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Acellular mucin in lymph nodes isolated from treatment-naïve colorectal cancer resections: a clinicopathologic analysis of 16 cases

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Abstract

Lymph nodes with acellular mucin harvested from treated colorectal cancers (CRC) are staged as pN0. However, there is variability among pathologists while reporting the pN stage when acellular mucin is found within nodes of untreated CRCs. While the UICC guidelines suggest staging them as pN1, the AJCC and CAP do not offer any recommendations. In order to characterize their clinicopathologic features and outcome, we compared 16 untreated CRCs (study group; mean age: 68 years) harboring nodes with acellular mucin with 34 pN0 and 25 pN1 untreated CRC controls. All tumors were unifocal; 12 (75%) were right-sided lesions. Most cases (75%) showed one node with acellular mucin (range: 1–3). MMR-deficient tumors were significantly more common in the study group (83%) compared to pN0 (33%; p = 0.006) and pN1 controls (8%; p < 0.001). The overall survival of study group patients was closer to pN0 compared to pN1 controls; however, this difference was not statistically significant. In conclusion, untreated CRC that harbor acellular mucin within lymph nodes commonly present as right-sided, MMR-deficient tumors in older women that show a non-mucinous phenotype. While the limited number of cases precludes us from making any formal recommendations about staging, we suggest that the finding of acellular mucin in a node should prompt evaluation of deeper levels (with or without cytokeratin immunohistochemistry) and submission of all pericolonic fat for additional lymph node harvest. Whether acellular mucin in nodes of untreated CRCs is related to the indolent biology of the disease, a robust local immune response or MMR deficiency requires further investigation.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA

    James E. Lapinski & Deepa T. Patil

  2. Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA

    Alok A. Khorana & Michael McNamara

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA

    Lisa Rybicki

  4. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Canan Firat & Jinru Shia

  5. Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA

    Hwajeong Lee

  6. Department of Pathology, Morristown Medical Center, Morristown, NJ, USA

    Kathryn Piotti

  7. Department of Pathology, St. Vincent’s Medical Center, Bridgeport, CT, USA

    Eugene H. Lewis III

  8. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Vikram Deshpande

  9. Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, USA

    Deepa T. Patil

Authors
  1. James E. Lapinski
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  8. Michael McNamara
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Contributions

Study concept, design, and draft preparation: JEL, LR, VD, JS, DTP

Sample retrieval, laboratory work, data collection: JEL, AK, CF, HL, KP, EL, JS, VD, MM, DTP

Interpretation of data, scoring, analysis: JEL, LR, AK, CF, HL, KP, EL, JS, VD, MM, and DTP

Critical revision, intellectual contribution, and supervision: JEL, LR, AK, CF, HL, KP, EL, JS, VD, MM, and DTP

All authors have approved the final draft of the manuscript.

Corresponding author

Correspondence to Deepa T. Patil.

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Conflict of interest

Alok A. Khorana, M.D. - Receives Institutional grant support from NIH, CDC, Leap, BMS, Celgene, Merck; Consulting fees from Janssen, Bayer, Pfizer, Anthos, Sanofi, BMS, Seagen, honorarium from Medscape for CME events, Support for attending meetings and/or travel from Janssen, Bayer, Seagen, BMS; Participated on a Data Safety Monitoring Board or Advisory Board - Bayer, BMS, Janssen; Medical and Scientific Advisory Board, NBCA (unpaid). All remaining authors have no conflicts of interest.

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Supplementary Fig. 1

Kaplan-Meier curve comparing survival outcomes of all MMR-D tumors in three groups shows that the clinical outcome of patients with acellular mucin (cases; study group) was more similar to pN0 controls compared to pN+ (N1) colon cancer controls. The number of cases and events in this sub-analysis were too low to calculate p values. (PNG 11 kb)

High resolution image (TIF 84 kb)

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Lapinski, J.E., Khorana, A.A., Rybicki, L. et al. Acellular mucin in lymph nodes isolated from treatment-naïve colorectal cancer resections: a clinicopathologic analysis of 16 cases. Virchows Arch 481, 63–72 (2022). https://doi.org/10.1007/s00428-022-03332-5

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  • DOI: https://doi.org/10.1007/s00428-022-03332-5

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