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Colorectal cancer (CRC) occurs as multiple, either synchronous or metachronous, neoplasms in 2–5% of the patients.1 Their onset may reflect either independent primaries or a metastatic spread from an original single neoplastic site. A careful pathological workup in order to clarify the origin of multiple colonic tumours is crucial to guide treatment. However, in some instances this distinction is challenging, requiring an accurate characterisation of the individual tumours, as exemplified by the case reported by Li et al.2 Indeed, in this study, two synchronous CRCs shared similar histology, immunohistochemical features and even the same microsatellite instability profile; thus, a lymphovascular metastatic spread was considered the most likely underlying mechanism. Though, KRAS testing, performed by real-time PCR using Taqman probes, detected a mutation in only one tumour. This demonstration of a distinct clonal origin of the two neoplasms led to a combined drug treatment suitable for both lesions. While in this case, simply testing for KRAS was sufficient to clarify the distinct nature of …
Contributors UM and GT: conceived the experiments and wrote the paper. CB: contributed as a pathologist. CC and ADS: contributed as oncologists.
Competing interests None declared.
Patient consent Obtained.
Ethics approval Institutional Review Board, Carlo Romano.
Provenance and peer review Not commissioned; internally peer reviewed.