Clinicopathological differences of colorectal cancers according to tumor origin: Identification of possibly de novo lesions

Papagiorgis,Petros  C.; Zizi,Adamantia  E.; Tseleni,Sophia; Oikonomakis,Ioannis  N.; Nikiteas,Nikolaos  I.

doi:10.3892/br.2012.17

Clinicopathological differences of colorectal cancers according to tumor origin: Identification of possibly de novo lesions

Authors:
- Petros C. Papagiorgis
- Adamantia E. Zizi
- Sophia Tseleni
- Ioannis N. Oikonomakis
- Nikolaos I. Nikiteas
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Affiliations: Department of Surgery, Athens Medical Center, Marousi 151 25, Greece, Department of Pathology, Tzaneio General Hospital, Piraeus 185 36, Greece, Department of Pathology, Medical School, University of Athens, Athens 115 27, Greece , Department of Surgery, 401 Army General Hospital, Athens 115 25, Greece, Second Department of Propedeutic Surgery, Medical School, University of Athens, Athens 115 27, Greece
Published online on: October 9, 2012 https://doi.org/10.3892/br.2012.17
Pages: 97-104

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Abstract

Colorectal cancer (CRC) is considered to develop through the conventional adenoma‑carcinoma sequence. However, the existence of de novo carcinogenesis, without any intervening precursor lesions, has been suggested for certain morphologically different tumors lacking polypoid characteristics. The presence of such tumors, along with their correlation with cardinal clinicopathological parameters, such as stage, grade and site, was retrospectively investigated in a series of 119 surgically treated CRC cases. The absence of particular polypoid characteristics (adenomatous remnants or coexisting polyps in the tumor vicinity) in combination with an infiltrative (or ulceroinfiltrative) growth pattern, were the criteria defining the nonpolypoid origin. The recorded frequencies of remnants, coexisting polyps and infiltrative tumors were 7, 5, 9 and 32%, respectively. The incidence of cases meeting the above-mentioned criteria was 28.5%. These nonpolypoid lesions exhibited a predilection for proximal anatomical site (P=0.04), probably associated with their infiltrative pattern. Most importantly, de novo lesions (unlike polypoid) were rarely found among cases with indolent tumor characteristics (stage I or grade I, P=0.008), showing a considerably different overall pattern of distribution by stage and grade as compared to that of polypoid tumors (P=0.03). The fact that nonpolypoid CRCs appeared to be clinicopathologically different from their polypoid counterparts is supportive of possible de novo origin and suggestive of a likely worse clinical behavior. The impact of these findings should be investigated to determine potential applications in the diagnosis, treatment and surveillance of these lesions.

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1.	Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T and Thun MJ: Cancer statistics. CA Cancer J Clin. 58:71–96. 2008.
2.	Morson B: President’s address. The polyp-cancer sequence in the large bowel. Proc R Soc Med. 67:451–457. 1974.
3.	Fearon ER and Vogelstein B: A genetic model for colorectal tumorigenesis. Cell. 6:759–767. 1990. View Article : Google Scholar
4.	Jass JR: Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology. 50:113–130. 2007. View Article : Google Scholar : PubMed/NCBI
5.	Kuramoto S and Oohara T: Minute cancers arising de novo in the human large intestine. Cancer. 61:829–834. 1988. View Article : Google Scholar : PubMed/NCBI
6.	Shimoda T, Ikegami M, Fujisaki J, Matsui T, Aizawa S and Ishikawa E: Early colorectal carcinoma with special reference to its development de novo. Cancer. 64:1138–1146. 1989. View Article : Google Scholar : PubMed/NCBI
7.	Bedenne L, Faivre J, Boutron MC, Piard F, Cauvin MJ and Hillon P: Adenoma-carcinoma sequence or de novo carcinogenesis? A study of adenomatous remnants in population-based series of large bowel cancers. Cancer. 69:883–888. 1992.PubMed/NCBI
8.	Stolte M and Bethke B: Colorectal mini-de novo carcinoma: a reality in Germany too. Endoscopy. 27:286–290. 1995. View Article : Google Scholar : PubMed/NCBI
9.	Mueller JD, Bethke B and Stolte M: Colorectal de novo carcinoma: a review of its diagnosis, histopathology, molecular biology, and clinical relevance. Virchows Arch. 440:453–460. 2002. View Article : Google Scholar : PubMed/NCBI
10.	Goto H, Oda Y, Murakami Y, et al: Proportion of de novo cancers among colorectal cancers in Japan. Gastroenterology. 131:40–46. 2006. View Article : Google Scholar : PubMed/NCBI
11.	Hornic J, Farraye F and Odze R: Clinicopathologic and immunohistochemical study of small apparently ‘de novo’ colorectal adenocarcinomas. Am J Surgh Pathol. 31:207–215. 2007.
12.	Chen CD, Yen MF, Wang WM, Wong JM and Chen TH: A case-cohort study for the disease natural history of adenoma-carcinoma and de novo carcinoma and surveillance of colon and rectum after polypectomy: implication for efficacy of colonoscopy. Br J Cancer. 88:1866–1873. 2003. View Article : Google Scholar : PubMed/NCBI
13.	Kaneko K, Kurahashi T, Makino R, et al: Pathological features and genetic alterations in colorectal carcinomas with characteristics of nonpolypoid growth. Br J Cancer. 91:312–318. 2004.PubMed/NCBI
14.	Kashida H and Kudo S: Early colorectal cancer: concept, diagnosis, and management. Int J Clin Oncol. 11:1–8. 2006. View Article : Google Scholar
15.	Tanaka T: Colorectal carcinogenesis: review of human and experimental animal studies. J Carcinog. 8:52009. View Article : Google Scholar : PubMed/NCBI
16.	Nawa T, Kato J, Kawamoto H, et al: Differences between right-and left-sided colon cancer in patient characteristics, cancer morphology and histology. J Gastroenderol Hepatol. 23:418–423. 2008. View Article : Google Scholar : PubMed/NCBI
17.	Ogawa T, Yoshida T, Tsuruta T, Saigenji K and Okayasu I: Genetic instability on chromosome 17 in the epithelium of non-polypoid colorectal carcinomas compared to polypoid lesions. Cancer Sci. 97:1335–1342. 2006. View Article : Google Scholar : PubMed/NCBI
18.	Nosho K, Yamamoto H, Takahashi T, et al: Genetic and epigenetic profiling in early colorectal tumors and prediction of invasive potential in pT1 (early invasive) colorectal cancers. Carcinogenesis. 28:1364–1370. 2007. View Article : Google Scholar : PubMed/NCBI
19.	Yasugi A, Yashima K, Hara A, et al: Fhit, Mlh1, p53 and phenotypic expression in the early stage of colorectal neoplasms. Oncol Rep. 19:41–47. 2008.PubMed/NCBI
20.	Nasir A, Boulware D, Kaiser H, et al: Flat and polypoid adenocarcinomas of the colorectum: a comparative histomorphologic analysis of 47 cases. Hum Pathol. 35:604–611. 2004. View Article : Google Scholar : PubMed/NCBI
21.	Soetikno R, Kaltenbach T, Rouse R, et al: Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 299:1027–1035. 2008. View Article : Google Scholar : PubMed/NCBI
22.	Yasutomi M, Baba S and Hojo K: Japanese classification of colorectal cancinoma. Kanehara & Co, Ltd; Tokyo: 1997
23.	Matsui T, Yao T and Iwashita A: Natural history of early colorectal cancer. World J Surg. 24:1022–1028. 2000. View Article : Google Scholar : PubMed/NCBI
24.	Nakamura K: De novo cancer and adenoma-carcinoma sequence of the colorectum-clinicopathological differences between de novo carcinoma and carcinoma with the sequence. Nihon Geka Gakkai Zaasshi. 100:766–775. 1999.(In Japanese).
25.	Goi T, Kawasaki M, Hirono Y, Katayama K and Yamaguchi A: Clinicopathological analysis of invading muscularis propria (T2) cancers ≤20 mm in diameter. Int Surg. 93:1–5. 2008.
26.	Sugai T, Habano W, Jiao YF, Tsukahara M, Takeda Y, Otsuka K and Nakamura S: Analysis of molecular alterations in left- and right-sided colorectal carcinomas reveals distinct pathways of carcinogenesis. J Mol Diagn. 8:193–201. 2006. View Article : Google Scholar : PubMed/NCBI
27.	Papagiorgis PC, Zizi AE, Tseleni S, et al: Site impact on colorectal cancer biological behavior in terms of clinicopathological and molecular features. J BUON. 16:84–92. 2011.PubMed/NCBI
28.	Wong R: Proximal tumors are associated with greater mortality in colon cancer. J Gen Intern Med. 25:1157–1163. 2010. View Article : Google Scholar : PubMed/NCBI
29.	Kurisu Y, Shimoda T, Ochiai A, Nakanishi Y, Hirata I and Katsu KI: Histologic and immunohistochemical analysis of early submucosal invasive carcinoma of the colon and rectum. Pathol Int. 49:608–616. 1999. View Article : Google Scholar : PubMed/NCBI
30.	Matsuda T, Saito Y, Hotta K, Sano Y and Fujii T: Prevalence and clinicopathological features of nonpolypoid colorectal neoplasms: should we pay more attention to indentifying flat and depressed lesions? Dig Endoscopy. 22:S57–S62. 2010. View Article : Google Scholar : PubMed/NCBI
31.	Sano Y, Fujii T, Oda Y, et al: A multicenter randomized controlled trial designed to evaluate follow-up surveillance strategies for colorectal cancer: the Japan Polyp Study. Dig Endoscop. 16:376–378. 2004. View Article : Google Scholar
32.	Dakubo GD, Jakupciak JP, Birch-Machin MA and Parr RL: Clinical implications and utility of field cancerization. Cancer Cell Int. 7:22007. View Article : Google Scholar : PubMed/NCBI
33.	Aivado M, Gynes M, Golerov V, Schmidt WU, Röher HD and Goretzki PE: ‘Field cancerization’ - an additional phenomenon in development of colon tumors? K-ras codon mutations in normal colonic mucosa of patients with colorectal neoplasms. Chirurg. 71:1230–1234. 2000.(In German).
34.	Weil R, Ohana G, Haplern M, Estlein D, Anvi A and Wolloch Y: Small nonpolypoid colorectal carcinoma. World J Surg. 26:503–508. 2002. View Article : Google Scholar : PubMed/NCBI