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August 2001
Facilitating the identification of lymph nodes in colorectal cancer resection specimens
Although it is important to identify all lymph nodes in a specimen resected for carcinoma, this is particularly important for colorectal carcinoma. Some authors have suggested that six to 17 lymph nodes per case be identified, and some studies have noted that submission of a small number of nodes is associated with an unfavorable prognosis, even when no lymph node metastases are identified. Moreover, one should be aware that nodes containing metastatic disease may be small; between 44 percent and 78 percent of positive lymph nodes are 5 mm or less in greatest dimension. To determine if the number of lymph nodes sampled could be improved, the authors compared 35 cases in which the lymph node-bearing mesocolon was processed using a solution of glacial acetic acid, ethanol, distilled water, and formaldehyde (GEWF). Thirty-two cases were processed using conventional sectioning, inspection, and palpation. The authors noted an increase from 6.8 ± 3.9 lymph nodes in the conventionally processed material to 10.2 ± 4.9 lymph nodes in the cases processed with GEWF (P = 0.002). Moreover, the positive lymph nodes were significantly smaller in the GEWF group (0.5 ± 0.2 cm) than in the non-GEWF group (0.7 ± 0.4 cm). Sixty percent of the GEWF-positive lymph nodes were 0.5 cm or smaller, compared with 41 percent of nodes in the non-GEWF group. The authors concluded that GEWF increases the yield of lymph nodes recovered from colorectal cancer specimens and may lead to improved staging of this cancer. Furthermore, GEWF is inexpensive and simple to use.
Newell KJ, Sawka BW, Rudrick BF, et al. GEWF solution. An inexpensive, simple, and effective aid for the retrieval of lymph nodes from colorectal cancer resections. Arch Pathol Lab Med. 2001;125:642-645.
Correspondence: David K. Driman, MBChB, FRCPC, Dept. of Pathology, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario N6A 4V2, Canada; ddriman@uwo.ca
Pseudohyperplastic prostatic adenocarcinoma
Prostatic adenocarcinoma with pseudohyperplastic features can be difficult to diagnose because the malignant acini architecturally resemble benign hyperplastic glands. The authors described the histologic features of 20 such cases in which the pseudohyperplastic foci accounted for 60 percent or more of the cancer. Sixteen of the 20 cases were needle biopsies. The pseudohyperplastic features in 13 of 20 cases accounted for 90 percent or more of the cancer. Features that resembled benign hyperplastic glands in a majority of these 20 cases included papillary infoldings and large atypical glands. Other features noted were branching glands (45 percent of cases) and corpora amylacea (20 percent of cases). Histologic features useful in establishing a diagnosis of adenocarcinoma were nuclear enlargement (95 percent of cases), occasional to frequent nucleoli (45 percent of cases), pink amorphous lumina secretions (70 percent of cases), and crystalloids (45 percent of cases). An infiltrative pattern of growth was noted in only 25 percent of cases. Immunohistochemical stains for high-molecular-weight keratin showed an absence of basal cells in the pseudohyperplastic areas in all cases, confirming the diagnosis of cancer. Subsequent radical prostatectomy specimens from seven cases revealed that adenocarcinoma with pseudohyperplastic features accounted for two percent to 80 percent of the tumor. In these cases, the pseudohyperplastic adenocarcinoma was associated with intermediate and high-grade cancer. Extraprostatic extension of pseudohyperplastic adenocarcinoma was noted in three cases. Based on these findings, the authors suggested that pseudohyperplastic prostatic adenocarcinoma is not equivalent to low-grade cancer. Additional studies are required to determine the biological significance of this histologic pattern.
Levi AW, Epstein JI. Pseudohyperplastic prostatic adenocarcinoma on needle biopsy and simple prostatectomy. Am J Surg Pathol. 2000;24:1039-1046.
Reprints: Jonathan I. Epstein, MD, Johns Hopkins Hospital, Dept. of Pathology, 600 N. Wolfe St., Baltimore, MD 21287; jepstein@jhmi.edu
Effect of neuroendocrine features on the clinical course of large cell carcinoma of the lung
The authors examined the clinical course of 119 patients with large cell carcinoma of the lung that was surgically resected at one Japanese hospital from 1969 to 1999. This represented 5.7 percent of all carcinomas resected during this period. The tumors were divided into groups using light and electron microscopy and immunohistochemical staining. The groups were: large cell neuroendocrine carcinoma (LCNEC)—50 cases; large cell carcinoma with neuroendocrine differentiation (LCCND)—nine cases; and large cell carcinoma with neuroendocrine morphology (LCCNM)—13 cases. These were compared with 47 cases of classic large cell carcinoma (CLCC). Overall and disease-free survival rates were similar between the three types of carcinoma with neuroendocrine features. When combined into one group, overall and disease-free survival rates were found by univariate and multivariate analysis to be adversely affected. Other features that adversely affected disease-free and overall survival rates included nodal status, mitosis, tumor size, and patient age. Interestingly, T-stage (WHO 1999) did not affect overall or disease-free survival using multivariate analysis. The authors concluded that pulmonary large cell carcinoma with neuroendocrine features has a poorer prognosis than classic large cell carcinoma.
Iyoda A, Hiroshima K, Toyozaki T, et al. Clinical characterization of pulmonary large cell neuroendocrine carcinoma and large cell carcinoma with neuroendocrine morphology. Cancer. 2001;91:1922-2000.
Reprints: Akira Iyoda, MD, Div. of Pathology, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan; iyoda@haibyo1.m.chiba-u.ac.jp; fax: (011) 81-43-226-2180
Behavior of borderline ovarian tumors
Information regarding the rate that borderline ovarian tumors progress to invasive carcinoma and mortality in a prospectively accrued population of women with such tumors should be useful for determining management options and understanding the biology of these tumors. The authors prospectively accrued and observed 339 women with borderline ovarian tumors (83.4 percent stage I, 7.9 percent stage II, and 8.5 percent stage III); median followup was 70 months (seven cases were lost to followup). Of these patients, three were alive with clinical disease, two died of disease, and 10 died of other causes. The remaining subjects (317/339) were alive with no clinical disease, including eight with documented subclinical persistence of disease. The authors reported that this is one of the highest survival rates noted in the literature, with disease-free survival rates of 99.6 percent for patients in stage I, 95.8 percent for stage II, and 89 percent for stage III. Conservative surgery was associated with a higher incidence of recurrences, however all but one woman with recurrence of borderline tumor or progression to carcinoma after conservative surgery were salvaged. Seven cases (five serous and two mucinous) with progression to invasive carcinoma were noted; six of these had been treated conservatively. Five of these seven patients could be salvaged however and were reported to be alive without evidence of disease at last followup. The incidence of recurrence or progression did not differ between those receiving chemotherapy and those who did not. Since the time to relapse may be long in this group of tumors, lengthier followup may be required to confirm or refute the observations noted in this study.
Zanetta G, Rota S, Chiari S, et al. Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: A prospective study. J Clin Oncol. 2001;19:2658-2664.
Reprints: Gerardo Zanetta, MD, Dept. of Obstetrics and Gynecology, Ospedale San Gerardo, Via Solferino 16, 20052 Monza, Italy; gzanetta@iol.itn
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