM-Ca disappeared due to destruction by invasion during its progression. In addition, it was also suggested that Ad-Ca≦2cm originated from de novo carcinoma.

 The phenotypic point of view is considered to be useful for the analysis of the carcinogenetic and progressive pathway of colorectal tumors. From this study, the major colorectal carcinogenetic is considered to be‘de novo', but further analysis is required for clarifying the exact ratio of ‘de novo' to adenoma-carcinoma sequence.

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