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Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms.

Stewart CJ, Hillery S, Platell C, Puppa G - Cancers (Basel) (2011)

Bottom Line: However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases.The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely.Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, SJOG Hospital, Perth, Western Australia. colin.stewart@health.wa.gov.au.

ABSTRACT
Transmural spread by colorectal carcinoma can result in tumor invasion of the serosal surface and, hence, more likely dissemination within the peritoneal cavity and potentially to additional metastatic sites. The adverse prognostic significance of serosal invasion is widely accepted and its presence may be considered an indication for chemotherapy in patients with node negative disease. However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases. Therefore, serosal invasion may be under-diagnosed in a significant proportion of tumors, potentially leading to sub-optimal treatment of high-risk patients. The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely. The relative prognostic significance of serosal invasion and of direct tumor spread to other organs, both of which are incorporated within the pT4 category of the AJCC/UICC TNM staging system, remains unclear. Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.

No MeSH data available.


Related in: MedlinePlus

Macroscopic image of colon carcinoma with serosal involvement. Note the thickened central plaque of the tumor involving the serosa on the anti-mesenteric border (arrow) in comparison with the normal shiny serosal surface on either side.
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f4-cancers-03-00164: Macroscopic image of colon carcinoma with serosal involvement. Note the thickened central plaque of the tumor involving the serosa on the anti-mesenteric border (arrow) in comparison with the normal shiny serosal surface on either side.

Mentions: Microscopically, the serosa is lined by mesothelial cells and their associated basement membrane, although the latter is not generally distinct on routine histological examination [12]. Underlying the mesothelium is a layer of fibrofatty stroma that constitutes the subserosa or the pericolic/perirectal tissue. The subserosa is of variable thickness but generally is most attenuated on the anti-mesenteric border of the bowel where tumors may rapidly involve the peritoneal surface after invading through the muscularis propria (Figure 4).


Assessment of Serosal Invasion and Criteria for the Classification of Pathological (p) T4 Staging in Colorectal Carcinoma: Confusions, Controversies and Criticisms.

Stewart CJ, Hillery S, Platell C, Puppa G - Cancers (Basel) (2011)

Macroscopic image of colon carcinoma with serosal involvement. Note the thickened central plaque of the tumor involving the serosa on the anti-mesenteric border (arrow) in comparison with the normal shiny serosal surface on either side.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756354&req=5

f4-cancers-03-00164: Macroscopic image of colon carcinoma with serosal involvement. Note the thickened central plaque of the tumor involving the serosa on the anti-mesenteric border (arrow) in comparison with the normal shiny serosal surface on either side.
Mentions: Microscopically, the serosa is lined by mesothelial cells and their associated basement membrane, although the latter is not generally distinct on routine histological examination [12]. Underlying the mesothelium is a layer of fibrofatty stroma that constitutes the subserosa or the pericolic/perirectal tissue. The subserosa is of variable thickness but generally is most attenuated on the anti-mesenteric border of the bowel where tumors may rapidly involve the peritoneal surface after invading through the muscularis propria (Figure 4).

Bottom Line: However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases.The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely.Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.

View Article: PubMed Central - PubMed

Affiliation: Department of Histopathology, SJOG Hospital, Perth, Western Australia. colin.stewart@health.wa.gov.au.

ABSTRACT
Transmural spread by colorectal carcinoma can result in tumor invasion of the serosal surface and, hence, more likely dissemination within the peritoneal cavity and potentially to additional metastatic sites. The adverse prognostic significance of serosal invasion is widely accepted and its presence may be considered an indication for chemotherapy in patients with node negative disease. However, controversy persists regarding the most appropriate criteria for diagnosis and there are also practical difficulties associated with histological assessment in some cases. Therefore, serosal invasion may be under-diagnosed in a significant proportion of tumors, potentially leading to sub-optimal treatment of high-risk patients. The examination of multiple microscopic sections combined with ancillary studies such as cytology preparations, elastin stains, and immunohistochemistry may prove beneficial in selected problematic cases, but these are not used routinely. The relative prognostic significance of serosal invasion and of direct tumor spread to other organs, both of which are incorporated within the pT4 category of the AJCC/UICC TNM staging system, remains unclear. Further studies are required to demonstrate whether recent adjustments to the TNM staging of pT4 tumors are appropriate.

No MeSH data available.


Related in: MedlinePlus