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Medullary colon cancer presenting with total necrosis of all regional lymph node metastases: morphologic description of a presumed immune-mediated event.

Mitchell A, Bendavid Y - Diagn Pathol (2014)

Bottom Line: Medullary carcinoma is a rare type of colon cancer with characteristic clinical and molecular features.Notably, despite its high-grade histology, the prognosis is generally better than for colonic adenocarcinoma of the usual type.We present herein a singular case of medullary colon cancer in which all of numerous lymph node metastases in the surgical resection specimen were completely necrotic in the face of a wholly viable primary tumor.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal H1T 2M4, Quebec, Canada. plaines@me.com.

ABSTRACT
Medullary carcinoma is a rare type of colon cancer with characteristic clinical and molecular features. Notably, despite its high-grade histology, the prognosis is generally better than for colonic adenocarcinoma of the usual type. We present herein a singular case of medullary colon cancer in which all of numerous lymph node metastases in the surgical resection specimen were completely necrotic in the face of a wholly viable primary tumor. Possible mechanisms are discussed with emphasis on immune-mediated factors.Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_204.

No MeSH data available.


Related in: MedlinePlus

Histology of the primary tumor. a) The well-circumscribed primary medullary carcinoma is on the left (arrows). The caecal muscular wall (right) shows a marked Crohn’s-like inflammatory infiltrate. b and c) Tumor cells are arranged in cords with associated intra-tumoral lymphocytes. Gland formation is absent. There are high-grade cytologic features and several mitoses. Necrosis is absent. d) Pancytokeratin positivity of the tumor cells. Normal colonic epithelium at bottom right provides a positive internal control.
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Fig1: Histology of the primary tumor. a) The well-circumscribed primary medullary carcinoma is on the left (arrows). The caecal muscular wall (right) shows a marked Crohn’s-like inflammatory infiltrate. b and c) Tumor cells are arranged in cords with associated intra-tumoral lymphocytes. Gland formation is absent. There are high-grade cytologic features and several mitoses. Necrosis is absent. d) Pancytokeratin positivity of the tumor cells. Normal colonic epithelium at bottom right provides a positive internal control.

Mentions: Microscopic examination demonstrated features typical of medullary cancer (MC) (Figure 1a, b, c). Tumor necrosis was absent. The tumor cells were positive with the epithelial markers pancytokeratine (Figure 1d) and Cam 5.2, calretinin, and CDX-2 (weak) in accordance with the diagnosis. CEA and EBV immunostaining were negative. PAS with diastase staining confirmed the absence of intra- or extracellular mucin. Microsatellite instability – high (MSI-high) was demonstrated by immunohistochemical staining: MLH1/PMS2 negative, MSH2/MSH6 positive. The BRAF V600E gene was mutated.Figure 1


Medullary colon cancer presenting with total necrosis of all regional lymph node metastases: morphologic description of a presumed immune-mediated event.

Mitchell A, Bendavid Y - Diagn Pathol (2014)

Histology of the primary tumor. a) The well-circumscribed primary medullary carcinoma is on the left (arrows). The caecal muscular wall (right) shows a marked Crohn’s-like inflammatory infiltrate. b and c) Tumor cells are arranged in cords with associated intra-tumoral lymphocytes. Gland formation is absent. There are high-grade cytologic features and several mitoses. Necrosis is absent. d) Pancytokeratin positivity of the tumor cells. Normal colonic epithelium at bottom right provides a positive internal control.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4209050&req=5

Fig1: Histology of the primary tumor. a) The well-circumscribed primary medullary carcinoma is on the left (arrows). The caecal muscular wall (right) shows a marked Crohn’s-like inflammatory infiltrate. b and c) Tumor cells are arranged in cords with associated intra-tumoral lymphocytes. Gland formation is absent. There are high-grade cytologic features and several mitoses. Necrosis is absent. d) Pancytokeratin positivity of the tumor cells. Normal colonic epithelium at bottom right provides a positive internal control.
Mentions: Microscopic examination demonstrated features typical of medullary cancer (MC) (Figure 1a, b, c). Tumor necrosis was absent. The tumor cells were positive with the epithelial markers pancytokeratine (Figure 1d) and Cam 5.2, calretinin, and CDX-2 (weak) in accordance with the diagnosis. CEA and EBV immunostaining were negative. PAS with diastase staining confirmed the absence of intra- or extracellular mucin. Microsatellite instability – high (MSI-high) was demonstrated by immunohistochemical staining: MLH1/PMS2 negative, MSH2/MSH6 positive. The BRAF V600E gene was mutated.Figure 1

Bottom Line: Medullary carcinoma is a rare type of colon cancer with characteristic clinical and molecular features.Notably, despite its high-grade histology, the prognosis is generally better than for colonic adenocarcinoma of the usual type.We present herein a singular case of medullary colon cancer in which all of numerous lymph node metastases in the surgical resection specimen were completely necrotic in the face of a wholly viable primary tumor.

View Article: PubMed Central - PubMed

Affiliation: Department of Anatomic Pathology and Cytology, Maisonneuve-Rosemont Hospital, 5415 Boulevard de L'Assomption, Montreal H1T 2M4, Quebec, Canada. plaines@me.com.

ABSTRACT
Medullary carcinoma is a rare type of colon cancer with characteristic clinical and molecular features. Notably, despite its high-grade histology, the prognosis is generally better than for colonic adenocarcinoma of the usual type. We present herein a singular case of medullary colon cancer in which all of numerous lymph node metastases in the surgical resection specimen were completely necrotic in the face of a wholly viable primary tumor. Possible mechanisms are discussed with emphasis on immune-mediated factors.Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_204.

No MeSH data available.


Related in: MedlinePlus