Histogenesis and morphogenesis of depressed-type early colorectal carcinoma.
The aim of this study was to elucidate the histogenesis and morphogenesis of depressed-type early colorectal carcinomas (DECas). Eighty-seven DECas were selected for examination. The 87 DECas included 23 (26.4%) absolutely depressed (ABS) types (depressed mucosa being thinner than the normal mucosa; histologically true depression), 40 (46.0%) relatively depressed (REL) types (the thickness of the depressed mucosa being the same or greater than that of normal mucosa, with depression being relative compared to marginal elevation) and 24 (27.6%) ulcerated (UL) types (no remnant intramucosal component in the depressed area). The rates of residual adenomatous components were 0/23 (0%) for ABS type and 12/40 (30%) for REL type, indicating that the ABS type was thought to have arisen de novo and the REL type was thought to have arisen de novo and via an adenoma-carcinoma sequence. In 13 of the 23 (56.5%) ABS types, carcinoma was located within the depressed area alone, suggesting that many ABS types show a depression from their initial stage. While 33 of the 40 (82.5%) REL types accompanied by marginal elevation consisted of neoplastic mucosa, in 19 of the 33 (57.6%) cases, the depressed area showed a higher grade of atypia than the area of marginal elevation. This suggested that the depression in the REL type was generated secondarily at the center of a pre-existing, superficially elevated tumor due to progression of its histological grade of atypia. ABS type was speculated to be the precursor of UL type since the two types showed similarity (no statistical significant difference) in percent depression (69.6 vs 64.3%), grade of atypia of carcinoma (52.2 and 79.2% consisted of carcinoma with high-grade atypia alone), and frequency of being accompanied by non-neoplastic reactive marginal elevation (56.5 vs 70.8%).
Kazama
Shinsuke
S
First Department of Pathology, School of Medicine, Niigata University, Niigata, Japan. ajioka@med.niigata-u.ac.jp
Ajioka
Yoichi
Y
Watanabe
Hidenobu
H
Watanabe
Toshiaki
T
Nagawa
Hirokazu
H
D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D009361:Neoplasm Invasiveness; D012720:Severity of Illness Index