Two Subtypes of Mucinous Adenocarcinoma of The Colorectum: Clinicopathological and Genetic Features

Authors: Leopoldo, Sarli¹; Lorena, Bottarelli²; Cinzia, Azzoni²; Gabriella, Di³; Angela Luciana, Barilli⁴; Renato, Costi⁵; Antonio, Mazzeo⁵; Carlo, Salvemini⁵; Cristina, Porrini⁵; Stefano, Cecchini⁵; Maurizio, Taglia⁵; Luigi, Roncoroni⁵; Cesare, Bordi²

Source: Annals of Surgical Oncology, Volume 15, Number 5, May 2008 , pp. 1429-1439(11)

Publisher: Springer

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Abstract:

This work is aimed at comparing mucinous colorectal adenocarcinomas (MUC) and non-mucinous colorectal adenocarcinomas (non-MUC), and at verifying the existence of two different subgroups of MUC, in terms of clinicopathological features, chromosomal alterations, and outcome, in a geographical area where mucinous colorectal cancer resulted as being very frequent.

One hundred and fifty-six unselected patients who underwent curative colorectal resection for sporadic colorectal cancer over a 4-year period were evaluated for histological classification as to MUC and non-MUC subtype, for microsatellite instability (MSI) using six microsatellite markers, and for the presence of p27, Fhit, and cyclooxygenase-2 (Cox-2). Molecular data, immunohistochemical results, recurrence frequency, and patient survival were analyzed statistically in relation to histological subtypes.

MUC accounted for 38.5% of all colorectal carcinomas. Compared to non-MUCs, MUCs were more frequently located in the proximal colon (p < 0.001), and more frequently showed MSI phenotype (p < 0.001), altered protein expression of hMlh1 (p = 0.030), Fhit (p <0.001), and p27 (p < 0.001). Compared to MUC with microsatellite-stable (MSS) phenotype, MUC with MSI more frequently resulted as being located in the proximal colon (p = 0.013), and more frequently showed altered expression of hMlh1 (p < 0.001), hMsh2 (p = 0.008), Fhit (p < 0.001), and p27 (p = 0.015). Significantly better survival of patients with proximal MUC (p = 0,012), with MSI MUC (p = 0.017), and with MUC with altered p27 expression (p = 0.02).

The results of the present study confirm that MUC represents distinct clinicopathological and genetic features as compared to non-mucinous tumors and support the hypothesis that MUC includes two subtypes with different genetic pathways and behavior.

Document Type: Research article

DOI: http://dx.doi.org/10.1245/s10434-007-9757-1

Affiliations: 1: Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University, Medical School, Parma, Italy, Email: leosarli@unipr.it 2: Department of Pathology and Laboratory Medicine, Section of Pathological Anatomy, Parma University, Medical School, Parma, Italy 3: Research Laboratory “Biotech”, Parma, Italy 4: Department of Internal Medicine and Biomedical Sciences, Parma University, Parma, Italy 5: Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University, Medical School, Parma, Italy

Publication date: 2008-05-01

Two Subtypes of Mucinous Adenocarcinoma of The Colorectum: Clinicopathological and Genetic Features

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