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Adverse histological features in malignant colorectal polyps: a contemporary series of 239 cases
  1. Ian S Brown1,2,
  2. Mark L Bettington1,3,4,
  3. Andrew Bettington5,
  4. Gregory Miller1,4,
  5. Christophe Rosty1,4,6
  1. 1Envoi Specialist Pathologists, Brisbane, Queensland, Australia
  2. 2Department of Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  3. 3The Conjoint Gastroenterology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
  4. 4School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  5. 5Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
  6. 6Department of Pathology, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Ian S Brown, Envoi Specialist Pathologists, 5/38 Bishop Street, Kelvin Grove, QLD, 4059 Australia; IanBrown{at}envoi.com.au

Abstract

Aims Screening colonoscopy has led to more colorectal carcinomas presenting at an early stage potentially curable by endoscopic resection. In this study, we examined the clinical and histological features of a contemporary series of malignant colorectal polyps (MCPs) with subsequent surgical resection.

Methods We conducted a retrospective study on a consecutive series of MCPs from 239 patients, predominantly males (57.7%) with a median age of 66 years, and assessed histological parameters associated with residual disease on the surgical specimens.

Results Median MCP size was 18.6 mm, with 23.1% polyps measuring ≤10 mm. From the 140 surgical resection specimens, residual disease was identified in 20 cases, including 12 cases with metastatic lymph nodes and/or 9 cases with residual carcinoma in the large bowel wall. Histological parameters associated with nodal metastases were greater width and greater depth of the invasive component (p=0.001 and 0.006, respectively), poor differentiation (p=0.003) and a cribriform pattern (p=0.01). The risk of nodal metastases was 23.3% if two or three of these features were identified, while it was 0% and 4.5% if none or one was present, respectively. A positive margin was not associated with nodal metastasis and might be adequately treated by local endoscopic resection.

Conclusions Surgical resection should be recommended if ≥2 of these adverse histological features are present and may be warranted if one feature is present. A positive margin may require additional local resection but not necessarily surgery if no other adverse factors are present.

  • COLON
  • MALIGNANT TUMOURS
  • CANCER
  • GASTROINTESTINAL DISEASE

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