CANCER ARISING IN INTESTINAL ADENOMA: % OF

LYMPH NODE METASTASIS

Low risk 0-7%

High risk 12- 35%

Sm1: Invasion from the mucosa to 300 : no limph node mts

1

3

2

H

A

G

G

I

T

T

KUDO123

KIKUCHI ‘95

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)

SEQUENZA ADENOMA-CARCINOMA

CANCRO CON FENOTIPO MSS

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%

SEQUENZA ADENOMA-CARCINOMA

CANCRO CON FENOTIPO MSI

MSH2

MLH1Microsatellite instability

Mutation

TGFbeta , BAX

TREATMENT OF DYSPLASIA IN IBD

• SPORADIC ADENOMA DALM

WITH EARY CANCERDysplasia Associated Lesions or Masses

POLIPECTOMY COLECTOMY

R. Odze ‘03

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)

Ca colon-retto

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

inattivato MLH1

epigeneticam.

15 %85 %

10 %5 %

mutato gene del Mismatch

Repair

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