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. 2009 Jun 14;15(22):2708-13.
doi: 10.3748/wjg.15.2708.

Size does not determine the grade of malignancy of early invasive colorectal cancer

Takahisa Matsuda  1 , Yutaka Saito, Takahiro Fujii, Toshio Uraoka, Takeshi Nakajima, Nozomu Kobayashi, Fabian Emura, Akiko Ono, Tadakazu Shimoda, Hiroaki Ikematsu, Kuang I Fu, Yasushi Sano, Takahiro Fujimori
Affiliations

Size does not determine the grade of malignancy of early invasive colorectal cancer

Takahisa Matsuda et al. World J Gastroenterol. .

Abstract

Aim: To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers (EI-CRCs), and to determine whether malignancy grade depends on size.

Methods: A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study. Lesions were classified into two groups based on size: small (<or= 10 mm) and large (> 10 mm). Clinicopathological features, incidence of lymph node metastasis (LNM) and risk factors for LNM, such as depth of invasion, lymphovascular invasion (LVI) and poorly differentiated adenocarcinoma (PDA) were analyzed in all resected specimens.

Results: There were 120 (21%) small and 463 (79%) large lesions. Histopathological analysis of the small lesion group revealed submucosal deep cancer (sm: >or= 1000 microm) in 90 (75%) cases, LVI in 26 (22%) cases, and PDA in 12 (10%) cases. Similarly, the large lesion group exhibited submucosal deep cancer in 380 (82%) cases, LVI in 125 (27%) cases, and PDA in 79 (17%) cases. The rate of LNM was 11.2% and 12.1% in the small and large lesion groups, respectively.

Conclusion: Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.

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Figures

Figure 1
Figure 1
The lesion was located in the transverse colon. Endoscopic examination revealed a flat, elevated lesion with a central depression, which was macroscopically diagnosed as 0-IIa+IIc. The high-magnification view revealed a typical type VI pit (invasive) pattern on the depressed margin. The final endoscopic diagnosis was a 0-IIa+IIc type early colon cancer with submucosal deep invasion. However, patient strongly hoped EMR as an initial treatment. We performed EMR after injecting normal saline into the submucosa.
Figure 2
Figure 2
The final histopathological diagnosis was early invasive colon cancer, well-differentiated adenocarcinoma, sm-deep, NPG type, ly (-), v (-), cut end (+) (vertical margin positive). Since cancer was exposed in the vertical cut margin, additional surgical resection was performed and LNM was detected.
See this image and copyright information in PMC

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