Spectrum of Histopathological Changes Encountered in Stented Colorectal Carcinomas (CRC)
Eve Fryer, Lai Mun Wang, Richard Guy, Runjan Chetty. John Radcliffe Hospital, Oxford, United Kingdom
Background: Presentation with obstruction is a poor prognostic feature in CRC, with surgery for obstruction carrying higher mortality and complication rates. Stenting can be used as a “bridge to surgery”, allowing optimisation of patient condition before surgery. Our institution has excellent clinical experience with stenting, with a high rate of successful relief of obstruction and subsequent elective surgery. Elective surgery results in better outcomes in terms of stoma avoidance and more rapid recovery as many cases can be performed laparoscopically. The histological features produced by stenting in the colon are poorly documented, with only case reports and one small case series reported. We present the largest series to date of stented CRC, performed and reported at a single institution.
Design: Stented CRC received January 2006 - December 2011 were identified from our pathology database using the search term “stent” in the clinical information or macroscopic description. The slides for each case were independently reviewed by two pathologists and a consensus reached.
Results: 72 CRC were identified, 15 right sided (including 2 from the ascending colon) and 57 left sided. 36 were stage pT3 and 36 pT4. Diverticulosis was present in 14 cases. Perforation was observed in 14 cases (8 tumour related, 6 non-tumour related). The effects of stenting on the tumour include tumour necrosis (100%) with flat ulceration (77.8%). Stent effects on the uninvolved bowel are given in table 1. The spectrum of changes includes mimics of inflammatory bowel disease, tumour regression post-neoadjuvant therapy and ischaemia.
|Feature||No. of cases (%)|
|Mimics of IBD|
|Hyperplastic mucosa||53 (73.6)|
|Pseudopolyp-like features||35 (48.6)|
|Fissuring ulceration||24 (33.3)[median depth 2.5 mm, range 1-13 mm]|
|Fissures without ulceration||14 (19.4)|
|Mucosal Crohn's like features||10 (13.9)|
|Eosinophil-rich inflammation||6 (8.3)|
|Abscess formation||5 (6.9)|
|Minics of neoadjuvant regression|
|Mucin pools||18 (25)|
|Foreign body giant cells||13 (18.1)|
|Ischaemia-like features||54 (75)|
|Fat necrosis||6 (8.3)|