Difference between revisions of "Medullary colorectal carcinoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Photomicrograph_of_colorectal_medullary_carcinoma_x20a.jpg
| Width      =
| Caption    = Micrograph of a medullary colorectal carcinoma. [[H&E stain]].
| Synonyms  =
| Micro      = Sheet-like architecture of malignant cells with vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Admixed inflammatory cells (lymphocytes and neutrophils) are common.
| Subtypes  =
| LMDDx      = Poorly differentiated adenocarcinoma, melanoma, poorly differentiated neuroendocrine tumours, high grade lymphoma
| Stains    =
| IHC        = May lose CK20 and CDX2. Frequent loss of MLH1/PMS2. SATB2 +ve, BRAF VE1 +ve, calretinin +ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Staging    =
| Site      = Colorectum, most commonly right side of colon
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = 1-3% of all colorectal carcinomas
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = Some papers suggest better prognosis than conventional adenocarcinoma
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Medullary colorectal carcinoma''' is a rare type of [[colorectal carcinoma]]. Precise incidence difficult to determine as there no strict criteria for diagnosis, especially if the tumour also contains conventional adenocarcinoma. Cases may not be recognised and  diagnosed as poorly differentiated adenocarcinona instead.<ref name=pmid33247957>{{cite journal |vauthors=Scott N, West NP, Cairns A, Rotimi O |title=Is medullary carcinoma of the colon underdiagnosed? An audit of poorly differentiated colorectal carcinomas in a large national health service teaching hospital |journal=Histopathology |volume=78 |issue=7 |pages=963–969 |date=June 2021 |pmid=33247957 |doi=10.1111/his.14310 |url=}}</ref>
'''Medullary colorectal carcinoma''' is a rare type of [[colorectal carcinoma]]. Precise incidence difficult to determine as there no strict criteria for diagnosis, especially if the tumour also contains conventional adenocarcinoma. Cases may not be recognised and  diagnosed as poorly differentiated adenocarcinona instead.<ref name=pmid33247957>{{cite journal |vauthors=Scott N, West NP, Cairns A, Rotimi O |title=Is medullary carcinoma of the colon underdiagnosed? An audit of poorly differentiated colorectal carcinomas in a large national health service teaching hospital |journal=Histopathology |volume=78 |issue=7 |pages=963–969 |date=June 2021 |pmid=33247957 |doi=10.1111/his.14310 |url=}}</ref>


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*Prognostic significance dependent on study.
*Prognostic significance dependent on study.
**A small series suggests the prognosis of medullary carcinoma with MSI is worse that conventional colorectal carcinoma without MSI.<ref>{{cite journal |authors=Gómez-Álvarez MA, Lino-Silva LS, Salcedo-Hernández RA, Padilla-Rosciano A, Ruiz-García EB, López-Basave HN, Calderillo-Ruiz G, Aguilar-Romero JM, Domínguez-Rodríguez JA, Herrera-Gómez Á, Meneses-García A |title=Medullary colonic carcinoma with microsatellite instability has lower survival compared with conventional colonic adenocarcinoma with microsatellite instability |journal=Prz Gastroenterol |volume=12 |issue=3 |pages=208–214 |date=2017 |pmid=29123583 |pmc=5672702 |doi=10.5114/pg.2016.64740 |url=}}</ref>
**A small series suggests the prognosis of medullary carcinoma with MSI is worse that conventional colorectal carcinoma without MSI.<ref>{{cite journal |authors=Gómez-Álvarez MA, Lino-Silva LS, Salcedo-Hernández RA, Padilla-Rosciano A, Ruiz-García EB, López-Basave HN, Calderillo-Ruiz G, Aguilar-Romero JM, Domínguez-Rodríguez JA, Herrera-Gómez Á, Meneses-García A |title=Medullary colonic carcinoma with microsatellite instability has lower survival compared with conventional colonic adenocarcinoma with microsatellite instability |journal=Prz Gastroenterol |volume=12 |issue=3 |pages=208–214 |date=2017 |pmid=29123583 |pmc=5672702 |doi=10.5114/pg.2016.64740 |url=}}</ref>
**A series with 102 cases suggests a better prognosis when compared on the basis of other pathological characteristics.<ref name=pmid25572685>{{cite journal |authors=Knox RD, Luey N, Sioson L, Kedziora A, Clarkson A, Watson N, Toon CW, Cussigh C, Pincott S, Pillinger S, Salama Y, Evans J, Percy J, Schnitzler M, Engel A, Gill AJ |title=Medullary colorectal carcinoma revisited: a clinical and pathological study of 102 cases |journal=Ann. Surg. Oncol. |volume=22 |issue=9 |pages=2988–96 |date=September 2015 |pmid=25572685 |doi=10.1245/s10434-014-4355-5 |url=}}</ref>
**A series with 102 cases suggests a better prognosis when compared on the basis of other pathological characteristics.<ref name=pmid25572685/>


==Gross==
==Gross==

Revision as of 20:39, 1 June 2023

Medullary colorectal carcinoma
Diagnosis in short

Micrograph of a medullary colorectal carcinoma. H&E stain.
LM Sheet-like architecture of malignant cells with vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Admixed inflammatory cells (lymphocytes and neutrophils) are common.
LM DDx Poorly differentiated adenocarcinoma, melanoma, poorly differentiated neuroendocrine tumours, high grade lymphoma
IHC May lose CK20 and CDX2. Frequent loss of MLH1/PMS2. SATB2 +ve, BRAF VE1 +ve, calretinin +ve
Site Colorectum, most commonly right side of colon
Prevalence 1-3% of all colorectal carcinomas
Prognosis Some papers suggest better prognosis than conventional adenocarcinoma

Medullary colorectal carcinoma is a rare type of colorectal carcinoma. Precise incidence difficult to determine as there no strict criteria for diagnosis, especially if the tumour also contains conventional adenocarcinoma. Cases may not be recognised and diagnosed as poorly differentiated adenocarcinona instead.[1]

General

  • Rare subtype of colorectal carcinoma. In these papers: 1.1%[1], 2.8%[2], and 3.6%[3]
  • Typically has microsatellite instability.[4]
  • Prognostic significance dependent on study.
    • A small series suggests the prognosis of medullary carcinoma with MSI is worse that conventional colorectal carcinoma without MSI.[5]
    • A series with 102 cases suggests a better prognosis when compared on the basis of other pathological characteristics.[2]

Gross

  • Well-circumscribed.

Microscopic

Features:

  • Poorly differentiated carcinoma:
    • Noninfiltrative border.
    • Solid pattern/nests.
    • No gland formation.
    • Lymphocytic infiltrate.

DDx:

IHC

Features:[4]

  • CDX2 +ve (though can be lost)
  • Beta-catenin +ve.
  • MLH1/PMS2 loss of staining.
  • Calretinin (67%-73%)[8][9]

Notes:

  • CDX2, beta-catenin, MLH1 useful for differentiating from poorly differentiated colorectal carcinoma.
  • SMARCB1 loss - reported in one case.[6]

See also

References

  1. ↑ 1.0 1.1 "Is medullary carcinoma of the colon underdiagnosed? An audit of poorly differentiated colorectal carcinomas in a large national health service teaching hospital". Histopathology 78 (7): 963–969. June 2021. doi:10.1111/his.14310. PMID 33247957.
  2. ↑ 2.0 2.1 "Medullary colorectal carcinoma revisited: a clinical and pathological study of 102 cases". Ann Surg Oncol 22 (9): 2988–96. September 2015. doi:10.1245/s10434-014-4355-5. PMID 25572685.
  3. ↑ "Medullary-type poorly differentiated adenocarcinoma of the large bowel: a distinct clinicopathologic entity characterized by microsatellite instability and improved survival". J Clin Oncol 17 (8): 2429–38. August 1999. doi:10.1200/JCO.1999.17.8.2429. PMID 10561306.
  4. ↑ 4.0 4.1 Cunningham J, Kantekure K, Saif MW (2014). "Medullary carcinoma of the colon: a case series and review of the literature". In Vivo 28 (3): 311–4. PMID 24815832.
  5. ↑ Gómez-Álvarez MA, Lino-Silva LS, Salcedo-Hernández RA, Padilla-Rosciano A, Ruiz-García EB, López-Basave HN, Calderillo-Ruiz G, Aguilar-Romero JM, Domínguez-Rodríguez JA, Herrera-Gómez Á, Meneses-García A (2017). "Medullary colonic carcinoma with microsatellite instability has lower survival compared with conventional colonic adenocarcinoma with microsatellite instability". Prz Gastroenterol 12 (3): 208–214. doi:10.5114/pg.2016.64740. PMC 5672702. PMID 29123583. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672702/.
  6. ↑ 6.0 6.1 Melloul S, Mosnier JF, Masliah-Planchon J, Lepage C, Le Malicot K, Gornet JM, Edeline J, Dansette D, Texereau P, Delattre O, Laurent Puig P, Taieb J, Emile JF (2020). "Loss of SMARCB1 expression in colon carcinoma". Cancer Biomark 27 (3): 399–406. doi:10.3233/CBM-190287. PMID 32083567.
  7. ↑ Delaney D, Chetty R (2012). "Lymphoepithelioma-like carcinoma of the colon". Int J Clin Exp Pathol 5 (1): 105–9. PMC 3267494. PMID 22295155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267494/.
  8. ↑ Winn B, Tavares R, Fanion J, Noble L, Gao J, Sabo E, Resnick MB (March 2009). "Differentiating the undifferentiated: immunohistochemical profile of medullary carcinoma of the colon with an emphasis on intestinal differentiation". Hum. Pathol. 40 (3): 398–404. doi:10.1016/j.humpath.2008.08.014. PMC 2657293. PMID 18992917. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657293/.
  9. ↑ Lin F, Shi J, Zhu S, Chen Z, Li A, Chen T, Wang HL, Liu H (August 2014). "Cadherin-17 and SATB2 are sensitive and specific immunomarkers for medullary carcinoma of the large intestine". Arch. Pathol. Lab. Med. 138 (8): 1015–26. doi:10.5858/arpa.2013-0452-OA. PMID 24437456.
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