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Japanese

Correlation of Histological Atypia and Cancersprouting with Vascular Permeation and Lymph Nodal Metastasis by Our New Histological Classification of Submucosal Invasion by Colorectal Carcinomas Masaaki Kobayashi 1 , Hidenobu Watanabe 1 , Seigo Maeo 2 , Yoichi Ajioka 1 , Mitsuhiro Yoshida 1 1The First Department of Pathology, Niigata University School of Medicine 2The Finst Department of Surgery, Oita Medical College Keyword: 大腸sm癌 , 低異型度癌 , 簇出 , リンパ管侵襲 , sm浸潤度分類 pp.1151-1160
Published Date 1994/10/25
DOI https://doi.org/10.11477/mf.1403105941
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 We studied 154 colorectal carcinomas, invading down to the submucosa, to evaluate the correlation of histological atypia and cancer-sprouting with vascular permeation and lymph nodal metastasis by our new histological classification of submucosal invasion. According to the criteria for cytologic grading by Watanabe et al, we divided well differentiated adenocarcinomas into two groups; cancers with low-grade atypia (CAL) and cancers with high-grade atypia (CAH). Moderately and poorly differentiated adenocarcinomas, and anaplastic carcinomas were grouped as CAH. Cancer-sprouting was defined as small cancer-cell nests composed of several cancer cells at the advancing margins in the submucosa. Venous permeation was verified by Victoria blue elastic fiber staining and lymphatic permeation by EGFR-immunostaining which shows cross-reaction for lymphatic endothelium of blood group A and AB patients. The grade of submucosal invasion was designated as follows: sm1; X≦500μm, sm2; 500<X<1,000μm, and sm3; X≧1,000μm by vertical length of cancer tissue in the submucosa, and sma; X≦1mm, smb; 1<X<3mm, and smc; X≧3mm by horizontal length of cancer tissue in the sumucosa.

 None of the CALs (n=13) regardless of grade of submucosal invasion, and the sml,2-CAHs (n=14) showed either vascular permeation or lymph nodal metastasis (Table1, 2). In the sm3-CAHs (n=117) cancer-sprouting was positively related to vascular permeation (venous permeation; 40.2% vs. 0%, p<0.0002, lymphatic permeation; 72.1% vs. 0%, p<0.001) and lymph nodal metastasis (22.5% vs. 5.6%) (Table3). All of the sm3a-CAHs (n=2) and sm3b-CAHs (n=5), however, were negative for vascular permeation and nodal metastasis.

 These results indicate that the histological atypia of colorectal cancers and their sprouting are useful parameters for predicting vascular permeation and lymph nodal metastasis, and that submucosal carcinomas of CAL or sm1,2-CAH or 94% of sm3-CAH without cancer-sprouting at the advancing margins do not need further surgery after endoscopic resection.


Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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