Ileocecal Junction Carcinoma: Clinical-Pathologic Features
Lik-Hang Lee, Vincent Falck, Xianyong Gui. Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada
Background: Epithelial transition zones (TZs) are associated with unique or increased cancer susceptibility. In GI tract, carcinomas arising in some TZs such as esophagogastric and anorectal junctions show certain features. Carcinomas in ileocecal junction (ICJ) are not uncommonly seen. Whether they have distinct clinical-pathological features, however, has never been described. We attempt to explore this subject.
Design: All intestinal carcinoma resections in Foothills Hospital between 1/2009 and 6/2012 were retrieved. Those located at and distal to ileum were included into the study. Peritoneal carcinomatosis was excluded. Original reports and slides were reviewed to record tumor location, gross appearance, histologic type, grade, depth of invasion (T), nodal metastasis (N), and other features. The carcinomas with gross tumor edge within 5 cm proximal and distal to ICJ were labelled as ICJ carcinoma (ICJ-CA). For each aspect these carcinomas were compared with those at other locations.
Results: Of 376 cases in total, 59 (15.7 %) were ICJ-CA, including 24 (6.4%) tumors crossed ICV. The others were located in ileum (6), right colon (83), left colon (86), rectum (139), and appendix (3). Clinically, ICJ-CAs were seen more in females as compared to carcinomas of left colon and rectum (57.6% vs 36.0% vs 30.9%, p < 0.05). Grossly, ICJ-CAs were mostly fungating masses (67.8%). Histologically, the type distribution of ICJ-CA differed from that of carcinomas at other locations, as shown in Fig 1.
ICJ-CAs tended to have mucinous or/and signet ring cell or/and neuroendocrine features. 1 case showed all of these features. 8 cases were classified as mucinous carcinoma, 2 cases as signet ring cell carcinoma. 4 tumors involved appendix, including 2 cases associated with goblet cell carcinoid, likely originating from appendix. 4 ICJ-CAs confined to ileal side were all neuroendocrine carcinoma. ICJ-CAs also invaded deeper than those of left colon and rectum (T4: 25.4% vs 11.5%, p < 0.05) but not different from those of right colon. The rate of positive nodes (N) in ICJ-CAs showed no difference from other CRCs.
Conclusions: Carcinomas of ICJ region seem to have some distinct features. Further study in more cases and more details would better define the 'ICJ carcinoma'.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 84, Wednesday Morning