Abstract
Adenomas represent the morphological precursors of the vast majority of colorectal cancers: although every adenoma has the capacity of malignant evolution, most adenomas stabilize their progression or even regress. Pathological factors are predictive of the natural history of adenomas in terms of potential and time interval for becoming malignant. Regression of adenomas is histologically well established, but it is thought to be a dynamic process, with cycling phases of regression and growth. Colorectal carcinoma invading the submucosa but not the muscular layer represents the earliest form of clinically relevant colorectal cancer. Grade of differentiation of carcinoma, lymphovascular invasion, and state of the resection margin predict the risk of metastasis. Microstaging of invasive cancer together with tumuor budding allow the metastatic risk to be further stratified into minimal, low, and high. Two distinct profiles are identifiable in the natural history of cancerous adenomas: blocking the growth of early cancer and allowing its progression towards advanced cancer. Thus, biomarkers to distinguish between progressive and non-progressive pT1 neoplasia are needed.
Zusammenfassung
Adenome stellen die morphologischen Vorstufen der meisten kolorektalen Karzinome dar. Obwohl jedes Adenom die Fähigkeit zur malignen Entartung besitzt, kommt es bei den meisten Adenomen nicht zu einer Tumorprogression oder sie bilden sich sogar zurück. Histopathologische Faktoren sind Prädiktoren für die natürliche Entwicklung der Adenome, was Malignitätspotenzial und Latenzzeit betrifft. Die Adenomrückbildung ist histologisch nachgewiesen worden, aber man geht von einem dynamischen Prozess mit zyklischen Rückbildungs- und Wachstumsphasen aus. Kolorektale Karzinome, die die Submukosa, aber nicht die Muscularis infiltrieren, sind die frühesten Formen klinisch relevanter Tumoren. Der Differenzierungsgrad eines Karzinoms, die Invasion von Lymph- und Blutgefäßen sowie der Zustand der Resektionsränder bestimmen das Metastasierungsrisiko mit. Ein Mikrostaging der invasiven Komponente erlaubt, das Metastasierungsrisiko in gering, mittel oder hoch einzuteilen. In der Krebsentstehung der neoplastischen Adenome werde zwei verschiedene Wachstumsprofile beschrieben, zum einen eine frühe Wachstumsblockade der Krebszellen und zum anderen Tumorprogression: Biomarker werden gebraucht, um diese beiden Verläufe von pT1-Neoplasien zu unterscheiden.
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The corresponding author states that there are no conflicts of interest. The supplement that this article is part of is not sponsored by industry.
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Risio, M. The natural history of colorectal adenomas and early cancer. Pathologe 33 (Suppl 2), 206–210 (2012). https://doi.org/10.1007/s00292-012-1640-6
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DOI: https://doi.org/10.1007/s00292-012-1640-6