Abstract
Primary tumors of the colorectal cancers are assessed pathologically based on the tumor spread into the bowel wall. The assessment of serosal involvement, which may be relevant to pT4, can be challenging for pathologists, making the consistency of diagnoses questionable. As solutions to this problem, the following two strategies could be adopted. One would be to use special staining or immunohistochemical staining techniques for diagnostic assistance. The other would be to construct recommendations for the assessment of tumor spreading and to obtain a world-wide consensus on the criteria used to assess tumor spreading. Using elastic staining, we previously reported that peritoneal elastic laminal invasion (ELI) could be objectively determined and would likely contribute to a simplified and more objective stratification of deep tumor invasion around the peritoneal surface. We also noted the importance of sampling, staining, and histo-anatomical knowledge in the application of elastic staining during routine pathological diagnosis. Here we review the history of primary tumor stratification leading to the present TNM classification and report on the current status of pathological assessments made at our hospital to summarize what has been established and what is further required for the pathological diagnosis of tumor spreading in patients with colorectal cancer.
Highlights
Since the first categorization efforts reported by LockhartMummery (1926–1927), primary colorectal cancers have been consistently stratified based on the extent of their spreading into the bowel wall (Dukes, 1932; Jass et al, 1987; Newland et al, 1995)
We previously showed that peritoneal elastic laminal invasion (ELI) could be objectively determined and would likely contribute to a simplified and more objective stratification of deep tumor invasion around the peritoneal surface (Kojima et al, 2010)
We will reflect on the brilliant achievements in the assessment of tumor spreading in colorectal cancer
Summary
Since the first categorization efforts reported by LockhartMummery (1926–1927), primary colorectal cancers have been consistently stratified based on the extent of their spreading into the bowel wall (Dukes, 1932; Jass et al, 1987; Newland et al, 1995). CD68-positive or CD204-positive macrophages are found predominantly around the peritoneal elastic lamina and fibrotic focus (Figures 3E,F) Such a variety of histopathological alterations makes it difficult to determine serosal involvement by H.E stain alone. Consistent data regarding tumor spreading as assessed at different hospitals is impossible, and this fact hinders the design of multicenter therapeutic trials for high risk stage II colon cancer patients To overcome this situation, two approaches can be considered. DIAGNOSTIC ASSISTANCE OF ASSESSING SEROSAL INVASION USING ELASTICA STAINING: ELASTIC LAMINAL INVASION OF COLON CANCER Special staining and immunohistochemical staining techniques may be useful for making objective diagnoses of serosal involvement. Tumor invasion beyond the peritoneal elastic lamina ( known as ELI) is not equal to serosal involvement, based on the position, the presence of deep invasion near the peritoneal surface can be estimated. Elastin immunostaining was reported not to be more sensitive than elastica staining www.frontiersin.org
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