title: [Colorectal carcinoma in consideration of the new German S3 guideline 2013].
abstract: In the current German S3 guidelines for colorectal carcinoma (CRC), morphologically based tumor grading is extended by molecular grading for poorly differentiated and undifferentiated carcinomas, as well as for special morphological subtypes. These CRC are classified as low-grade when microsatellite instability (MSI) is found. In routine diagnostics, immunohistochemistry for hMLH1 and hMSH2, capturing MSI-CRC with high sensitivity and specificity, can be used as an inexpensive substitute for molecular MSI-testing. In patients with positive Bethesda criteria, a stepwise immunohistochemical and molecular diagnostic scheme is proposed. The detection of a BRAF mutation in tumors with hMLH1 loss allows distinguishing between sporadic and HNPCC-associated MSI-CRC. For rectal cancer the residual tumor classification (R-status) is completed by the circumferential resection margin classification (CRM).
authors.affiliation: Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Str. 36, 80337, München, Deutschland, jens.neumann@med.uni-muenchen.de.
authors.forename: J H L
authors.initials: JH
authors.lastname: Neumann
authors.forename: T
authors.initials: T
authors.lastname: Kirchner
mesh_terms: D048868:Adaptor Proteins, Signal Transducing / Q000235:genetics; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003106:Colon / Q000473:pathology; D015179:Colorectal Neoplasms / Q000145:classification / Q000235:genetics* / Q000473:pathology*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000145:classification / Q000235:genetics / Q000473:pathology; D004252:DNA Mutational Analysis; D004260:DNA Repair / Q000235:genetics; D019983:Guideline Adherence; D006801:Humans; D007150:Immunohistochemistry; D053842:Microsatellite Instability; D000070957:MutL Protein Homolog 1; D000070956:MutL Proteins; D060787:Neoplasm Grading; D009363:Neoplasm Proteins / Q000235:genetics; D018365:Neoplasm, Residual / Q000145:classification / Q000235:genetics / Q000473:pathology; D009687:Nuclear Proteins / Q000235:genetics; D011237:Predictive Value of Tests; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D012007:Rectum / Q000473:pathology
chemical_list: D048868:Adaptor Proteins, Signal Transducing; C501486:MLH1 protein, human; D009363:Neoplasm Proteins; D009687:Nuclear Proteins; C088996:PMS1 protein, human; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; D000070957:MutL Protein Homolog 1; D000070956:MutL Proteins
references.citation: Cancer. 2000 Nov 15;89(10):2025-37
references.pmid: 11066042
references.citation: Am J Surg Pathol. 2008 Aug;32(8):1246-51
references.pmid: 18677806
references.citation: J Clin Oncol. 2005 Jan 20;23(3):609-18
references.pmid: 15659508
references.citation: Clin Cancer Res. 2005 Dec 1;11(23):8332-40
references.pmid: 16322293
references.citation: Br J Surg. 2000 Sep;87(9):1197-202
references.pmid: 10971428
references.citation: Ann Surg Oncol. 2008 May;15(5):1429-39
references.pmid: 18301950
references.citation: J Clin Oncol. 2008 Jan 10;26(2):303-12
references.pmid: 18182672
references.citation: Lancet. 2009 Mar 7;373(9666):821-8
references.pmid: 19269520
references.citation: J Clin Oncol. 1999 Aug;17(8):2429-38
references.pmid: 10561306
references.citation: J Natl Cancer Inst. 2004 Feb 18;96(4):261-8
references.pmid: 14970275
references.citation: Int J Colorectal Dis. 2001 Sep;16(5):298-304
references.pmid: 11686527
references.citation: J Mol Diagn. 2012 Mar-Apr;14(2):91-103
references.pmid: 22260991
references.citation: Clin Cancer Res. 2007 Jul 1;13(13):3831-9
references.pmid: 17606714
references.citation: Dtsch Med Wochenschr. 2013 Dec;138(49):2545
references.pmid: 24281967
references.citation: J Am Coll Surg. 1997 Jan;184(1):84-92
references.pmid: 8989307
references.citation: Gut. 2004 Mar;53(3):371-5
references.pmid: 14960518
references.citation: J Clin Oncol. 2002 Feb 15;20(4):1043-8
references.pmid: 11844828
references.citation: Mod Pathol. 2002 Jul;15(7):741-9
references.pmid: 12118112