Pathomorphologic Study Concerning Risk Factor of Lymph Node Metastasis in Colorectal Submucosal Invasive (sm) Carcinomas of Is Type Akinori Iwashita 1 1Department of Pathology, Fukuoka University Chikushi Hospital Keyword: 大腸sm癌 , リンパ節転移 , リンパ管侵襲 , 簇出 , 転移リスクファクター pp.1511-1520
Published Date 1997/10/25
DOI https://doi.org/10.11477/mf.1403105229
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 We studied 79 surgically resected colorectal sm carcinomas of Is type pathomorphologically with special reference to risk factors of regional lymph node metastasis. The incidence of lymph node metastasis was 10.1% (eight cases) among all of the 79 cases of colorectal sm carcinoma, 5.9% (one case) among 17 cases of sm1 carcinoma, 10% (two cases) among 20 cases of sm2 carcinoma, and 11.9% (five cases) among 42 cases of sm3 carcinoma. However, no positive statistical correlation existed between the incidence and the depth of carcinomatous invasion in the submucosa. The incidence was higher in moderately differentiated adenocarcinomas (28.6%) than in well differentiated adenocarcinomas (8.5%). The difference between the moderately differentiated adenocarcinoma group and the well differentiated adenocarcinoma group was not statistically significant. All eight carcinomas with lymph node metastasis had foci of poor differentiation at least in a small portion of the advancing margins of the submucosa. The incidence of lymph node involvement increased according to the grade of lymphatic permeation, namely it was 0% in carcinomas without lymphatic permeation (ly0), 18.8% in carcinomas with grade 1 lymphatic permeation (ly1) and 50% in carcinomas with grade 2 lymphatic permeation (ly2). A statistically significant difference existed between the incidence in carcinomas with ly0 and that in carcinomas with ly1 or 1y2. The incidence of lymph node metastasis was higher in carcinomas with sprouting of cancer tissue at advancing margins in the submucosa (19.4%) than in carcinoma without it (2.4%). The difference between the sprouting group and the non-sprouting group was statistically significant. There was no positive statistical correlation between the incidence of lymph node metastasis and tumor size, nor between the anatomical sites of the carcinomas. Moreover, no statistically significant difference existed between the mean labeling index of Ki67, the incidence of overexpression of p53 protein and the incidence of expression of VEGF and c-erbB-2 protein, between the metastatic group and the nonmetastatic group. According to the results, we were able to point out that lymphatic permeation, sprouting of cancer tissue, and histologic type, especially a poorly differentiated component at the advancing margins of the submucosa are the three important risk factors of lymph node metastasis in colorectal sm carcinomas of Is type. It was also shown that endoscopic resection for sm carcinomas of Is type is curative in carcinomas without lymphatic permeation.

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