Colorectal Biopsies Research Articles

Gastric Helicobacter pylori infection associates with an increased risk of colorectal polyps in African Americans.

BackgroundGastric Helicobacter pylori (H. pylori) infection and colorectal polyps are more prevalent in African Americans than in the general population. We aimed to investigate whether gastric H. pylori infection is associated with colorectal polyps in African Americans.MethodsMedical records of African Americans, 40 years and older (n = 1256) who underwent bidirectional gastrointestinal endoscopy on the same day were reviewed. H. pylori status was assessed by immunohistochemistry on gastric specimens. Colorectal polyps were confirmed by histological examination of colorectal biopsies. A subset of serum samples from healthy and polyp-bearing patients (n = 163) were analyzed by ELISA for anti-H. pylori and anti-CagA antibodies. The crude and adjusted effect of H. pylori on the risk of colorectal adenoma and polyp were computed by logistic regression models.ResultsThe prevalence of colorectal polyps and adenomas were 456 (36%) and 300 (24%) respectively. Colorectal polyps were more prevalent in gastric H. pylori infected than non-infected subjects [43% vs. 34%; Odds Ratio (OR) (95% CI): 1.5 (1.2-1.9), P = 0.001]. Patients with H. pylori-associated chronic active gastritis were at high risk to have adenomas [Unadjusted OR (95% CI): 1.3 (1.0-1.8); P = 0.04]. There was no difference in histopathology, size, or location of polyps with respect to H. pylori status. Gastric H. pylori infection, age, male gender and high risk clinical presentations were independent risk factors for colorectal polyps. Serological testing also revealed a higher prevalence of H. pylori and its toxin Cag-A in polyp patients vs. non polyp patients’ sera, although in a non-statistically significant manner.ConclusionsThis study showed that current gastric H. pylori infection is associated with an increased risk of colorectal polyps in African Americans. Patients with H. pylori induced gastritis may benefit from early screening colonoscopy as a preventative measure for colorectal cancer.

Proinflammatory human 6-sulfo LacNAc-positive dendritic cells accumulate in intestinal acute graft-versus-host disease

Proinflammatory human 6-sulfo LacNAc-positive dendritic cells accumulate in intestinal acute graft-versus-host disease

Fusobacterium nucleatum associates with stages of colorectal neoplasia development, colorectal cancer and disease outcome

Commensal bacteria in the colon may play a role in colorectal cancer (CRC) development. Recent studies from North America showed that Fusobacterium nucleatum (Fn) infection is over-represented in disease tissue versus matched normal tissue in CRC patients. Using quantitative real-time polymerase chain reaction (qPCR) of DNA extracted from colorectal tissue biopsies and surgical resections of three European cohorts totalling 122 CRC patients, we found an over-abundance of Fn in cancerous compared to matched normal tissue (p < 0.0001). To determine whether Fn infection is an early event in CRC development, we assayed Fn in colorectal adenoma (CRA) tissue from 52 Irish patients. While for all CRAs the Fn level was not statistically significantly higher in disease versus normal tissue (p = 0.06), it was significantly higher for high-grade dysplasia (p = 0.015). As a secondary objective, we determined that CRC patients with low Fn levels had a significantly longer overall survival time than patients with moderate and high levels of the bacterium (p = 0.008). The investigation of Fn as a potential non-invasive biomarker for CRC screening showed that, while Fn was more abundant in stool samples from CRC patients compared to adenomas or controls, the levels in stool did not correlate with cancer or adenoma tissue levels from the same individuals. This is the first study examining Fn in the colonic tissue and stool of European CRC and CRA patients, and suggests Fn as a novel risk factor for disease progression from adenoma to cancer, possibly affecting patient survival outcomes. Our results highlight the potential of Fn detection as a diagnostic and prognostic determinant in CRC patients.

Cytomegalovirus colitis in intensive care unit patients: Difficulties in clinical diagnosis

PurposeCytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. MethodsCMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. ResultsWe identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. ConclusionDiagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.

Colorectal cancer: a study of risk factors in a tertiary care hospital of north bengal.

Age, sex, living place (urban or rural), smoking, alcohol consumption, dietary pattern, obesity are considered as risk factors for Colorectal cancer. Our study was done to evaluate the association between these risk factors and colorectal cancer in the population of North Bengal. The present study was done over a period of one year as a hospital-based analytical observational type of study with cross-sectional type of study design. All the patients undergoing colorectal endoscopic biopsy at the Department of Surgery, NBMC&H during the study period for various clinical indications comprised the study population. History and clinical examination were done of the patients whose colorectal biopsy were taken and filled-up in a pre-designed pre-tested proforma. Significance was tested at 95% confidence interval. There is an increased risk of colorectal carcinoma (CRC) with increasing age in our study population. Odd's ratio for last 2 age groups are statistically significant with 2.83 for 41-50 years age group (95% CI is0.3-24), 13.6 for 51-60 years age group (95% CI is 2.1-85.9), 42.5 for more than 60 y age group patients (95% CI is 3.1-571). There is increased risk of colorectal carcinoma in males with an Odd's ratio of 1.6 (95% CI is 0.5-5.5), but it is not statistically significant. There was an increased urban incidence of colorectal carcinoma compared to rural population with an Odd's ratio of 1.8 (with a 95% CI of 0.6-5.9). In our study smoking also proved to be a risk factor and it is significant with an Odd's ratio of 5.4 with a 95% CI of 1.6-8.7. Odd's ratio for cases of alcohol consumption was 3.5 with a 95% CI of 1-11.6. Carcinoma cases were more common among patients with history of non-vegetarian dietary intake with Odds ratio of 1.5 (with a 95% CI of 0.3-8.7), but it was not statistically significant. Obesity has got a significant association with CRC in our study with an Odd's ratio of 7.2 (with 95% CI of 1.3-40.2). More than 50 years of age, smoking, obesity were significant risk factors in our study. Other risk factors were though not significant, but much more common in colorectal cancer patients compared to non-malignant population.

Is colorectal biopsy necessary in irritable bowel syndrome?

Background Clinical symptom based criteria for IBS is not sufficient enough to rule out microscopic colitis (MC). We sought to study whether biopsy is necessary in IBS. Methods This prospective study included colonic mucosa of 197 patients with IBS (129 IBS-D, 50IBS-C and 18 IBS-M) to rule out MC. Results Overall prevalence of MC in patients with IBS was 23.4% (46/197). The prevalence of MC in patients with IBS-D was 28.7% (37/129), higher than in patients with IBS-C 12% (6/50) and IBS-M 16.7% (3/18). Conclusions Microscopic colitis is present in a relevant proportion of symptomatic patients meeting diagnostic criteria for IBS. Despite the fact that IBS is a functional disorder, in many patients morphological changes occur in colon mucosa. The diagnostic criteria of IBS are not specific enough to exclude the presence of MC. Therefore, in patients of IBS, it may be reasonable to perform a biopsy to screen for MC.

Mimics of inflammatory bowel disease

Chronic inflammatory bowel disease (CIBD) infers ulcerative colitis, Crohns disease and the pathological spectrum between, encompassing indeterminate colitis in resections and IBDU on biopsy. Histological assessment remains the gold standard for CIBD diagnosis and yet there are many conditions that show pathological mimicry of CIBD. It cannot be overemphasised that context is a critical determinant of the pathological diagnosis in inflamed colorectal biopsies. The lecture will focus on drug-induced colitis, diverticular colitis, focal active colitis, microscopic colitis and secondary colitis. All these conditions show pathological features similar to those seen in CIBD. There are also interesting parallels and associations between these conditions and CIBD. A small proportion of diverticular colitis cases will eventually re-present with classical ulcerative colitis, despite, initially, a normal rectal histology. In a similar proportion of cases, focal active colitis precedes the onset of classical Crohns disease. Drugs, especially NSAIDs, have an extraordinary relationship with CIBD. They cause (?), they mimic, they exacerbate, they induce and they treat CIBD. The diligent pathologist must be aware of the important mimics of CIBD and ensure that they are fully cognisant with the clinical, endoscopic, microbiological and radiological context before committing a patient to a definitive diagnosis of CIBD.

Specimens from Biopsies of Colorectal Polyps Often Harbor Additional Diagnoses

Objectives. The utility of examining specimens from colorectal biopsies of polyps for nonneoplastic diseases is currently unknown. Our objectives were to characterize such additional diagnoses that could be rendered. Methods. We retrospectively and prospectively reviewed specimens from endoscopic biopsies of colorectal polyps obtained during routine screening or surveillance. Results. 17 of 168 specimens (10.1%) contained additional diagnoses, including schistosomiasis, eosinophilic colitis, intestinal spirochetosis, melanosis coli, and other entities. These findings were easily overlooked because they often affected mucosa that was spared by the polyps or were often evident only at high magnification. Schistosomiasis, eosinophilic colitis, and intestinal spirochetosis were clinically occult. Conclusions. Specimens from biopsies of colorectal polyps often harbor other diagnoses, in addition to polyps, and can be simultaneously screened for polyps and examined for nonneoplastic diseases. Detection of other diagnoses in addition to polyps requires awareness, examination at high magnification, and examination of areas spared by the polyps.

3-D visualization and quantitation of microvessels in transparent human colorectal carcinoma [corrected

Microscopic analysis of tumor vasculature plays an important role in understanding the progression and malignancy of colorectal carcinoma. However, due to the geometry of blood vessels and their connections, standard microtome-based histology is limited in providing the spatial information of the vascular network with a 3-dimensional (3-D) continuum. To facilitate 3-D tissue analysis, we prepared transparent human colorectal biopsies by optical clearing for in-depth confocal microscopy with CD34 immunohistochemistry. Full-depth colons were obtained from colectomies performed for colorectal carcinoma. Specimens were prepared away from (control) and at the tumor site. Taking advantage of the transparent specimens, we acquired anatomic information up to 200 μm in depth for qualitative and quantitative analyses of the vasculature. Examples are given to illustrate: (1) the association between the tumor microstructure and vasculature in space, including the perivascular cuffs of tumor outgrowth, and (2) the difference between the 2-D and 3-D quantitation of microvessels. We also demonstrate that the optically cleared mucosa can be retrieved after 3-D microscopy to perform the standard microtome-based histology (H&E staining and immunohistochemistry) for systematic integration of the two tissue imaging methods. Overall, we established a new tumor histological approach to integrate 3-D imaging, illustration, and quantitation of human colonic microvessels in normal and cancerous specimens. This approach has significant promise to work with the standard histology to better characterize the tumor microenvironment in colorectal carcinoma.

Histologic grading based on counting poorly differentiated clusters in preoperative biopsy predicts nodal involvement and pTNM stage in colorectal cancer patients

Histologic grading is commonly assessed in colorectal cancer preoperative biopsies. Nevertheless, its clinical impact is limited by low interobserver reproducibility and poor concordance with grading found in the final resection specimen. In the present study, we aimed to investigate the reproducibility, accuracy, and predictive value on lymph node status or pTNM stage of a novel grading system based on the number of poorly differentiated clusters in colorectal cancer preoperative endoscopic biopsies. Grading based on counting poorly differentiated clusters was assessed in 163 colorectal cancer endoscopic biopsies and corresponding surgical specimens. With this system, 152 biopsies could be graded with good interobserver agreement (κ = 0.735). In comparison with the surgical specimens, 75% of colorectal cancers were correctly graded in the biopsy, and 81% of poorly differentiated colorectal cancers were identified at initial biopsy. High poorly differentiated clusters grade in the biopsy was significantly associated with nodal metastasis, high pTNM stage (P < .0001), or histologic features suggestive of more aggressive behavior (tumor budding, perineural invasion, vascular invasion, and infiltrating tumor border) in the surgical specimen. Furthermore, this system identified colorectal cancer with nodal involvement or high pTNM stage with a 78% positive predictive value and 71% and 69% negative predictive values, respectively. Our findings suggest that a grading system based on the quantification of poorly differentiated clusters is feasible in most colorectal cancer endoscopic biopsies. In view of its good reproducibility, accuracy, and predictive value on the anatomical extent of the disease, it may be taken into account for decision-making in colorectal cancer treatment.

Ulcerative colitis or Crohn's disease? Pitfalls and problems

The interpretation of colorectal biopsies taken for the initial diagnosis of chronic idiopathic inflammatory bowel disease (IBD) is challenging. Subclassification of IBD as ulcerative colitis (UC) or Crohn's disease, which may be particularly difficult, is the subject of this review. Biopsies taken at first presentation are emphasised, partly because their features have not been modified by time or treatment. Aspects of longstanding disease and of resections are also mentioned. The first part of the review comprises background considerations and a summary of histological features that are discriminant, according to published evidence, between UC and Crohn's disease in initial biopsies. Pitfalls and problems associated with making the distinction between UC and Crohn's disease are then discussed. These include: mimics of IBD; inadequate clinical details; unreliable microscopic features; absence of histological changes in early IBD; discontinuity in UC; cryptolytic granulomas; differences between paediatric and adult UC; reliance on ileal and oesophagogastroduodenal histology; and atypical features in IBD resections. Avoidance by pathologists of known pitfalls should increase the likelihood of accurate and confident subclassification of IBD, which is important for optimum medical and surgical management.

Highlights from Recent Cancer Literature

Highlights from Recent Cancer Literature

Abstract A198: Flow cytometric analysis and sorting of dissociated cells from human solid tumors derived from PDX mouse models.

Abstract Functional and genetic heterogeneity in tumor tissue was first observed over 50 years ago. Today, tumor heterogeneity is frequently evoked in describing the pathway from pre-cancerous lesions to aggressive, metastatic cancer. During this progression, multiple clonal lineages are thought to arise, leading to subpopulations of the tumor showing different metastatic profiles and susceptibility to anti-cancer therapy. In addition, the role of the tumor microenvironment became recognized and infiltrating leukocytes or tumor associated fibroblasts are no longer viewed as mere contaminants of a solid tumor biopsy. The emerging picture is increasingly compared to macroscopic ecosystems and a detailed understanding of the interactions between numerous cell subgroups seems necessary for the complete understanding of cancer pathogenesis. Scarcity of appropriate tools and model systems are an obstacle to the investigation of this heterogeneity at a molecular level but advances over the last few years have led to a significant acceleration in this field. More sensitive and far cheaper methods for collection of genomic and transcriptomic data have revealed a complex picture of the evolution of individual solid tumors. To turn this deeper understanding of tumorigenesis into improved clinical outcomes, routine methods are required to separate complex tumors into subpopulations. This stratification will provide a more comprehensive characterization of the tumor and enable more detailed prediction of disease progression and resistance development. We have developed dissociation methods for solid tumor tissue which allows flow cytometric analysis as well as sorting to provide cells for multiple downstream analysis modalities. Using patient derived xenograft (PDX) mouse models derived from primary human breast, colorectal and lung cancer biopsies we have demonstrated efficient dissociation, surface marker analysis and nucleic acid purification from sorted populations. Conditions have been optimized for a range of relevant surface markers (e.g. CD 24, 44, 133, 184, 326 (EpCAM), and CD45) which are suitable to identify cells predicted to have stem cell, endothelial, epithelial or immune cell functions, respectively. Through sequencing of subpopulations identified by their phenotype we have demonstrated the compatibility of our workflow with downstream analysis methods such as Next Generation Sequencing (NGS). Our RNA stability measurements suggest that gene expression analysis is equally feasible. Our data provide a standardized basis for in depth investigation of subpopulations of cells from solid tumors with various molecular techniques. Citation Information: Mol Cancer Ther 2013;12(11 Suppl):A198. Citation Format: Rainer Blaesius, Friedrich Hahn, Eileen Snowden, Warren Porter, Mitchell Ferguson, Tina Marmura, Frances Tong, Shannon Dillmore, Aaron Middlebrook, Joyce Ruitenberg, Maria Suni, Smita Ghanekar. Flow cytometric analysis and sorting of dissociated cells from human solid tumors derived from PDX mouse models. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr A198.

Comparative Serum Proteomic Analysis of Serum Diagnosis Proteins of Colorectal Cancer Based on Magnetic Bead Separation and MALDI-TOF Mass Spectrometry

At present, the diagnosis of colorectal cancer (CRC) requires a colorectal biopsy which is an invasive procedure. We undertook this pilot study to develop an alternative method and potential new biomarkers for diagnosis, and validated a set of well-integrated tools called ClinProt to investigate the serum peptidome in CRC patients. Fasting blood samples from 67 patients diagnosed with CRC by histological diagnosis, 55 patients diagnosed with colorectal adenoma by biopsy, and 65 healthy volunteers were collected. Division was into a model construction group and an external validation group randomly. The present work focused on serum proteomic analysis of model construction group by ClinProt Kit combined with mass spectrometry. This approach allowed construction of a peptide pattern able to differentiate the studied populations. An external validation group was used to verify the diagnostic capability of the peptidome pattern blindly. An immunoassay method was used to determine serum CEA of CRC and controls. The results showed 59 differential peptide peaks in CRC, colorectal adenoma and health volunteers. A genetic algorithm was used to set up the classification models. Four of the identified peaks at m/z 797, 810, 4078 and 5343 were used to construct peptidome patterns, achieving an accuracy of 100% (> CEA, P < 0. 05). Furthermore, the peptidome patterns could differentiate the validation group with high accuracy close to 100%. Our results showed that proteomic analysis of serum with MALDI-TOF MS is a fast and reproducible approach, which may provide a novel approach to screening for CRC.

Campylobacter Colitis

When a patient presents with acute bloody diarrhea, it is important to differentiate an infectious disease from a first attack of inflammatory bowel disease. In cases with prolonged or acute illness when steroids are being considered, colorectal mucosal visualization and biopsy might be helpful. The author presents a case with Campylobacter colitis and the endoscopic appearance of infectious colitis with inflammation of the mucosa. This article is part of an expert video encyclopedia.

201: Interleukin-11 is the dominant IL-6 family cytokine during gastrointestinal tumourigenesis

The concept of combating tumour progression through pharmacological inhibition of growth promoting cytokines within the tumour micro-environment is emerging as a therapeutic opportunity that bypasses the difficulties of targeting intracellular signaling components, including transcription factors. To date, much focus has been placed on antagonizing Interleukin (IL)-6, with clinical trials for ovarian, renal, prostate, and breast cancers underway. While IL-6 is one of the most well recognized intrinsic connections between inflammation and cancer, surprisingly little is known about the role of the closely related cytokine, IL-11. Both IL-6 and IL-11 form a multimeric GP130/JAK signaling complex to activate the Signal Transducer and Activator of Transcription (STAT)-3 pathway. Persistent STAT3 activation is a recurrent feature of many metastatic human cancers and is associated with poor prognosis. In a panel of human colorectal cancer biopsies, we have shown that IL-11 expression has a stronger correlation with elevated epithelial STAT3 activation than IL-6. We have genetically manipulated STAT3 signaling in a series of mouse models to demonstrate that IL-11 is a critical regulator of the network of inflammatory cells present in the tumour microenvironment, and ultimately provides survival signals for tumour cells. Using genetic inhibition of IL-6 and IL-11 signaling in mouse models, we reveal that IL-11 has a dominant role during the progression of sporadic and inflammation-associated colon and gastric cancers. Accordingly, we show that in these cancers, as well as in human tumour cell line xenografts, pharmacological inhibition of IL-11 signaling alleviated STAT3 activation, suppressed tumour cell proliferation and reduced the invasive capacity and growth of tumours. Our results introduce a new cytokine targeted therapy, and suggest that in many disease models that were previously considered to be IL-6 centric, the role of IL-11 should be carefully examined.

Near Infrared Optical Visualization of Epidermal Growth Factor Receptors Levels in COLO205 Colorectal Cell Line, Orthotopic Tumor in Mice and Human Biopsies

In this study, we present the applicability of imaging epidermal growth factor (EGF) receptor levels in preclinical models of COLO205 carcinoma cells in vitro, mice with orthotopic tumors and ex vivo colorectal tumor biopsies, using EGF-labeled with IRDye800CW (EGF-NIR). The near infrared (NIR) bio-imaging of COLO205 cultures indicated specific and selective binding, reflecting EGF receptors levels. In vivo imaging of tumors in mice showed that the highest signal/background ratio between tumor and adjacent tissue was achieved 48 hours post-injection. Dissected colorectal cancer tissues from different patients demonstrated ex vivo specific imaging using the NIR bio-imaging platform of the heterogeneous distributed EGF receptors. Moreover, in the adjacent gastrointestinal tissue of the same patients, which by Western blotting was demonstrated as EGF receptor negative, no labeling with EGF-NIR probe was detected. Present results support the concept of tumor imaging by measuring EGF receptor levels using EGF-NIR probe. This platform is advantageous for EGF receptor bio-imaging of the NCI-60 recommended panel of tumor cell lines including 6–9 colorectal cell lines, since it avoids radioactive probes and is appropriate for use in the clinical setting using NIR technologies in a real-time manner.

Both STAT1 and STAT3 are favourable prognostic determinants in colorectal carcinoma

Background:Aberrant activities of Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling pathways have been implicated in the development and spread of various cancer entities, among them colorectal carcinoma (CRC). Transcription factors STAT3 and STAT1, both downstream effectors of interleukin (IL)-6 and its receptor, are involved in growth and developmental control of CRC cells. Constituents of the signalling network around IL-6 and STAT activation are discussed as potential biomarkers and therapeutic targets in CRC.Methods:By immunohistochemical analysis of a tissue microarray covering >400 CRC biopsies, the expression and activity status of STAT1, STAT3 as well as of IL-6 and the IL-6 receptor α-chain was determined. The outcome was correlated with clinical information and patients' survival data. Colorectal carcinoma biopsies were also analysed for specific DNA-binding activity of STATs.Results:Statistical analysis showed tendential associations between individual STATs, IL-6/IL-6 receptor-α and clinicopathological parameters. The study revealed a significant correlation of high STAT1 activity with longer patient overall survival. Surprisingly, strong STAT3 expression in surgical specimens was correlated with an increase in median overall survival by about 30 months. Statistical analysis revealed that high expression levels of STAT1 and STAT3 were associated. This finding was backed up by biochemical data that showed simultaneous STAT1 and STAT3 DNA-binding activity in randomly selected CRC biopsies.Conclusion:By multivariate data analysis, we could show that STAT3 expression and activity constitutes an independent favourable prognostic marker for CRC.

PTH-052 Microscopic Colitis Is Expensive To Diagnose: An Analysis Of The Utility Of Random Colonic Biopsies

IntroductionMicroscopic colitis is reported in up to 9.5% of patients with watery diarrhoea, and in almost 20% of those older than 701. The Joint Advisory Group on GI Endoscopy mandates...

Expression of transcription factor Scratch2 in colorectal cancer.

e14669 Background: The Scratch genes constitute an independent subgroup of the Snail superfamily of transcription factors (TFs). Vertebrates contain 2 Snail and 2 Scratch genes (Scrt1 and Scrt2). Members of the Snail/Scratch superfamilies are characterized by a having both zinc finger domains, which mediate DNA-binding and a SNAG domain that is necessary for the transcriptional repression. Under normal conditions, the Scratch genes are expressed exclusively in the nervous system, where they regulate cortical neurogenesis (Paul, Tonchev, et al. Cerebral Cortex 2012, Epub ahead of print; doi: 10.1093/cercor/bhs356). However, expression of Scrt2 under pathological conditions is poorly characterized, especially in humans. Methods: We investigated the expression of Scrt2 by immunohistochemistry in 50 primary or metastatic (hepatic metastasis) colorectal cancer biopsies acquired through routine operations at the Department of General Surgery, Medical University-Varna, Bulgaria. We also evaluated the histological type and clinical stage of the tumors. Results: We found that both the primary and the metastatic tumor strongly expressed Scrt2 protein. Interestingly, the expression was mostly in the cytoplasm, in accordance with the reported pattern in the developing cortex (Paul, Tonchev, et al. Cerebral Cortex 2012, Epub ahead of print; doi: 10.1093/cercor/bhs356). Notably, in the hepatic metastatic tumors, we found no or scarce expression in the normal hepatic parenchyma surrounding the tumor, while a strong expression in the colorectal cancer metastasis. Conclusions: Scrt2 represents a putative novel marker for colorectal cancer. Detailed correlation of the clinical parameters, such as patient survival, and the expression level of Scrt2 might yield novel prognostic value of this TF in the pathogenesis of colorectal cancer.