ADENOMAS WITH ADENOCARCINOMA: A STUDY EVALUATING THE RISK OF RESIDUAL CANCER AND LYMPH NODE METASTASIS
|
|
- Melissa Morris
- 6 years ago
- Views:
Transcription
1 253SJS / S. E. Steigen, et al.adenomas with adenocarcinomas and risk factors Scandinavian Journal of Surgery 102: 90 95, 2013 ADENOMAS WITH ADENOCARCINOMA: A STUDY EVALUATING THE RISK OF RESIDUAL CANCER AND LYMPH NODE METASTASIS S. E. Steigen 1,2, V. Isaksen 1,2, A. Skjæveland 3, B. Vonen 4,5,6 1 Department of Pathology, University Hospital of North Norway, Tromsø, Norway 2 Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway 3 Health Centre Sagvåg, Vassneset 1, Sagvåg, Norway 4 Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway 5 Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway 6 Nordland Hospital, Bodø, Norway ABSTRACT Background and Aims: The increasing number of cases with colorectal adenomas with adenocarcinoma necessitates renewed evaluation of classification systems and risk factors. The aim for this retrospective study was to evaluate the potential risk of residual cancer and lymph node metastasis in patients with colorectal adenomas with adenocarcinoma. Material and Methods: An investigation of adenomas with adenocarcinoma in 74 patients was performed on histological slides and compared with clinical characteristics. A total of 44 of the samples were from macroscopically and microscopically completely resected lesions, and cancer at extended surgery was compared with pathology reports, classifications, and histopathological features. Results: In all, 26 cases of adenomas with adenocarcinoma in the rectum and rectosigmoid were among women and 11 in men while 22 men as opposed to 15 women had primary lesions in colon, giving a significant association between gender and localization (p = 0.01). For macroscopically and microscopically fully resected lesions, Haggitt classification or submucosal invasion did not correlate with cancer at extended surgery. The lack of information on resection margins in the primary pathology reports was found to correlate significantly with residual cancer at extended surgery (p < 0.001) with residual cancer in 3 out of the 10 cases with no information, 1 out of the 5 where the resection margins were uncertain, 1 out of the 4 where the resection margins were not free, and none of the 25 cases when the resection margins were reported as free. In colon, 1 case out of the 6 with extended surgery (16.7%) was diagnosed with residual cancer compared with 4 out of the 10 (40%) from rectum. Conclusions: Haggitt or submucosal classifications were not found to be predictors for residual cancer in the remaining bowel tissue or lymph node metastasis. The only significant factor indicating increased risk of residual cancer was the lack of information on resection margins in the pathology report. Surgeons should therefore be alert when adenomas with adenocarcinomas are not confirmed as microscopically free in the pathology report. Key words: Adenoma with adenocarcinoma, Haggitt, submucosal invasion, resection margins, location, residual cancer Correspondence: Sonja E. Steigen Department for Pathology University Hospital of North Norway N-9038 Tromsø Norway Sonja.steigen@unn.no
2 Adenomas with adenocarcinomas and risk factors 91 INTRODUCTION A colorectal polyp can histologically be classified as hyperplastic or adenomatous, with only the latter being regarded as a premalignant lesion. The adenoma-carcinoma sequence is widely accepted as a model for the development of adenocarcinoma in colon and rectum (1 3). The prevalence of adenomas varies among countries but was found to be just slightly less than 20% in a large regional cohort screening study of sigmoid tumors among 50- to 64-yearolds (4). In endoscopy studies, the prevalence of adenomas in colon is somewhat higher at around 25%, and in an autopsy study, there were twice as many adenomas in colon than adenomas found in the sigmoid and rectum (5, 6). Adenomas are often classified as pendunculated or sessile ( flat, without stalk), the former being more common. In some adenomas, there is an invasive component that has penetrated the basal basement in the mucosa but is still limited to the submucosa. Such adenocarcinoma in adenomas is classified as T1 tumors in the tumor, node, metastasis (TNM) classification (7). With a biopsy from an adenoma with adenocarcinoma, a histological assessment is performed to estimate the probability of residual cancer in the bowel wall. A classification was introduced by Haggitt in 1985 (8). Adenocarcinoma confined to the upper part of the polyp head just under the mucosa is graded as level 1, while adenocarcinomas invading the submucosa in the head, neck, or stalk of a pendunculated adenoma are graded as level 2, 3, or 4 according to the depth of invasion. Adenocarcinoma invading into submucosa at the base of the stalk is classified as level 4, and so is adenocarcinoma in any sessile adenoma. If the adenocarcinoma has invaded beyond the submucosa into the muscularis propria, it is a T2 tumor, and the Haggitt classification is not applicable. Haggitt suggested that the different levels of invasiveness of the adenocarcinoma in an adenoma correlated with the presence of metastasis to regional lymph nodes. A few other reports have studied the occurrence of residual cancer, recurrent or metastatic disease on longterm follow-up of patients with adenocarcinoma in adenomas treated with polypectomy, and these showed similar correlation with the classification of levels of Haggitt (9 12). Aiming for new guidelines for management of cancer in polyps, Kikuchi et al. (13) evaluated the influence of level of invasion in the submucosa according to the previously defined criteria (14); Sm 1 when there is slight submucosal (Sm) invasion (upper third), Sm 2 with an intermediate Sm invasion (middle third), and Sm 3 with invasion near the muscularis propria (lower third). Using this classification, lesions with Haggitt level 1, 2, and 3 are all Sm 1, and level 4 (sessile or penduncular) can be Sm 1, Sm 2, or Sm 3 depending on the depth of Sm invasion. Tissue sampling is important, as a biopsy must be representative for the whole lesion. Several studies have shown that the rate of adenocarcinoma in adenomas in biopsies is underestimated when compared with later total polypectomy (15, 16). The excision margins have also been discussed. Free distance from cancer to resection margin of less than 1 mm has been regarded as a high-risk factor and a 2- to 3-mm tumorfree margin is argued as sufficient to inhibit local recurrence (17 19). The aim of this study was to evaluate adenomas with adenocarcinoma according to the established classifications and other clinicopathological factors and to estimate the probability of risk for residual cancer and lymph node metastasis. This is to ensure correct follow-up and treatment for patients with such lesions. PATIENTS AND METHODS The University Hospital of North Norway serves a population of approximately 231,500 with pathology services. The coding system is according to The Systematized Nomenclature of Medicine (SNOMED). Cases were identified by searching for colon and rectal biopsies with adeocarcinomas in adenomatous polyps and cases diagnosed as a combination of adenomatous polyps and adenocarcinoma. The archival slides were all initially stained with hematoxylin and eosin according to the standard procedures and evaluated using light microscopy. In our study, all cases were re-evaluated by two experienced pathologists in addition to one medical student. A total of 84 unique specimens were identified over the 11-year period investigated, 37 from men and 47 from women. Ten cases (four men and six women) were excluded from the study due to fragmented specimens or invasive adenocarcinoma beyond submucosa discovered at our second revision yielding 74 patients with adenomas with adenocarcinomas. A total of 25 of the cases from colon and 27 of the cases in the rectum and rectosigmoid group were first diagnosed using biopsies, while 19 had primary resections and 3 had undergone transanal endoscopic microsurgery (TEM). Among the 52 biopsied lesions, the endoscopist reported that in five cases, the lesion was not completely resected, and in three cases, the resection margins were difficult for the pathologist to interpret, giving a possibility for residual cancer in the margins. This left 44 cases for examination for residual cancer at extended surgery, which was performed on 19 cases shortly after diagnosis was given on the biopsy (92% within 2 months). The patients were recruited from five different hospitals, so endoscopic follow-up was difficult to incorporate into the study, but with one shared pathology department for all these institutions; colorectal biopsies from 38 of the patients were later evaluated. This study was approved by the regional ethics committee. All data were tabulated and analyzed with PASW statistics 18 (IBM SPSS), and the chi-squared test was used to study relations of various risk factors. Differences and correlations were considered significant at the level of p < RESULTS The basic characteristics of all the 74 patients with adenomas with adenocarcinoma are listed in Table 1.
3 92 S. E. Steigen, et al. TABLE 1 Basic characteristics of all cases. Men Women Cases Age of all cases Range Median Mean Age colon Range Median Mean Age rectum Range Median Mean Localization Ascendens 1 1 Transversum 2 0 Descendens 3 1 Sigmoideum Rectosigmoideum 2 4 Rectum 9 22 Size (mm) < > Cases/year TABLE 2 Haggitt classification correlated with findings at extended surgery and lymph node metastasis for all cases primarily diagnosed on biopsies with free resection margins. Total number of cases No resection Resection without cancer Resection with residual cancer* Lymph node metastasis Haggitt level Haggitt level Haggitt level Haggitt level *p= The follow-up time was between 25 and 346 months (median 74 months). A total of 26 cases of the adenomas with adenocarcinoma in the rectum group were among women and 11 in men while 22 men as opposed to 15 women had primary lesions in colon, giving a significant association between gender and localization (p = 0.01). Haggitt classification was evaluated on all samples, including biopsies, resections, and TEMs, except for eight cases where the interpretation was difficult due to incomplete resection margins, giving 16 graded as level 1, 20 as level 2, 11 as level 3, and 19 as level 4. For the 44 biopsies diagnosed on macroscopically and microscopically freely resected lesions, the classification was compared with residual cancer at extended surgery and lymph node metastasis (Table 2). No association was found between the Haggitt classification and the further resection with or without residual cancer or lymph node metastasis. Similarly, the total numbers of cases with Sm invasion were 53 in Sm 1, 4 in Sm 2, and 9 in Sm 3, and the depth of the invasion in the 44 biopsies compared with residual cancer and lymph node metastasis is shown in Table 3. When calculating only with regard to the 44 biopsy specimens, no significant correlation between appearance of residual cancer at extended surgery or lymph node metastasis was found. When comparing Haggitt s classification with a classification according to the Sm invasion, all cases in Haggitt level 1 3 were Sm 1, while at Haggitt level 4, one was Sm 1 and four were Sm 3. In the cases where biopsy reports did not give any information about the resection margins, there was a significantly higher incidence of residual cancer at extended surgery (p < 0.001) even if the lesions were completely removed according to the endoscopist (Table 4). Most of the cases with missing information about resection margins were reported the first 6 years of investigation with 9 cases, while 5 cases the last 5 years. There is a significant association between cases with missing information on resection margins and being from the period prior to 2004 (p = 0.04).
4 Adenomas with adenocarcinomas and risk factors 93 TABLE 3 Classification according to the submucosal invasion correlated with findings at extended surgery and lymph node metastasis for all cases primarily diagnosed on biopsies with free resection margins. Total number of cases No resection Resection without cancer Resection with residual cancer* Lymph node metastasis Sm Sm *p=0.897; Sm: submucosal. TABLE 4 Information from primary pathology reports about resection margins in biopsies correlated with finding at extended surgery and lymph node metastasis for all cases primarily diagnosed on biopsies with free resection margins. Total number of cases No resection Resection without cancer Resection with residual cancer* Lymph node metastasis Free resection margin Cancer at resection margins Uncertain resection margins No information about resection margins *p< Of the 44 cases with completely resected lesions, 6 cases with localization in colon, 3 cases from the rectosigmoid, and 10 cases from rectum received extended surgical resections. In colon, 1 case out of the 6 (16.7%) was diagnosed with residual cancer compared with 4 out of the 10 (40%) from rectum. No cases with residual cancer were found in the rectosigmoid group. The only case with a lymph node metastasis at extended surgery had primary lesion in the distal part of rectum. In all, 6 men and 13 women had extended resections performed after the diagnosis of adenocarcinoma in adenoma, with residual cancer in 3 cases in the first group and 2 in the latter without any significant increased risk with respect to gender. The diameter of colonic lesions was not significantly larger than the rectal and rectosigmoid lesions (mean vs mm). No correlation was found between size of lesion and gender. Size was found to associate neither with site of primary lesion nor with residual cancer on extended surgery or lymph node metastasis. Approximately two-thirds of the lesions were classified as adenomas with adenocarcinoma with a tubular pattern, while one-third of the lesions had tubulovillous features. Two cases were classified as villous and included in the tubulovillous group. The mean diameter of the tubular lesions was mm and the tubulovillous lesions mm. A total of 26 cases in colon and 27 cases in rectum and rectosigmoidal were classified as tubular, and 11 colon and 10 rectal and rectosigmoidal cases were classified as tubulovillous. Tubular versus tubulovillous features for only the biopsies were not associated with the risk of residual cancer at extended surgery or lymph node metastasis. Follow-up colorectal biopsies from 38 patients were evaluated after the diagnosis of adenoma with adenocarcinoma. In all, 22 of the patients had the first biopsies taken between 2 and 7 months after the primary diagnosis. No further cancer was found in any of these biopsies. DISCUSSION Management of adenomas with adenocarcinoma is complex, with achieving a balance between clinical settings and pathology reports being a challenge. Critical and renewed validation of existing classifications and evaluation of risk factors is most appropriate as more cases are likely to be found in upcoming screening programs for colorectal cancers. Haggitt classified adenomas with adenocarcinoma into four levels he and others claimed that classification into level 1 hardly ever gave residual cancer with slightly increasing incidence for level 2 and level 3. For level 4, the risk of residual cancer was described to be 15% 25% (8, 11, 12). Haggitt s study included 129 cases, later studies by Coverlizza included 31 cases and Pollard s 82 cases. In a study by Kyzer et al. (20), 44 patients out of a total of 82 had extended surgery after polypectomi with residual cancer in three cases, all being previously classified as Haggitt level 4. In a study of 151 patients by Nivatvongs et al. (21) in 1991, no incidence of lymph node metastasis was found with Haggitt level 1, 2, or 3, suggesting the distinction between levels 1 3 and level 4 was unnecessary. The other classification used is the depth of invasion in submucosa, and adenomas with adenocarcinoma are regarded as high-risk lesions for the presence of lymph node metastasis when the invasion is at the level of Sm 3 and perhaps also Sm 2 (13, 14). Our results do not support the use of Haggitt or Sm classifications as reliable predictors of finding residual cancer in the remaining regional bowel tissue or lymph nodes. Adenocarcinoma in adenomas with location in the rectum is regarded as an important factor for residual
5 94 S. E. Steigen, et al. disease and for lymph node metastasis. In our series, a higher number of lesions with residual cancer were observed at extended surgery in rectal lesions compared with colonic lesions. This is in accordance with studies done on risk for high-grade dysplasia in adenomas, where a significant higher number was found in the rectum compared to locations in colon (22). Kikuchi et al. (13) also found that location in rectum was a significant risk factor for the development of lymph node metastasis and local recurrence compared to other locations in the large bowel. The completeness and free margins after excision of premalignant and malignant lesions have previously been accepted as important risk factors (17, 23). Incomplete resection margins are most likely an important and independent factor for adverse outcomes (18), but the importance of the distance to free margins might still be discussed. In our experience, the resection margins can be difficult to judge because of heat damage from diathermy. Cells with an atypical appearance close to the resection margin can be difficult to interpret as malignant or simply damaged cells. In our study, the adenomas with adenocarcinoma where no information of the resection margins was available in the primary pathology report had the highest risk of containing residual cancer at extended surgery. This lack of information on resection margins can be due to the standard of reporting from the individual pathologist or simply just forgotten. Most of the reports with lack of information were from the first year of this study, implying that there might have been improvements over time in the routines for reporting resection margins in adenomas with adenocarcinoma. In our department, two pathologists now evaluate all new premalignant and malignant cases to ensure adequate reporting. Size is often regarded as an important risk factor, but some studies challenge this. In a smaller study by Whitlow et al. (24), the range of the size of the adenomas with adenocarcinoma was reported without commenting on size being of importance for the results on long-time survival after treatment. This suggests that size did not play a significant role. In the study by Kikutchi et al. (13) with 182 patients, the diameter was not found to be a risk factor for lymph node metastasis and local recurrence. In a study by Hermanek et al. (25) of more than 2000 adenomas, close to 200 were found to harbor adenocarcinoma with the size influencing the malignancy rate. In our study, the lesions from colon were slightly larger compared with those from rectum and rectosigmoid, but no significance was found concerning the risk of malignancy in extended resection. Thus in our study, other factors seem to weigh more than size as risk factors for the presence of residual cancer. A slight increase in the number of cases the last 5 years could be due to an increase in the occurrence of adenocarcinoma in adenomas, or just as likely due to increased awareness of the adenoma-carcinoma sequence resulting in more biopsies. Pathologists might also have been less aware of the diagnosis earlier and therefore overlooked the diagnosis or failed to report them. The average age in the population is rising, and this could account for the increase in number of cases. More lesions appear with increasing age, and the fact that a larger number of women get this disease may simply reflect that they live longer than men. For the pathologist, a frequent challenge is the lack of orientation of biopsies. Small biopsies less than 1 cm in diameter are often too small to be divided alongside the stalk, and fixation in formalin also makes the tissue curl up, making the orientation even more difficult. Fragmented and shallow biopsies can be impossible to interpret with a risk of overlooking a cancer. CONCLUSION We could not reproduce previous results where classifications based on levels of adenocarcinoma in an adenoma or depth of Sm invasion to predict the risk of residual cancer in extended resections or lymph node metastasis. In our study, the only factor indicating increased risk of residual cancer was adenomas with adenocarcinomas with lack of information on resection margins in the pathology report. It is important that the surgeons be aware of the prognostic implications of incomplete or uncertain resection margins as this should be an indication for reexcision. The pathologist should likewise be aware that description of resection margins is of clinical importance for the patient. REFERENCES 1. Stryker SJ, Wolff BG, Culp CE et al: Natural history of untreated colonic polyps. Gastroenterology 1987;93: Fearon ER, Vogelstein B: A genetic model for colorectal tumorigenesis. Cell 1990;61: Shen L, Toyota M, Kondo Y et al: Integrated genetic and epigenetic analysis identifies three different subclasses of colon cancer. Proc Natl Acad Sci U S A 2007;104 : Gondal G, Grotmol T, Hofstad B et al: The Norwegian Colorectal Cancer Prevention (NORCCAP) screening study: Baseline findings and implementations for clinical work-up in age groups years. Scand J Gastroenterol 2003;38: Neugut A, Jacobsen J, Rella V: Prevalence and incidence of colorectal adenomas and cancer in asymptomatic persons. Gastrointest Endosc Clin N Am 1997;7: Eide TJ, Stalsberg H: Polyps of the large intestine in Northern Norway. Cancer 1978;42: Sobin LH, Gospodarowicz MK, Wittekind C: TNM classification of malignant tumours, 7th ed., Wiley-Blackwell, Haggitt RC, Glotzbach RE, Soffer EE et al: Prognostic factors in colorectal carcinomas arising in adenomas: Implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985;89: Rothenberger D, Garcia-Aguilar J: Management of cancer in a polyp. In: Saltz L (Ed.) Colorectal cancer: Multimodality management, 1st ed. Humana Press Inc., Totowa, NJ, 2002, pp Stein BL, Coller JA: Management of malignant colorectal polyps. Surg Clin North Am 1993;73: Pollard CW, Nivatvongs S, Rojanasakul A et al: The fate of patients following polypectomy alone for polyps containing invasive carcinoma. Dis Colon Rectum 1992;35: Coverlizza S, Risio M, Ferrari A et al: Colorectal adenomas containing invasive carcinoma. Pathologic assessment
6 Adenomas with adenocarcinomas and risk factors 95 of lymph node metastatic potential. Cancer 1989;64: Kikuchi R, Takano M, Takagi K et al: Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995;38: Sakatani A, Koizumi K, Maruyama M: Diagnosis of sm cancer of the large intestine with special reference to its x-ray diagnosis. Stomach Intest 1991;26: Gondal G, Grotmol T, Hofstad B et al: Biopsy of colorectal polyps is not adequate for grading of neoplasia. Endoscopy 2005;37: Absar MS, Haboubi NY: Colonic neoplastic polyps: Biopsy is not efficient to exclude malignancy. The Trafford experience. Tech Coloproctol 2004;8(Suppl. 2):s257 s Seitz U, Bohnacker S, Seewald S et al: Is endoscopic polypectomy an adequate therapy for malignant colorectal adenomas? Presentation of 114 patients and review of the literature. Dis Colon Rectum 2004;47: Netzer P, Forster C, Biral R et al: Risk factor assessment of endoscopically removed malignant colorectal polyps. Gut 1998;43: Cooper HS, Deppisch LM, Gourley WK et al: Endoscopically removed malignant colorectal polyps: Clinicopathologic correlations. Gastroenterology 1995;108: Kyzer S, Begin LR, Gordon PH et al: The care of patients with colorectal polyps that contain invasive adenocarcinoma. Endoscopic polypectomy or colectomy? Cancer 1992;15: Nivatvongs S, Rojanasakul A, Reiman HM, et al: The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma. Dis Colon Rectum 1991;34: Kristjansdottir S, Jonasson JG, Cariglia N et al: Colonic adenomas found via colonoscopy: Yield and risk factors for highgrade dysplasia. Digestion 2010;82: Hassan C, Zullo A, Risio M et al: Histologic risk factors and clinical outcome in colorectal malignant polyp: A pooled-data analysis. Dis Colon Rectum 2005;48: Whitlow C, Gathright JB Jr, Hebert SJ et al: Long-term survival after treatment of malignant colonic polyps. Dis Colon Rectum 1997;40: Hermanek P, Fruhmorgen P. Guggenmoos-Holzmann I, et al: The malignant potential of colorectal polyps a new statistial approach. Endoscopy 1983;15:16-20 Received: August 16, 2012 Accepted: November 19, 2012
Large Colorectal Adenomas An Approach to Pathologic Evaluation
Anatomic Pathology / LARGE COLORECTAL ADENOMAS AND PATHOLOGIC EVALUATION Large Colorectal Adenomas An Approach to Pathologic Evaluation Elizabeth D. Euscher, MD, 1 Theodore H. Niemann, MD, 1 Joel G. Lucas,
More informationmalignant polyp Daily Challenges in Digestive Endoscopy for Endoscopists and Endoscopy Nurses BSGIE Annual Meeting 18/09/2014 Mechelen
Plan Incidental finding of a malignant polyp 1. What is a polyp malignant? 2. Role of the pathologist and the endoscopist 3. Quantitative and qualitative risk assessment 4. How to decide what to do? Hubert
More informationManagement of pt1 polyps. Maria Pellise
Management of pt1 polyps Maria Pellise Early colorectal cancer Malignant polyp Screening programmes SM Invasive adenocar cinoma Advances in diagnostic & therapeutic endoscopy pt1 polyps 0.75 5.6% of large-bowel
More informationMalignant colorectal polyps: venous invasion and
774 Gut, 1991,32, 774-778 Malignant colorectal polyps: venous invasion and successful treatment by endoscopic polypectomy Department of Pathology J M Geraghty Endoscopy Unit C B Williams and ICRF Colorectal
More informationAlberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines
Alberta Colorectal Cancer Screening Program (ACRCSP) Post Polypectomy Surveillance Guidelines June 2013 ACRCSP Post Polypectomy Surveillance Guidelines - 2 TABLE OF CONTENTS Background... 3 Terms, Definitions
More informationPATHOLOGY GROUP GUIDELINES FOR THE EXAMINATION AND REPORTING OF COLORECTAL CANCER SPECIMENS
PATHOLOGY GROUP GUIDELINES FOR THE EXAMINATION AND REPORTING OF COLORECTAL CANCER SPECIMENS Produced by: Address: Yorkshire Cancer Network Pathology Group Arthington House, Cookridge Hospital, Hospital
More informationPathology in Slovenian CRC screening programme:
Pathology in Slovenian CRC screening programme: Findings, organisation and quality assurance Snježana Frković Grazio University Medical Center Ljubljana, Slovenia Slovenia s population: 2 million Incidence
More informationMalignant colonic adenomas. Therapeutic criteria. Long-term results of therapy in a series of 42 patients in our healthcare area
1130-0108/2009/101/12/830-836 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright 2009 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 101. N. 12, pp. 830-836, 2009 ORIGINAL PAPERS Malignant colonic
More informationColon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition
Colon and Rectum Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix are excluded. Protocol revision date: January
More informationNeoplastic Colon Polyps. Joyce Au SUNY Downstate Grand Rounds, October 18, 2012
Neoplastic Colon Polyps Joyce Au SUNY Downstate Grand Rounds, October 18, 2012 CASE 55M with Hepatitis C, COPD (FEV1=45%), s/p vasectomy, knee surgery Meds: albuterol, flunisolide, mometasone, tiotropium
More informationAdenoma and Malignant Colorectal Polyp: Pathological Considerations and Clinical Applications
Adenoma and Malignant Colorectal Polyp: Pathological Considerations and Clinical Applications Authors: *Emil Salmo, 1 Najib Haboubi 2 1. Department of Histopathology, The Pennine Acute Hospitals NHS Trust,
More informationIncidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea
Original Article Journal of the Korean Society of J Korean Soc Coloproctol 2012;28(4):213-218 http://dx.doi.org/10.3393/jksc.2012.28.4.213 pissn 2093-7822 eissn 2093-7830 Incidence and Multiplicities of
More informationThe malignant colorectal polyp
The malignant colorectal polyp Dr Ian Brown Envoi Pathology Envoi data reproduced from J Clin Path 2015 article Definition Adenocarcinoma found in an endoscopically resected polypoidal tumour Submucosal
More informationHistopathology of Endoscopic Resection Specimens from Barrett's Esophagus
Histopathology of Endoscopic Resection Specimens from Barrett's Esophagus Br J Surg 38 oct. 1950 Definition of Barrett's esophagus A change in the esophageal epithelium of any length that can be recognized
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationColonic Polyp. Najmeh Aletaha. MD
Colonic Polyp Najmeh Aletaha. MD 1 Polyps & classification 2 Colorectal cancer risk factors 3 Pathogenesis 4 Surveillance polyp of the colon refers to a protuberance into the lumen above the surrounding
More informationPathology in Slovenian CRC screening programme: Organisation and quality assurance. Snježana Frković Grazio and Matej Bračko
Pathology in Slovenian CRC screening programme: Organisation and quality assurance Snježana Frković Grazio and Matej Bračko June 2009 to December 2013 (first three rounds) 33 969 colonoscopies were performed
More informationPatologia sistematica V Gastroenterologia Prof. Stefano Fiorucci. Colon polyps. Colorectal cancer
Patologia sistematica V Gastroenterologia Prof. Stefano Fiorucci Colon polyps Colorectal cancer Harrison s Principles of Internal Medicine 18 Ed. 2012 Colorectal cancer 70% Colorectal cancer CRC and colon
More informationGreater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy
Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy Authors: Dr Gordon Armstrong, Dr Sue Pritchard 1. General Comments 1.1 Cancer reporting: Biopsies
More informationA916: rectum: adenocarcinoma
General facts of colorectal cancer The colon has cecum, ascending, transverse, descending and sigmoid colon sections. Cancer can start in any of the r sections or in the rectum. The wall of each of these
More informationSummary. Cezary ŁozińskiABDF, Witold KyclerABCDEF. Rep Pract Oncol Radiother, 2007; 12(4):
Rep Pract Oncol Radiother, 2007; 12(4): 201-206 Original Paper Received: 2006.12.19 Accepted: 2007.04.02 Published: 2007.08.31 Authors Contribution: A Study Design B Data Collection C Statistical Analysis
More information05/07/2018. Organisation. The English screening programme what is happening? Organisation. Bowel cancer screening in the UK is:
Organisation The English screening programme what is happening? Phil Quirke Lead Pathologist Bowel Cancer Screening PHE England Bowel Cancer Screening Pathology Committee Started 2006 with roll out 4 devolved
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationQuality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care
Quality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Outcome DESCRIPTION:
More informationIN THE DEVELOPMENT and progression of colorectal
Digestive Endoscopy 2014; 26 (Suppl. 2): 73 77 doi: 10.1111/den.12276 Treatment strategy of diminutive colorectal polyp
More informationEndoscopic Submucosal Dissection ESD
Endoscopic Submucosal Dissection ESD Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated
More informationLocal recurrence after endoscopic resection of colorectal tumors
Int J Colorectal Dis (2009) 24:225 230 DOI 10.1007/s00384-008-0596-8 ORIGINAL ARTICLE Local recurrence after endoscopic resection of colorectal tumors Kinichi Hotta & Takahiro Fujii & Yutaka Saito & Takahisa
More informationUpdate on Colonic Serrated (and Conventional) Adenomatous Polyps
Update on Colonic Serrated (and Conventional) Adenomatous Polyps Maui, HI 2018 Robert D. Odze, MD, FRCPC Chief, Division of GI Pathology Professor of Pathology Brigham and Women s Hospital Harvard Medical
More informationMorphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens
ISPUB.COM The Internet Journal of Pathology Volume 12 Number 1 Morphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens C Rose, H Wu Citation C Rose, H Wu.. The Internet Journal of Pathology.
More informationDiagnostic accuracy of pit pattern and vascular pattern in colorectal lesions
Diagnostic accuracy of pit pattern and vascular pattern in colorectal lesions Digestive Disease Center, Showa University Northern Yokohama Hospital Department of Pathology Yoshiki Wada, Shin-ei Kudo, Hiroshi
More informationLarge polyps: EMR, ESD, TEM and segmental resection. Terry Phang 2017 SON fall update
Large polyps: EMR, ESD, TEM and segmental resection Terry Phang 2017 SON fall update Key Points: Large polyps No RCT re: Recurrence, complications Piecemeal vs en bloc: EMR vs ESD Partial vs full-thickness:
More informationModern colonoscopy allows for both diagnosis and treatment
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:662 667 CLINICAL PATHOLOGY The Malignant Colon Polyp: Diagnosis and Therapeutic Recommendations MARIE E. ROBERT Department of Pathology, Yale University
More informationcolorectal cancer Colorectal cancer hereditary sporadic Familial 1/12/2018
colorectal cancer Adenocarcinoma of the colon and rectum is the third most common site of new cancer cases and deaths in men (following prostate and lung or bronchus cancer) and women (following breast
More informationColonic adenomas-a colonoscopy survey
Gut, 1979, 20, 240-245 Colonic adenomas-a colonoscopy survey P. E. GILLESPIE, T. J. CHAMBERS, K. W. CHAN, F. DORONZO, B. C. MORSON, AND C. B. WILLIAMS From St Mark's Hospital, City Road, London SUMMARY
More informationremoval of adenomatous polyps detects important effectively as follow-up colonoscopy after both constitute a low-risk Patients with 1 or 2
Supplementary Table 1. Study Characteristics Author, yr Design Winawer et al., 6 1993 National Polyp Study Jorgensen et al., 9 1995 Funen Adenoma Follow-up Study USA Multi-center, RCT for timing of surveillance
More informationCHAPTER 7 Concluding remarks and implications for further research
CONCLUDING REMARKS AND IMPLICATIONS FOR FURTHER RESEARCH CHAPTER 7 Concluding remarks and implications for further research 111 CHAPTER 7 Molecular staging of large sessile rectal tumors In this thesis,
More informationPrognosis after Treatment of Villous Adenomas
Prognosis after Treatment of Villous Adenomas of the Colon and Rectum JOHN CHRISTIANSEN, M.D., PREBEN KIRKEGAARD, M.D., JYTTE IBSEN, M.D. With the existing evidence of neoplastic polyps of the colon and
More informationManagement of malignant colon polyps: Current status and controversies
Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.3748/wjg.v20.i43.16178 World J Gastroenterol 2014 November 21; 20(43): 16178-16183 ISSN 1007-9327
More informationSurveying the Colon; Polyps and Advances in Polypectomy
Surveying the Colon; Polyps and Advances in Polypectomy Educational Objectives Identify classifications of polyps Describe several types of polyps Verbalize rationale for polypectomy Identify risk factors
More informationPolypectomy and Local Resections of the Colorectum Structured Pathology Reporting Proforma
Polypectomy and Local Resections of the Colorectum Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth
More informationClinicopathological Characteristics of Superficial Type
Diagnostic and Therapeutic Endoscopy, 1995, Vol. 2, pp. 99-105 Reprints available directly from the publisher Photocopying permitted by license only (C) 1995 Harwood Academic Publishers GmbH Printed in
More informationShort and longterm outcomes after endoscopic resection of malignant polyps.
Short and longterm outcomes after endoscopic resection of malignant polyps. Short and longterm outcomes High risk features Lymph node metastasis Lymph node metastases sm1 sm2 sm3 Son 2008 3.1 % 14.9% 25.0
More informationHistopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer
ORIGINAL ARTICLE pissn 2288-6575 eissn 2288-6796 https://doi.org/10.4174/astr.2017.93.5.266 Annals of Surgical Treatment and Research Histopathologic risk factors for lymph node metastasis in patients
More informationPAPER. Review of Results After Endoscopic and Surgical Therapy
Rectal Carcinoid Tumors PAPER Review of Results After Endoscopic and Surgical Therapy Mary R. Kwaan, MD, MPH; Joel E. Goldberg, MD; Ronald Bleday, MD Objective: To assess whether endoscopic treatment can
More informationwhat is the alternative mechanism of histogenesis? Aspects of the morphology of the adenomacarcinoma Morphology of the
Refer to: Morson B: Polyps and cancer of the large bowel. West J Med 125:93-99, Aug 1976 THE WESTERN Journal of Miedicine Polyps and Cancer of the Large Bowel BASIL MORSON, MD, London MORTALITY STATISTICS
More informationA Comparative Study of Rectal and Colonic Carcinoma: Demographic, Pathologic and TNM Staging Analysis
Journal of the Egyptian Nat. Cancer Inst., Vol. 18, 3, September: 2-263, 2006 A Comparative Study of Rectal and ic Carcinoma: Demographic, Pathologic and TNM Staging Analysis TAREK N. EL-BOLKAINY, M.D.;
More informationBC CRC Update Malignant Polyp Who Needs Surgery
BC CRC Update Malignant Polyp Who Needs Surgery Anthony MacLean, MD, FRCSC, FACS, FASCRS Colorectal Surgeon Foothills Medical Centre Clinical Associate Professor of Surgery and Oncology University of Calgary
More informationGuidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer
Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer David A. Lieberman, 1 Douglas K. Rex, 2 Sidney J. Winawer,
More informationClinical Policy Title: Mucosal and submucosal endoscopic resection of colorectal polyps
Clinical Policy Title: Mucosal and submucosal endoscopic resection of colorectal polyps Clinical Policy Number: CCP.1328 Effective Date: October 1, 2017 Initial Review Date: August 17, 2017 Most Recent
More informationPeritoneal Involvement in Stage II Colon Cancer
Anatomic Pathology / PERITONEAL INVOLVEMENT IN STAGE II COLON CANCER Peritoneal Involvement in Stage II Colon Cancer A.M. Lennon, MB, MRCPI, H.E. Mulcahy, MD, MRCPI, J.M.P. Hyland, MCh, FRCS, FRCSI, C.
More informationEMR, ESD and Beyond. Peter Draganov MD. Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida
EMR, ESD and Beyond Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated by Endoscopy
More informationESD for EGC with undifferentiated histology
ESD for EGC with undifferentiated histology Jun Haeng Lee, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Biopsy: M/D adenocarcinoma ESD: SRC >>
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Outcome High Priority
Quality ID #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Preventive Care 2019 COLLECTION TYPE: MIPS CLINICAL QUALITY
More informationSynchronous and Subsequent Lesions of Serrated Adenomas and Tubular Adenomas of the Colorectum
Tsumura T, et al 1 Synchronous and Subsequent Lesions of Serrated Adenomas and Tubular Adenomas of the Colorectum T. Tsumura a T. Hiyama d S. Tanaka b M. Yoshihara d K. Arihiro c K. Chayama a Departments
More informationColorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY
Colorectal Cancer Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth DD MM YYYY S1.02 Clinical details
More information6 semanas de embarazo. Tubulovillous adenoma with dysplasia icd 10. Inicio / Embarazo / 6 semanas de embarazo
Inicio / Embarazo / 6 semanas de embarazo 6 semanas de embarazo Tubulovillous adenoma with dysplasia icd 10 Free, official coding info for 2018 ICD-10-CM D13.2 - includes detailed rules, notes, synonyms,
More informationTHE BIG, AWKWARD, FLAT POLYP THAT CAN T BE REMOVED WITH A (SINGLE) SNARE THE CASE FOR EMR AND ESD
THE BIG, AWKWARD, FLAT POLYP THAT CAN T BE REMOVED WITH A (SINGLE) SNARE THE CASE FOR EMR AND ESD Surgical Oncology Network meeting Dr. Eric Lam MD FRCPC October 14, 2017 DISCLOSURES None OBJECTIVES Appreciate
More informationHyperplastische Polyps Innocent bystanders?
Hyperplastische Polyps Innocent bystanders?? K. Geboes P th l i h O tl dk d Pathologische Ontleedkunde, KULeuven Content Historical Classification Relation Hyperplastic polyps carcinoma The concept cept
More informationRomanian Journal of Morphology and Embryology 2006, 47(3):
Romanian Journal of Morphology and Embryology 26, 7(3):239 23 ORIGINAL PAPER Predictive parameters for advanced neoplastic adenomas and colorectal cancer in patients with colonic polyps a study in a tertiary
More informationENDOLUMINAL APPROACH FOR THE MANAGEMENT OF GASTROINTESTINAL CARCINOID
ENDOLUMINAL APPROACH FOR THE MANAGEMENT OF GASTROINTESTINAL CARCINOID Manoop S. Bhutani, MD, FASGE, FACG, FACP, AGAF, Doctor Honoris Causa Professor of Medicine Eminent Scientist of the Year 2008, World
More informationReferences. GI Biopsies. What Should Pathologists Assistants Know About Gastrointestinal Histopathology? James M Crawford, MD, PhD
What Should Pathologists Assistants Know About Gastrointestinal Histopathology? James M Crawford, MD, PhD jcrawford1@nshs.edu Executive Director and Senior Vice President for Laboratory Services North
More informationRisk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer
498 Original article Risk factors for lymph node metastasis in histologically poorly differentiated type early gastric cancer Authors C. Kunisaki 1, M. Takahashi 2, Y. Nagahori 3, T. Fukushima 3, H. Makino
More informationWendy L Frankel. Chair and Distinguished Professor
1 Wendy L Frankel Chair and Distinguished Professor Case 1 59 y/o woman Abdominal pain No personal or family history of cancer History of colon polyps Colonoscopy Polypoid rectosigmoid mass Biopsy 3 4
More informationAMSER Rad Path Case of the Month: December 2018
AMSER Rad Path Case of the Month: December 2018 Rectosigmoid Carcinoma Catherine McNulty, MS IV, Tulane University School of Medicine Dr. Matthew Hartman, M.D. Medical Student Radiology Director Dr. Matthew
More informationPrinciples of diagnosis, work-up and therapy The Gastroenterologist s role
Principles of diagnosis, work-up and therapy The Gastroenterologist s role Dr. Christos G. Toumpanakis MD PhD FRCP Consultant in Gastroenterology/Neuroendocrine Tumours Hon. Senior Lecturer University
More informationPrimary mucinous adenocarcinoma developing in an ileostomy stoma
Gut, 1988, 29, 1607-1612 Primary mucinous adenocarcinoma developing in an ileostomy stoma P J SMART, S SASTRY, AND S WELLS From the Departments of Histopathology and Surgery, Bolton General Hospital, Fan
More informationSeventh Edition Staging 2017 Colorectum. Overview. This webinar is sponsored by. the Centers for Disease Control and Prevention.
Seventh Edition Staging 2017 Colorectum Donna M. Gress, RHIT, CTR Validating science. Improving patient care. No materials in this presentation may be repurposed in print or online without the express
More informationMeasure #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clincal Care
Measure #343: Screening Colonoscopy Adenoma Detection Rate National Quality Strategy Domain: Effective Clincal Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY DESCRIPTION: The percentage
More informationGiant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM)
Int J Colorectal Dis (2006) 21: 533 537 DOI 10.1007/s00384-005-0025-1 ORIGINAL ARTICLE Hartmut Schäfer Stefan E. Baldus Arnulf H. Hölscher Giant adenomas of the rectum: complete resection by transanal
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Kaminski MF, Regula J, Kraszewska E, et al. Quality indicators
More informationImaging Evaluation of Polyps. CT Colonography: Sessile Adenoma. Polyps, DALMs & Megacolon Objectives
Polyps, DALMs & Megacolon: Pathology and Imaging of the Colon and Rectum Angela D. Levy and Leslie H. Sobin Washington, DC Drs. Levy and Sobin have indicated that they have no relationships which, in the
More informationEmerging Interventions in Endoscopy. Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital
Emerging Interventions in Endoscopy Margaret Vance Nurse Consultant in Gastroenterology St Mark s Hospital Colon Cancer Colon cancer is common. 1 in 20 people in the UK will develop the disease 19 000
More informationResearch Article Endoscopic Management of Nonlifting Colon Polyps
Diagnostic and Therapeutic Endoscopy Volume 2013, Article ID 412936, 5 pages http://dx.doi.org/10.1155/2013/412936 Research Article Endoscopic Management of Nonlifting Colon Polyps Shai Friedland, 1,2
More informationColorectal adenocarcinoma leading cancer in developed countries In US, annual deaths due to colorectal adenocarcinoma 57,000.
Colonic Neoplasia Remotti Colorectal adenocarcinoma leading cancer in developed countries In US, annual incidence of colorectal adenocarcinoma 150,000. In US, annual deaths due to colorectal adenocarcinoma
More informationPage 1. Is the Risk This High? Dysplasia in the IBD Patient. Dysplasia in the Non IBD Patient. Increased Risk of CRC in Ulcerative Colitis
Screening for Colorectal Neoplasia in Inflammatory Bowel Disease Francis A. Farraye MD, MSc Clinical Director, Section of Gastroenterology Co-Director, Center for Digestive Disorders Boston Medical Center
More informationNUMERATOR: Reports that include the pt category, the pn category and the histologic grade
Quality ID #100 (NQF 0392): Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade National Quality Strategy Domain: Effective
More informationRisk Factors for Lymph Node Metastasis in Patients with Submucosal Invasive Colorectal Carcinoma
J Korean Surg Soc 2010;78:207-212 DOI: 10.4174/jkss.2010.78.4.207 원 저 Risk Factors for Lymph Node Metastasis in Patients with Submucosal Invasive Colorectal Carcinoma Division of Gastroenterology, Department
More informationDIGESTIVE SYSTEM SURGICAL PROCEDURES May 1, 2015 INTESTINES (EXCEPT RECTUM) Asst Surg Anae
ENDOSCOPY Z50 Duodenoscopy (not to be claimed if Z399 and/or Z00 performed on same patient within 3 months)... 92.10 Z9 Subsequent procedure (within three months following previous endoscopic procedure)...
More informationORIGINAL INVESTIGATION
ORIGINAL INVESTIGATION Colon Polyp Recurrence in a Managed Care Population Marianne Ulcickas Yood, DSc, MPH; Susan Oliveria, ScD, MPH; J. Gregory Boyer, PhD; Karen Wells, BS; Paul Stang, PhD; Christine
More informationBarrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI
Barrett s Esophagus Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI A 58 year-old, obese white man has had heartburn for more than 20 years. He read a magazine
More informationEuropean guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition
SE116 European guidelines for quality assurance in colorectal cancer screening and diagnosis. First Edition Quality assurance in pathology in colorectal cancer screening and diagnosis Co-Funded by the
More informationNUMERATOR: Reports that include the pt category, the pn category and the histologic grade
Quality ID #100 (NQF 0392): Colorectal Cancer Resection Pathology Reporting: pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes) with Histologic Grade National Quality Strategy Domain: Effective
More informationThe Incidence and Significance of Villous Change in Adenomatous Polyps
The Incidence and Significance Villous Change in Adenomatous Polyps CHRISTOPHER H. K. FUNC, M.D., AND HARVEY GOLDMAN, M.D. Department Pathology, Harvard Medical School and Beth Israel Hospital, Boston,
More informationSmall Intestine. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6 th edition
Small Intestine Protocol applies to all invasive carcinomas of the small intestine, including those with focal endocrine differentiation. Excludes carcinoid tumors, lymphomas, and stromal tumors (sarcomas).
More informationPhysician s Cognitive and Communication Failures Result in Cancer Treatment Delay
1 Physician s Cognitive and Communication Failures Result in Cancer Treatment Delay Abstract: The estate of a 60 year old male alleged negligence against a gastroenterologist in failing to properly evaluate
More informationQuestion: If in a particular case, there is doubt about the correct T, N or M category, what do you do?
Exercise 1 Question: If in a particular case, there is doubt about the correct T, N or M category, what do you do? : 1. I mention both categories that are in consideration, e.g. pt1-2 2. I classify as
More informationManagement of Difficult Colorectal Polyps: Literature Review. Abstract. Introduction. imedpub Journals
Review Article imedpub Journals www.imedpub.com Management of Difficult Colorectal Polyps: Literature Review Abstract Colorectal cancer remains one of the worldwide leading causes of death. Fortunately,
More informationGreater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14
Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14 Contents 14. Neuroendocrine Tumours 161 14.1. Diagnostic algorithm
More informationColon and Rectum: 2018 Solid Tumor Rules
2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING Colon and Rectum: 2018 Solid Tumor Rules 1 Colon and Rectum Solid Tumor Rules Separate sections for: Introduction Changes from 2007 MP/H rules Equivalent
More informationLOINC. Clinical information. RCPA code. Record if different to report header Operating surgeon name and contact details. Absent.
Complete as narrative or use the structured format below 55752-0 17.02.28593 Clinical information 22027-7 17.02.30001 Record if different to report header Operating surgeon name and contact details 52101004
More informationEndoscopically Removed Malignant Colorectal Polyps: Clinicopathologic Correlations
GASTROENTEROLOGY 1995;108:1657-1665 Endoscopically Removed Malignant Colorectal Polyps: Clinicopathologic Correlations HARRY S. COOPER,* LUDWIG M. DEPPISCH,* WILLIAM K. GOURLEY, ~ ELLEN I. KAHN, [I ROBERT
More informationBarrett s Esophagus: Old Dog, New Tricks
Barrett s Esophagus: Old Dog, New Tricks Stuart Jon Spechler, M.D. Chief, Division of Gastroenterology, VA North Texas Healthcare System; Co-Director, Esophageal Diseases Center, Professor of Medicine,
More informationCollege of American Pathologists. Pathology Performance Measures included in CMS 2012 PQRS
College of American Pathologists Pathology Performance Measures included in CMS 2012 PQRS Breast Cancer Resection Pathology Reporting Measure #99 pt category (primary tumor) and pn category (regional lymph
More informationColon Polyp Morphology on Double-Contrast Barium Enema: Its Pathologic Predictive Value
965 David J. Ott 1 David W. Gelfand 1 Wallace C. Wu 2 Deborah S. Ablin 1-3 Received March 21, 1983; accepted after revision July 8, 1983. 'Department of Radiology, Bowman Gray School of Medicine, Winston-Salem,
More informationSurveillance of Small Rectal Carcinoid Tumors in the Absence of Metastatic Disease
Ann Surg Oncol (2012) 19:3486 3490 DOI 10.1245/s10434-012-2442-z ORIGINAL ARTICLE ENDOCRINE TUMORS Surveillance of Small Rectal Carcinoid Tumors in the Absence of Metastatic Disease Sara E. Murray, MD
More informationChromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis
Chromoendoscopy or Narrow Band Imaging with Targeted biopsies Should be the Cancer Surveillance Endoscopy Procedure of Choice in Ulcerative Colitis Bret A. Lashner, M.D. Professor of Medicine Director,
More informationPostoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery
Original article Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery B. H. Endreseth*, A. Wibe*, M. Svinsås*, R. Mårvik*
More informationGASTROINTESTINAL METASTASES FROM LOBULAR BREAST CANCER
42. 1,. 1,. 2,. 2. 1 1, 2, GASTROINTESTINAL METASTASES FROM LOBULAR BREAST CANCER V. Gerova 1, L. Tankova 1, A. Mihova 2, I. Drandarsk 2 and H. Kadian 1 1 Clinic of Gastroenterology, University Hospital
More informationCOLON AND RECTUM SOLID TUMOR RULES ABSTRACTORS TRAINING
COLON AND RECTUM SOLID TUMOR RULES ABSTRACTORS TRAINING COLON AND RECTUM SOLID TUMOR RULES Separate sections for: Introduction Changes from 2007 MP/H rules Equivalent Terms Terms that are NOT Equivalent
More informationThe Pathologist s Role in the Diagnosis and Management of Neoplasia in Barrett s Oesophagus Cian Muldoon, St. James s Hospital, Dublin
The Pathologist s Role in the Diagnosis and Management of Neoplasia in Barrett s Oesophagus Cian Muldoon, St. James s Hospital, Dublin 24.06.15 Norman Barrett Smiles [A brief digression - Chair becoming
More information