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CANCER ARISING IN INTESTINAL ADENOMA: % OF LYMPH NODE METASTASIS

CANCER ARISING IN INTESTINAL ADENOMA: % OF LYMPH NODE METASTASIS. Low risk 0-7% High risk 12- 35% . H A G G I T T. 1. KIKUCHI ‘95. 2. 3. 1 2 3. Sm1: Invasion from the mucosa to 300 m : no limph node mts. KUDO.

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CANCER ARISING IN INTESTINAL ADENOMA: % OF LYMPH NODE METASTASIS

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  1. CANCER ARISING IN INTESTINAL ADENOMA: % OF LYMPH NODE METASTASIS Low risk 0-7% High risk 12- 35%

  2. H A G G I T T 1 KIKUCHI ‘95 2 3 1 2 3 Sm1: Invasion from the mucosa to 300 m: no limph node mts KUDO

  3. RISK FACTORS FOR METASTASIS FROM A CANCER ARISING IN INTESTINAL ADENOMA • SIZE: > 2.5 – 3.5 cm (Nusco ’97) • TUMOR/DYSPLASIA AT THE RESECTION MARGIN <2 mm (Cooper ’95) • POORLY DIFFERENTIATED CARCINOMA (Coverlizza-Risio ’89) • LYMPHATIC INVASION: grade 1-3 (Jap Res Soc Canc ’85) • HIGH TUMOR BUDDING (Prall, Nizze, Barten 2005)

  4. SEQUENZA ADENOMA-CARCINOMA CANCRO CON FENOTIPO MSS

  5. Deletions of 17p are associated with transition from early to advanced colorectal cancerM. Risio 2003 • 20 adenomas with early carcinoma: 15% • 20 advanced adenocarcinomas: 60%

  6. SEQUENZA ADENOMA-CARCINOMA Microsatellite instability Mutation TGFbeta , BAX MSH2 MLH1 CANCRO CON FENOTIPO MSI

  7. TREATMENT OF DYSPLASIA IN IBD • SPORADIC ADENOMA DALM Dysplasia Associated Lesions or Masses WITH EARY CANCER POLIPECTOMY COLECTOMY R. Odze ‘03

  8. RISK FACTORS FOR METASTASES FROM A CANCER ARISING IN INTESTINAL ADENOMA • SIDE: RECTUM • SESSILE (Nicholls_Binda ’04, Kikuchi ’95) • SIZE > 2.5-3.5 cm (Nusco ’97) • TUMOR/DYSPLASIA AT THE RESECTION MARGIN <2 mm (Cooper ’95) • POORLY DIFFERENTIATED CARCINOMA (Coverlizza-Risio ’89) • LYMPHATIC INVASION (Morson ’77, Coper ’98) • HIGH BUDDING (Prall, Nizze, Barten 2005)

  9. Ca colon-retto 85 % 15 % Instabilità Cromosomica perdita di eterozigosi diffusa Aneuploidie o poliploidie Localiz. prefer. lato sinistro colon Aspetto istol. molto differenziato Scarsa infiltraz. linfocitaria Raramente “mucinoso” Prognosi peggiore Instabilità Microsatelliti instabilità dei microsatelliti Diploidie Localiz. prefer. lato destro colon Aspetto istol. scars. differenziato Infiltraz. linfocitaria Spesso “mucinoso” Prognosi migliore 5 % 10 % inattivato MLH1 epigeneticam. mutato gene del Mismatch Repair

  10. Robert Odze, Mod Pathol 2003;16(4):347–358

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