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Questions and Answers
What is the characteristic of the nuclei in cylindrical epithelial cells in the colon?
What is the characteristic of the nuclei in cylindrical epithelial cells in the colon?
What is the most common etiology of polyp formation in the colon?
What is the most common etiology of polyp formation in the colon?
What is the characteristic of a sessile polyp?
What is the characteristic of a sessile polyp?
What is the characteristic of a hyperplastic polyp?
What is the characteristic of a hyperplastic polyp?
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What is the characteristic of a tubular adenoma (dysplastic polyp)?
What is the characteristic of a tubular adenoma (dysplastic polyp)?
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What is the characteristic of a T1 stage tumor in the TNM classification?
What is the characteristic of a T1 stage tumor in the TNM classification?
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What is the characteristic of the epithelial cells in Adenocarcinoma colon?
What is the characteristic of the epithelial cells in Adenocarcinoma colon?
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What is the stepwise process in the development of colon carcinoma?
What is the stepwise process in the development of colon carcinoma?
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What is the significance of the differentiation grade in colon carcinoma?
What is the significance of the differentiation grade in colon carcinoma?
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What is the characteristic of a well-differentiated colon carcinoma?
What is the characteristic of a well-differentiated colon carcinoma?
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What is the role of APC in the Wnt pathway?
What is the role of APC in the Wnt pathway?
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What is the risk of endometrial carcinoma in Lynch syndrome?
What is the risk of endometrial carcinoma in Lynch syndrome?
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What is the characteristic of MSI-high CRC in Lynch syndrome?
What is the characteristic of MSI-high CRC in Lynch syndrome?
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What is the characteristic of MSI-high CRC in sporadic cases?
What is the characteristic of MSI-high CRC in sporadic cases?
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Study Notes
TNM Classification
- T1 stage: superficial tumor
- T2 stage: lamina propria
- T3 stage: beneath muscle, in fat tissue
- T4 stage: outside of colon, metastasis
Colon Epithelial Cells
- Normal cells: nuclei located at the bottom
- Tumor cells: nuclei not neatly located at the bottom
- Goblet cells: whitish, decrease in number with tumor formation
Polyps
- Polyp shape: varies
- Etiology:
- Hyperplasia: most common, no danger for tumor formation
- Neoplasia: dysplastic polyps
- Inflammation
- Forms of polyps:
- Pedunculated polyp: stalk polyp
- Sessile polyp: often caused by hypermethylation, BRAF mutations
Hyperplastic Polyp
- Serrated lumina (up and down lumen)
- No dysplasia
- No hyperchromasia, enlarged nuclei, disturbed growth patterns, or mitosis
- Many Goblet cells present
Dysplastic Polyp
- Hyperchromasia
- Enlarged nuclei
- Disturbed growth patterns
- Mitoses
- Few or no Goblet cells
Adenocarcinoma Colon
- Submucosal proliferation of glands
- Epithelial cells also under the mucosal layer (invasive growth)
Development of Colon Carcinoma
- Stepwise process
- Accumulation of mutations
- Morphologic features increasing during progression
Genes Involved in Colon Carcinoma
- APC
- KRAS
- SMAD2/SMAD4
- TP53
Population Screening
- pT1 CRC: targeted screening
Risks and Follow-up
- Lymph node metastases: risk assessment based on differentiation grade
- High-risk patients: removal of lymph node
Differentiation Grade
- Well differentiated: tubules in >95% of the tumor
- Moderately differentiated: tubules in 50-95% of the tumor
- Poorly differentiated: tubules in <50% of the tumor
Familial Syndromes
- FAP: germline mutation of APC, part of the Wnt pathway
- Lynch syndrome: non-polyposis, high risk for endometrial carcinoma
- MAP: MUTYH-associated polyposis
- Other familial syndromes
Microsatellite Instability
- MSI-high: sporadic (15%) or Lynch syndrome (2-3%)
- Germline defects in one of the MMR-genes (MLH1, PMS2, MSH2, and MSH6)
Lynch Syndrome Cancers
- Colorectal cancers (80%)
- Endometrial cancers (50%)
- Other cancers (pancreatic, gastric, small bowel, sebaceous skin, ovarian, genitourinary, GBM)
- Screening: colonoscopy, endometrial sampling, transvaginal ultrasound, dermatological examination, urine testing
MSI-HIGH CRC (Sporadic)
- Mostly MLH-1 promoter methylation
- IHC MLH1 and PMS-2 negative
- BRAF V600E mutation
Pathology of MSI-H Colon-Carcinoma
- Right-sided
- Older age
- Genes frequently involved: known
- New possibilities for immunotherapies
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Description
This quiz covers the TNM classification system for colorectal cancer, including the different stages of tumor progression and the histopathological changes observed in the colon.
