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Cribriform colon cancer: a morphological growth pattern associated with extramural venous invasion, nodal metastases and microsatellite stability
  1. Alexander S Taylor1,
  2. Natalia Liu2,
  3. Jiayun M Fang1,
  4. Nicole Panarelli3,
  5. Lili Zhao4,
  6. Jerome Cheng1,
  7. Purva Gopal5,
  8. Suntrea Hammer5,
  9. Jing Sun5,
  10. Henry Appelman1,
  11. Maria Westerhoff1
  1. 1Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California, USA
  3. 3Department of Pathology, Montefiore Medical Center, Bronx, New York, USA
  4. 4Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Department of Pathology, UT Southwestern, Dallas, Texas, USA
  1. Correspondence to Dr Alexander S Taylor, Pathology, University of Michigan, Ann Arbor, MI 48109, USA; taalexan{at}med.umich.edu

Abstract

Background Cribriform comedo-type adenocarcinoma was a colon cancer subtype recognised in the previous WHO classification of tumours that is no longer included in the recent edition. Previous reports have described colon cancers with cribriform growth as having worse overall survival and being associated with microsatellite stability. We sought to validate whether cribriform carcinoma (CC) is a distinct morphological subtype with clinical relevance in the context of modern colon cancer diagnosis.

Methods Consecutive cases of non-neoadjuvantly treated colon cancer resections were identified (n=177) and reviewed to evaluate for CC and other histopathological and clinical features. CC was defined as solid nests of cancer with round, ‘punched out’ spaces and intraluminal bridges, reminiscent of ductal carcinoma in situ of the breast.

Results CC was present in 18.6% of the consecutive case cohort. Compared with all other cases, CC was associated with positive lymph nodes, increased depth of invasion, extramural venous involvement (EMVI), and microsatellite stability, and was less likely to have tumour infiltrating lymphocytes (p<0.05). In contrast to previous reports, we did not find significantly worse overall, disease-specific or recurrence-free survival for CC. Morphological features mimicking CC occurred in 33.3% of all other colon cancer cases.

Conclusion Identifying CC may be useful due to its association with worse stage at presentation and EMVI, but given that cribriform-like appearance may be found in many colon cancer cases and that we did not find a survival difference for CC, CC may not necessitate its own subtype classification.

  • colon
  • pathology
  • surgical
  • gastrointestinal neoplasms
  • colorectal neoplasms
  • pathology
  • molecular

Data availability statement

No data are available. All data relevant to the study are included in the article.

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Data availability statement

No data are available. All data relevant to the study are included in the article.

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Footnotes

  • AST and NL are joint first authors.

  • Handling editor Runjan Chetty.

  • Twitter @alextaylormd

  • Contributors All authors contributed to interpretation of results and critical revision of the manuscript. In addition: AST and NL contributed to study design, data collection, data analysis, and drafting of the manuscript. JMF collected data regarding clinical outcomes and the results of ancillary testing. LZ performed and interpreted multivariate statistical analyses. JC designed parameters for case identification. NP, PG, SH and JS identified extrainstitutional cases that contributed significantly to the morphological definition of CC. HA identified the constellation of morphological features that helped define the entity, informing the design of the study, and contributed to histopathological review/verification of our cohort of CC cases. MW designed the study and oversaw data collection; she collected and verified all histopathological metrics personally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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