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. 2017 Dec 12;17(1):158.
doi: 10.1186/s12876-017-0702-x.

Clinicopathologic and endoscopic features of early-stage colorectal serrated adenocarcinoma

Daiki Hirano  1 , Shiro Oka  2 , Shinji Tanaka  3 , Kyoku Sumimoto  1 , Yuki Ninomiya  1 , Yuzuru Tamaru  1 , Kenjiro Shigita  1 , Nana Hayashi  3 , Yuji Urabe  1 , Yasuhiko Kitadai  4 , Fumio Shimamoto  5 , Koji Arihiro  6 , Kazuaki Chayama  1
Affiliations

Clinicopathologic and endoscopic features of early-stage colorectal serrated adenocarcinoma

Daiki Hirano et al. BMC Gastroenterol. .

Abstract

Background: Serrated adenocarcinoma (SAC) is a distinct colorectal carcinoma variant that accounts for approximately 7.5% of all advanced colorectal carcinomas. While its prognosis is worse than conventional carcinoma, its early-stage clinicopathologic features are unclear. We therefore aimed to clarify the clinicopathologic and endoscopic characteristics of early-stage SACs.

Methods: Forty consecutive early-stage SAC patients at Hiroshima University Hospital were enrolled; SACs were classified into epithelial serration (Group A, n = 17) and non-epithelial serration (Group B, n = 23) groups. Additionally, we classified serrated adenoma into 4 types: sessile serrated adenoma (SSA), traditional serrated adenoma (TSA), unclassified, and non-serrated adenoma type.

Results: There were significant differences between Groups A and B in terms of tumor size (27.6 vs. 43.1 mm), incidences of T1 carcinoma (71% vs. 13%), and having the same color as normal mucosa (47% vs. 17%), respectively (p <0.01). In SACs >20 mm, the incidence of T1 carcinoma in Group A (70%) was significantly greater than that in Group B (13%) (p <0.05). There were significant differences in 'Japan NBI Expert Team' type 3 and type V pit pattern classifications between the 2 groups. The average TSA-type tumor size (42.6 mm) was significantly larger than that of the SSA (17.2 mm) and non-serrated component types (18.3 mm). The incidences of submucosal invasion in SSA- (80%), unclassified- (100%), and non-serrated-type (100%) tumors were significantly higher than that in the TSA type (11%).

Conclusions: Epithelial serration in the cancerous area and a non-TSA background indicated aggressive behavior in early-stage SACs.

Keywords: Colorectal cancer; Narrow band imaging; Pit pattern; Serrated adenocarcinoma.

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Conflict of interest statement

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the Hiroshima University Hospital. Written informed consent was obtained from all patients who participated in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A case of Tis serrated adenocarcinoma with a serrated adenoma. a Colonoscopic view of a serrated adenocarcinoma lesion in the ascending colon. b Endoscopic findings after indigo carmine spraying; the small elevated nodule in the tumor can be observed. c Magnifying narrow-band imaging (NBI) observation. In the tumor lesion, mucosa with a Japan NBI Expert Team classification type B can be observed. d Magnifying endoscopic finding after indigo carmine dye spraying. Type II-open-containing normal type II pits are observed in the tumor. e Hematoxylin and eosin (HE) staining of the whole specimen. f, g High-power view of the HE-stain specimen; a section of adenocarcinoma is shown
Fig. 2
Fig. 2
A case of T1 serrated adenocarcinoma without a serrated adenoma. a Colonoscopic view of serrated adenocarcinoma in the cecum. b Endoscopic view after indigo carmine dye spraying. A 0-Is lesion is clearly delineated. c Magnifying narrow-band imaging (NBI) observation; a Japan NBI Expert Team classification type 2B lesion can be observed. d Magnifying view of a crystal violet-stained section. e Hematoxylin and eosin (HE) staining of the whole specimen. f Immunostaining of the specimen with anti-desmin antibody; the muscle fibers are no longer visible. g High-power view of HE-stained specimen; epithelial serration is visible, and adenocarcinoma can be observed invading the submucosa
See this image and copyright information in PMC

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