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The tumor border configuration of colorectal cancer as a histomorphological prognostic indicator.

Koelzer VH, Lugli A - Front Oncol (2014)

Bottom Line: The invasive margin is a central feature for prognostication shaped by the complex processes governing tumor-host interaction.This pattern, termed "infiltrative tumor border configuration" has been consistently associated with poor survival outcome and early disease recurrence of CRC-patients.A pushing border is a feature frequently associated with mismatch-repair deficiency and can be used to identify patients for molecular testing.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pathology Division and Translational Research Unit, Institute of Pathology, University of Bern , Bern , Switzerland.

ABSTRACT
Histomorphological features of colorectal cancers (CRC) represent valuable prognostic indicators for clinical decision making. The invasive margin is a central feature for prognostication shaped by the complex processes governing tumor-host interaction. Assessment of the tumor border can be performed on standard paraffin sections and shows promise for integration into the diagnostic routine of gastrointestinal pathology. In aggressive CRC, an extensive dissection of host tissue is seen with loss of a clear tumor-host interface. This pattern, termed "infiltrative tumor border configuration" has been consistently associated with poor survival outcome and early disease recurrence of CRC-patients. In addition, infiltrative tumor growth is frequently associated with presence of adverse clinicopathological features and molecular alterations related to aggressive tumor behavior including BRAFV600 mutation. In contrast, a well-demarcated "pushing" tumor border is seen frequently in CRC-cases with low risk for nodal and distant metastasis. A pushing border is a feature frequently associated with mismatch-repair deficiency and can be used to identify patients for molecular testing. Consequently, assessment of the tumor border configuration as an additional prognostic factor is recommended by the AJCC/UICC to aid the TNM-classification. To promote the assessment of the tumor border configuration in standard practice, consensus criteria on the defining features and method of assessment need to be developed further and tested for inter-observer reproducibility. The development of a standardized quantitative scoring system may lay the basis for verification of the prognostic associations of the tumor growth pattern in multivariate analyses and clinical trials. This article provides a comprehensive review of the diagnostic features, clinicopathological associations, and molecular alterations associated with the tumor border configuration in early stage and advanced CRC.

No MeSH data available.


Related in: MedlinePlus

(A) Low power image (5×) of a H&E slide and pan-cytokeratin (brown)/CD8 (red) double stain demonstrating a primary CRC with a pushing tumor border configuration of growth. The tumor border is round and well-recognizable at low magnification. Tumor and host tissue can be easily differentiated. Host tissue is displaced by expansile tumor growth. (B) High power detail (20×) of (A). CD8+ lymphocytes are commonly observed (arrows). Tumor budding can be recognized as a superimposed feature but is generally infrequent (arrow heads).
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Figure 2: (A) Low power image (5×) of a H&E slide and pan-cytokeratin (brown)/CD8 (red) double stain demonstrating a primary CRC with a pushing tumor border configuration of growth. The tumor border is round and well-recognizable at low magnification. Tumor and host tissue can be easily differentiated. Host tissue is displaced by expansile tumor growth. (B) High power detail (20×) of (A). CD8+ lymphocytes are commonly observed (arrows). Tumor budding can be recognized as a superimposed feature but is generally infrequent (arrow heads).

Mentions: The histomorphological variance of the tumor border configuration of CRC was first described by Jass in 1986 as an important histomorphological prognostic indicator in rectal cancer patients (21). Methodologically, tumor border configuration is a feature diagnosed at low magnification and must be clearly differentiated from diagnostic features seen at high power such as tumor budding (10). According to Jass, an infiltrative border configuration should already be suspected when examination of the histopathologic slide with the naked eye does not allow a clear definition of the invasive margin and it seems impossible to resolve host tissue from malignant glands (Figure 1A) (21–23). At low magnification, tumors with an infiltrative growth pattern show dissection of tumor tissue through the anatomic structures of the bowel wall with little or absent desmoplastic stromal response (21–23). The dissecting tumor glands often form irregular clusters or cords of cells, long-stretched glandular structures, or sharp wedges leaving residual host tissue in between, a pattern termed “streaming dissection” (Figure 1B) (10, 11, 23, 24). Presence of perineural invasion on the histologic slide is a further indicator of diffuse infiltration (23). In contrast, a pushing tumor border configuration should be suspected when naked eye examination of the histologic slide allows a clear delineation of the tumor invasive front and host tissue (Figure 2A). Under low magnification, a round “circumscribed” configuration of the infiltrative margin is characteristic of the “pushing” pattern of infiltration (23). Widely dissecting tumor glands in the muscularis propria or mesenteric adipose tissue are absent (Figure 2B).


The tumor border configuration of colorectal cancer as a histomorphological prognostic indicator.

Koelzer VH, Lugli A - Front Oncol (2014)

(A) Low power image (5×) of a H&E slide and pan-cytokeratin (brown)/CD8 (red) double stain demonstrating a primary CRC with a pushing tumor border configuration of growth. The tumor border is round and well-recognizable at low magnification. Tumor and host tissue can be easily differentiated. Host tissue is displaced by expansile tumor growth. (B) High power detail (20×) of (A). CD8+ lymphocytes are commonly observed (arrows). Tumor budding can be recognized as a superimposed feature but is generally infrequent (arrow heads).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927120&req=5

Figure 2: (A) Low power image (5×) of a H&E slide and pan-cytokeratin (brown)/CD8 (red) double stain demonstrating a primary CRC with a pushing tumor border configuration of growth. The tumor border is round and well-recognizable at low magnification. Tumor and host tissue can be easily differentiated. Host tissue is displaced by expansile tumor growth. (B) High power detail (20×) of (A). CD8+ lymphocytes are commonly observed (arrows). Tumor budding can be recognized as a superimposed feature but is generally infrequent (arrow heads).
Mentions: The histomorphological variance of the tumor border configuration of CRC was first described by Jass in 1986 as an important histomorphological prognostic indicator in rectal cancer patients (21). Methodologically, tumor border configuration is a feature diagnosed at low magnification and must be clearly differentiated from diagnostic features seen at high power such as tumor budding (10). According to Jass, an infiltrative border configuration should already be suspected when examination of the histopathologic slide with the naked eye does not allow a clear definition of the invasive margin and it seems impossible to resolve host tissue from malignant glands (Figure 1A) (21–23). At low magnification, tumors with an infiltrative growth pattern show dissection of tumor tissue through the anatomic structures of the bowel wall with little or absent desmoplastic stromal response (21–23). The dissecting tumor glands often form irregular clusters or cords of cells, long-stretched glandular structures, or sharp wedges leaving residual host tissue in between, a pattern termed “streaming dissection” (Figure 1B) (10, 11, 23, 24). Presence of perineural invasion on the histologic slide is a further indicator of diffuse infiltration (23). In contrast, a pushing tumor border configuration should be suspected when naked eye examination of the histologic slide allows a clear delineation of the tumor invasive front and host tissue (Figure 2A). Under low magnification, a round “circumscribed” configuration of the infiltrative margin is characteristic of the “pushing” pattern of infiltration (23). Widely dissecting tumor glands in the muscularis propria or mesenteric adipose tissue are absent (Figure 2B).

Bottom Line: The invasive margin is a central feature for prognostication shaped by the complex processes governing tumor-host interaction.This pattern, termed "infiltrative tumor border configuration" has been consistently associated with poor survival outcome and early disease recurrence of CRC-patients.A pushing border is a feature frequently associated with mismatch-repair deficiency and can be used to identify patients for molecular testing.

View Article: PubMed Central - PubMed

Affiliation: Clinical Pathology Division and Translational Research Unit, Institute of Pathology, University of Bern , Bern , Switzerland.

ABSTRACT
Histomorphological features of colorectal cancers (CRC) represent valuable prognostic indicators for clinical decision making. The invasive margin is a central feature for prognostication shaped by the complex processes governing tumor-host interaction. Assessment of the tumor border can be performed on standard paraffin sections and shows promise for integration into the diagnostic routine of gastrointestinal pathology. In aggressive CRC, an extensive dissection of host tissue is seen with loss of a clear tumor-host interface. This pattern, termed "infiltrative tumor border configuration" has been consistently associated with poor survival outcome and early disease recurrence of CRC-patients. In addition, infiltrative tumor growth is frequently associated with presence of adverse clinicopathological features and molecular alterations related to aggressive tumor behavior including BRAFV600 mutation. In contrast, a well-demarcated "pushing" tumor border is seen frequently in CRC-cases with low risk for nodal and distant metastasis. A pushing border is a feature frequently associated with mismatch-repair deficiency and can be used to identify patients for molecular testing. Consequently, assessment of the tumor border configuration as an additional prognostic factor is recommended by the AJCC/UICC to aid the TNM-classification. To promote the assessment of the tumor border configuration in standard practice, consensus criteria on the defining features and method of assessment need to be developed further and tested for inter-observer reproducibility. The development of a standardized quantitative scoring system may lay the basis for verification of the prognostic associations of the tumor growth pattern in multivariate analyses and clinical trials. This article provides a comprehensive review of the diagnostic features, clinicopathological associations, and molecular alterations associated with the tumor border configuration in early stage and advanced CRC.

No MeSH data available.


Related in: MedlinePlus