Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;481(1):63-72.
doi: 10.1007/s00428-022-03332-5. Epub 2022 May 6.

Acellular mucin in lymph nodes isolated from treatment-naïve colorectal cancer resections: a clinicopathologic analysis of 16 cases

James E Lapinski  1 , Alok A Khorana  2 , Lisa Rybicki  3 , Canan Firat  4 , Hwajeong Lee  5 , Kathryn Piotti  6 , Eugene H Lewis 3rd  7 , Michael McNamara  2 , Vikram Deshpande  8 , Jinru Shia  4 , Deepa T Patil  9   10
Affiliations

Acellular mucin in lymph nodes isolated from treatment-naïve colorectal cancer resections: a clinicopathologic analysis of 16 cases

James E Lapinski et al. Virchows Arch. 2022 Jul.

Abstract

Lymph nodes with acellular mucin harvested from treated colorectal cancers (CRC) are staged as pN0. However, there is variability among pathologists while reporting the pN stage when acellular mucin is found within nodes of untreated CRCs. While the UICC guidelines suggest staging them as pN1, the AJCC and CAP do not offer any recommendations. In order to characterize their clinicopathologic features and outcome, we compared 16 untreated CRCs (study group; mean age: 68 years) harboring nodes with acellular mucin with 34 pN0 and 25 pN1 untreated CRC controls. All tumors were unifocal; 12 (75%) were right-sided lesions. Most cases (75%) showed one node with acellular mucin (range: 1-3). MMR-deficient tumors were significantly more common in the study group (83%) compared to pN0 (33%; p = 0.006) and pN1 controls (8%; p < 0.001). The overall survival of study group patients was closer to pN0 compared to pN1 controls; however, this difference was not statistically significant. In conclusion, untreated CRC that harbor acellular mucin within lymph nodes commonly present as right-sided, MMR-deficient tumors in older women that show a non-mucinous phenotype. While the limited number of cases precludes us from making any formal recommendations about staging, we suggest that the finding of acellular mucin in a node should prompt evaluation of deeper levels (with or without cytokeratin immunohistochemistry) and submission of all pericolonic fat for additional lymph node harvest. Whether acellular mucin in nodes of untreated CRCs is related to the indolent biology of the disease, a robust local immune response or MMR deficiency requires further investigation.

Keywords: Acellular mucin; Colon cancer; Lymph nodes; Untreated.

PubMed Disclaimer

Conflict of interest statement

DECLARATIONS:

Conflict of interest: Alok A. Khorana, M.D. - Receives Institutional grant support from NIH, CDC, Leap, BMS, Celgene, Merck; Consulting fees from Janssen, Bayer, Pfizer, Anthos, Sanofi, BMS, Seagen, honorarium from Medscape for CME events, Support for attending meetings and/or travel from Janssen, Bayer, Seagen, BMS; Participated on a Data

Safety Monitoring Board or Advisory Board - Bayer, BMS, Janssen; Medical and Scientific Advisory Board, NBCA (unpaid).

All remaining authors have no conflicts of interest.

Figures

Figure 1:
Figure 1:
Acellular mucin deposit within a pericolonic lymph node from a 66-year-old woman with invasive moderately differentiated adenocarcinoma involving the ascending colon (pT3). (20X magnification)
Figure 2:
Figure 2:
Kaplan-Meier curve comparing survival outcomes shows that the clinical outcome of patients with acellular mucin (cases; study group) was more similar to pN0 controls compared to pN+ (N1) colon cancer controls.
See this image and copyright information in PMC

References

    1. Booth CM, Nanji S, Wei X, Peng Y, Biagi JJ, Hanna TP, Krzyzanowska MK, Mackillop WJ (2016) Use and Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer: A Population-Based Study J Natl Compr Canc Netw 14:47–56. doi: 10.6004/jnccn.2016.0006 - DOI - PubMed
    1. Haller DG, Catalano PJ, Macdonald JS, O’Rourke MA, Frontiera MS, Jackson DV, Mayer RJ (2005) Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089 J Clin Oncol 23:8671–8678. doi: 10.1200/JCO.2004.00.5686 - DOI - PubMed
    1. Sargent D, Sobrero A, Grothey A, O’Connell MJ, Buyse M, Andre T, Zheng Y, Green E, Labianca R, O’Callaghan C, Seitz JF, Francini G, Haller D, Yothers G, Goldberg R, de Gramont A (2009) Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials J Clin Oncol 27:872–877. doi: 10.1200/JCO.2008.19.5362 - DOI - PMC - PubMed
    1. Franke AJ, Parekh H, Starr JS, Tan SA, Iqbal A, George TJ Jr. (2018) Total Neoadjuvant Therapy: A Shifting Paradigm in Locally Advanced Rectal Cancer Management Clin Colorectal Cancer 17:1–12. doi: 10.1016/j.clcc.2017.06.008 - DOI - PubMed
    1. Jessup JM, Goldberg RM, Asare EA, et al. (2017) Colon and Rectum. In: Amin MB (ed) AJCC Cancer Staging Manual, 8th.edn. Springer, Chicago (IL), pp. 251–274