title: Tumor budding and recurrence in submucosal invasive colorectal cancers of favorable histology: case reports of two early colorectal cancers with advanced recurrences.
abstract: Complete resection of submucosal invasive colorectal cancer (SICC) showing favorable histology is regarded as curative. We report on two cases of SICC showing recurrence within 5 years despite complete resection. The first patient was a 68-year-old woman with well differentiated rectal adenocarcinoma invading the superficial submucosa, which recurred after 4.7 years. The second patient was a 53-year-old man with pT1N0 moderately differentiated colonic adenocarcinoma. He developed widespread tumor recurrence after 3.9 years. Retrospective pathologic review of the original tumors showed multiple foci of tumor budding at the invasive front. Immunohistochemical staining for D2-40 of deeper levels of the paraffin blocks showed rare foci of small lymphatic invasion. Tumor budding at the invasive front may be an important indicator for SICC aggressiveness or may reflect early lymphatic invasion. More aggressive pathologic examination and follow-up is required for patients with SICC showing tumor budding, even in the absence of unfavorable histologic findings.
authors.affiliation: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Heae Surng
authors.initials: HS
authors.lastname: Park
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Chang
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Park
authors.forename: Byung Chang
authors.initials: BC
authors.lastname: Kim
authors.forename: Dae Kyung
authors.initials: DK
authors.lastname: Sohn
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Hong
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Baek
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Hyo Seong
authors.initials: HS
authors.lastname: Choi
authors.forename: Jae Hwan
authors.initials: JH
authors.lastname: Oh
keywords: Early colorectal neoplasms; Recurrence; Tumor budding