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Kolorektal Kanserlerde Venöz İnvazyonun Elastik Lif Boyası Eşliğinde Yeniden Değerlendirilmesi

Year 2022, , 294 - 300, 30.06.2022
https://doi.org/10.31832/smj.1016076

Abstract

Amaç : Kolorektal kanserlede ( KRK) venöz invazyonun(Vİ) prognostik önemi uzun yıllardır bilinmektedir. Vİ uzak organ metastazları için bağımsız prediktör olarak kabul edilmektedir.
KRK'lerde beklenen Vİ oranı en az % 25’dir. Gastrointestinal kanal spesmenlerine spesifik bakan patologların olduğu merkezlerde bu oran genel patalogların baktığı spesmenlerle karşılaştırıldığında daha fazladır. Elastik Lif Boyası (ELB) kullanımının VI oranlarını artırdığı ileri sürülmektedir.
Bu çalışmada amacımız Vİ olmayan KRK olgularına ELB uygulayarak yeniden değerlendirmek, yanlış yorumlamaya neden olan etkenleri belirlemek ve ELB'nin rutinde kullanımını sorgulamaktır.
Gereç ve Yöntemler: 2018-2020 tarihleri arasında tanı almış 166 KRK materyalinden Vİ bulunmayan, Vİ belirlenirken boyama işlemi yapılmamış, 77 olgunun preparatları yeniden incelendi. Seçilen bir bloğa ELB uygulandıktan sonra yeniden değerlendirildi.
Bulgular: Olguların 49’u Erkek (%63,6), 28’i Kadın (%36,4), E/K oranı: 1,75 idi. Yaş ortalaması 63,5 (29-101) yaş idi. Ortalama tümör çapı 4,85 cm (1-11 cm) idi. Olguların 6’sı (%7.8) high grade, 71’i (%92.2) low grade histolojik dereceye sahipti. Olguların patolojik T evreleri sırasıyla, 3 olgu pT1 (%3,9), 14 olgu pT2 (%18,2), 50 olgu pT3 (%65), 10 olgu pT4 (%12,9) idi. Patolojik N evreleri sırasıyla, 2 olgu pNx (%2,6), 57 olgu pN0 (%74), 14 olgu pN1 (%18,2), 4 olgu pN2 (%5,2) idi. ELB yapılan preparatlar yeniden değerlendirildi. 77 olgunun 6’sında (%7,8) ELB boyama sonrası Vİ tespit edildi.
Sonuç: Çalışmamızda ELB ile Vİ tespit edilen olgularda, oblitere olmuş damar duvarlarında tümörü çevreleyen alanın desmoplastik stroma lehine değerlendirildiğini gözlemledik. Sonuç olarak H&E kesitlerde Vİ bulunmayan olguların tamamına ELB gibi damar duvarı belirleyicilerinin uygulanmasını önermekteyiz. Böylece hastanın tedavi protokolünü ve sağ kalımını etkileyen Vİ’nin yorumlanmasında oluşabilecek hatalar azaltılmış olacaktır.

References

  • Referans1 Hwang C, Lee S, Kim A, Kim YG, Ahn SJ, Park DY. Venous Invasion in Colorectal Cancer: Impact of Morphologic Findings on Detection Rate, Cancer Res Treat. 2016;48: 1222-1228.
  • Referans2 Seefeld PH, Bargen JA. The Spread Of Carcınoma Of The Rectum: Invasıon Of Lymphatıcs, Veıns And Nerves. Ann Surg. 1943; 118: 76–90.
  • Referans3 Roxburgh CS, McMillan DC, Richards CH, Atwan M, Anderson JH, Harvey T, Horgan PG, Foulis AK. The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer. Ann Surg. 2014;259:1156-1165.
  • Referans4 Van Wyk HC, Roxburgh CS, Horgan PG, Foulis AF, McMillan DC. The detection and role of lymphatic and blood vessel invasion in predicting survival in patients with node negative operable primary colorectal cancer. Crit Rev Oncol Hematol. 2014;90:77-90.
  • Referans5 Talbot IC, Ritchie S, Leighton M, Hughes AO, Bussey HJ, Morson BC. Invasion of veins by carcinoma of rectum: method of detection, histological features and significance. Histopathology. 1981;5:141-163.
  • Referans6 Messenger DE, Driman DK, McLeod RS, et al Current practice patterns among pathologists in the assessment of venous invasion in colorectal cancer. Journal of Clinical Pathology 2011;64:983-989.
  • Referans7 Chand M, Siddiqui MR, Swift I, Brown G. Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol. 2016;22:1721-1726.
  • Referans8 Knijn N, van Exsel UEM, de Noo ME, Nagtegaal ID. The value of intramural vascular invasion in colorectal cancer - a systematic review and meta-analysis. Histopathology. 2018;72:721-728.
  • Referans9 Amin MB, Edge S, Greene F, Byrd DR, Brookland RK. AJCC Cancer Staging Manual. 8th ed. Springer International Publishing; 2017.
  • Referans10 Das P, Baloda V. Use of smooth muscle markers is better than the endothelial cell markers for identification of tumor venous invasion and extramural tumor deposits in gastrointestinal tract tumors. Indian J Pathol Microbiol 2021;63:3-4.
  • Referans11 Abdulkader M, Abdulla K, Rakha E, Kaye P. Routine elastic staining assists detection of vascular invasion in colorectal cancer. Histopathology. 2006 Nov;49:487-492.
  • Referans12 Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S,et al. Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol. 2013;37:200-210.
  • Referans13 Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:1539-1551.
  • Referans14 Ekinci Ö, Öǧüt B, Çelik B, Dursun A. Compared with elastin stains, h-caldesmon and desmin offer superior detection of vessel invasion in gastric, pancreatic, and colorectal adenocarcinomas. Int J Surg Pathol 2018;26:318-326.
  • Referans15 Loughrey MB, Quirke P, Shepherd NA. Standard Datasets for Reporting Cancers: Dataset for Colorectal Cancer. 2nd ed. 2018. Document G049. https://www.rcpath.org/uploads/assets/uploaded/0d5e22ce-be66-474c-ba3097adae84121d.pdf. [Last accessed on 2019 Apr 05]
  • Referans16 Miçooğulları LD, Konur M, Kirsch R , Altındağ SD, Küçükzeybek BB, Sarı AA. Venöz Invazyon: Kolorektal Kanserlerde Göz Ardı Edilebilen Önemli Bir Prognostik Parametre, Türkiye’de Patologlar Arasında Yapılan Anket Ve Tek Merkez Araştırma Sonuçları. journal of current pathology 2021;5; 24-25.

Reevaluation of Venous Invasion with Elastic Tissue Stain in Colorectal Cancers

Year 2022, , 294 - 300, 30.06.2022
https://doi.org/10.31832/smj.1016076

Abstract

Objective: The prognostic importance of venous invasion(VI) in colorectal cancer(CRC) has been known for many years. VI was considered an independent predictor for distant organ metastases. In cases with VI, visceral organ metastases of the tumor occur more rapidly than lymphatic spread. A VI rate of at least 25% was expected in CRC. It was claimed that the use of Elastic Tissue Stain(ETS) increases the VI ratios. In this study, our aim is to reevaluate CRC cases without VI by applying ETS, and to question the routine use of ETS.
Materials and Methods: Between 2018- 2020, 166 colorectal resection materials diagnosed with cancer were found. VI negative ones were selected. When determining VI, 77 cases were identified that did not have histochemistry/immunohistochemistry. Tissues of 77 cases were reevaluated after ETS was applied.
Results: 49 of the cases were male(63.6%), 28 of them were female(36.4%). The mean age was 63.5 (29-101) years. The mean tumor diameter was 4.85 cm(1-11 cm). Six of the cases(7.8%) had high and 71(92.2%) had low grade. The pT stages of the cases were respectively 3 cases pT1(3.9%), 14 cases pT2(18.2%), 50 cases pT3(65%), 10 cases pT4(12.9%). N stages were pNx in 2 cases(2.6%), pN0 in 57 cases(74%), pN1 in 14 cases (18.2%), and pN2 in 4 cases(5.2%), respectively. ETS preparations were reevaluated. VI was detected after ETS staining in 6(7.8%) of 77 cases.
Conclusion: As a result, we recommend the application of vessel wall markers such as ETS to all cases without VI on HE sections. Thus, the errors that may occur in the interpretation of VI, which affect the treatment protocol and survival of the patient, will be reduced.

References

  • Referans1 Hwang C, Lee S, Kim A, Kim YG, Ahn SJ, Park DY. Venous Invasion in Colorectal Cancer: Impact of Morphologic Findings on Detection Rate, Cancer Res Treat. 2016;48: 1222-1228.
  • Referans2 Seefeld PH, Bargen JA. The Spread Of Carcınoma Of The Rectum: Invasıon Of Lymphatıcs, Veıns And Nerves. Ann Surg. 1943; 118: 76–90.
  • Referans3 Roxburgh CS, McMillan DC, Richards CH, Atwan M, Anderson JH, Harvey T, Horgan PG, Foulis AK. The clinical utility of the combination of T stage and venous invasion to predict survival in patients undergoing surgery for colorectal cancer. Ann Surg. 2014;259:1156-1165.
  • Referans4 Van Wyk HC, Roxburgh CS, Horgan PG, Foulis AF, McMillan DC. The detection and role of lymphatic and blood vessel invasion in predicting survival in patients with node negative operable primary colorectal cancer. Crit Rev Oncol Hematol. 2014;90:77-90.
  • Referans5 Talbot IC, Ritchie S, Leighton M, Hughes AO, Bussey HJ, Morson BC. Invasion of veins by carcinoma of rectum: method of detection, histological features and significance. Histopathology. 1981;5:141-163.
  • Referans6 Messenger DE, Driman DK, McLeod RS, et al Current practice patterns among pathologists in the assessment of venous invasion in colorectal cancer. Journal of Clinical Pathology 2011;64:983-989.
  • Referans7 Chand M, Siddiqui MR, Swift I, Brown G. Systematic review of prognostic importance of extramural venous invasion in rectal cancer. World J Gastroenterol. 2016;22:1721-1726.
  • Referans8 Knijn N, van Exsel UEM, de Noo ME, Nagtegaal ID. The value of intramural vascular invasion in colorectal cancer - a systematic review and meta-analysis. Histopathology. 2018;72:721-728.
  • Referans9 Amin MB, Edge S, Greene F, Byrd DR, Brookland RK. AJCC Cancer Staging Manual. 8th ed. Springer International Publishing; 2017.
  • Referans10 Das P, Baloda V. Use of smooth muscle markers is better than the endothelial cell markers for identification of tumor venous invasion and extramural tumor deposits in gastrointestinal tract tumors. Indian J Pathol Microbiol 2021;63:3-4.
  • Referans11 Abdulkader M, Abdulla K, Rakha E, Kaye P. Routine elastic staining assists detection of vascular invasion in colorectal cancer. Histopathology. 2006 Nov;49:487-492.
  • Referans12 Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S,et al. Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol. 2013;37:200-210.
  • Referans13 Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 2009;133:1539-1551.
  • Referans14 Ekinci Ö, Öǧüt B, Çelik B, Dursun A. Compared with elastin stains, h-caldesmon and desmin offer superior detection of vessel invasion in gastric, pancreatic, and colorectal adenocarcinomas. Int J Surg Pathol 2018;26:318-326.
  • Referans15 Loughrey MB, Quirke P, Shepherd NA. Standard Datasets for Reporting Cancers: Dataset for Colorectal Cancer. 2nd ed. 2018. Document G049. https://www.rcpath.org/uploads/assets/uploaded/0d5e22ce-be66-474c-ba3097adae84121d.pdf. [Last accessed on 2019 Apr 05]
  • Referans16 Miçooğulları LD, Konur M, Kirsch R , Altındağ SD, Küçükzeybek BB, Sarı AA. Venöz Invazyon: Kolorektal Kanserlerde Göz Ardı Edilebilen Önemli Bir Prognostik Parametre, Türkiye’de Patologlar Arasında Yapılan Anket Ve Tek Merkez Araştırma Sonuçları. journal of current pathology 2021;5; 24-25.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Ebru Akay 0000-0003-1190-1800

Serdal Sadet Özcan This is me 0000-0002-6272-1220

Merve Doğan 0000-0002-8742-5014

Fatoş Tekelioğlu 0000-0002-0828-0831

Saliha Karagöz Eren 0000-0003-4114-6578

Hatice Karaman 0000-0002-5250-5663

Publication Date June 30, 2022
Submission Date October 28, 2021
Published in Issue Year 2022

Cite

AMA Akay E, Özcan SS, Doğan M, Tekelioğlu F, Karagöz Eren S, Karaman H. Kolorektal Kanserlerde Venöz İnvazyonun Elastik Lif Boyası Eşliğinde Yeniden Değerlendirilmesi. Sakarya Tıp Dergisi. June 2022;12(2):294-300. doi:10.31832/smj.1016076

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