PATHOLOGICAL MORPHOLOGY AND CLINICO-PATHOLOGICAL FEATURES OF EARLY COLORECTAL CANCER

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  • HOSAKA Hisashi
    First Department of Pathology, Showa University School of Medicine
  • SAITO Koji
    First Department of Pathology, Showa University School of Medicine
  • ASONUMA Kunio
    First Department of Pathology, Showa University School of Medicine
  • TAKANO Yuichi
    First Department of Pathology, Showa University School of Medicine
  • OCHIAI Yasuo
    First Department of Pathology, Showa University School of Medicine
  • KITAYAMA Takeyoshi
    First Department of Pathology, Showa University School of Medicine
  • MOROHOSHI Toshio
    First Department of Pathology, Showa University School of Medicine

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Other Title
  • 早期大腸癌の病理形態像と臨床病理学的特徴
  • ソウキ ダイチョウガン ノ ビョウリ ケイタイゾウ ト リンショウ ビョウリガクテキ トクチョウ

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Primary colon cancers are often discovered as early cancer with a favorable prognosis, however, there are some cases of superficial colon cancer with an unfavorable prognosis. In this study, pathological examination was performed for cases of early colon cancer, to determine their clinico-pathological feature. A total of 413 cases of primary early colon carcinoma, all of which underwent total colon endoscopic examination and bioptic examination, were prepared for examination. Mean age of the patients was 64.5 years old, and males were dominant (M/F: 2.2). Primary focus was most dominantly at S-colon and rectum (257 cases: 62%), and then cecum-ascending colon (86 cases: 21%), transfer-colon (42 cases: 10%) and descending-colon (28 cases: 7%). Macroscopically, elevated type made up 61% (251 cases), flat type, 31% (130 cases), and depressed type 8% (32 cases). Histologically, the majority of cases are well differentiated adenocarcinoma (98%: 398 cases), and the next, moderately differentiated adenocarcinoma (4%: 15 cases). No case of poorly differentiated adenocarcinoma or undifferentiated carcinoma was included in this series. Combined cases with adenoma and carcinoma were the most common histological type in the elevated and flat type, but all cases of the Depressed type consisted purely of carcinoma with no adenoma-component. The most common type of early cancer was elevated type with intramural carcinoma (pM, 46%: 192 cases), followed by flat type with pM (24%: 101 cases), elevated type with submucal infiltration (pSM: 14%: 59 cases), flat type with pSM and depressed type with pSM (7%: 29 cases), and depressed type with pM (less than 1%: 3 cases). Lymphoid and venular infiltration were not found in pM cases, but lymph (12%: 51 cases) and venular (8%: 33 cases) infiltration was found in pSM cases. In conclusion, elevated and flat type of early colon cancer commonly consisted of carcinoma- and adenoma-components, and pM cases were more favorable. However, the depressed type is pure carcinoma with adenoma-components, and it may be considered as de novo cancer with an un-favorable prognosis with early infiltration into submucal layer and vessels. Consequently more aggressive therapy should be administered for those cases.

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