Tumour deposit: Difference between revisions
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A '''tumour deposit''' is a microscopic or macroscopic tumour nodule in the lymphatic drainage bed of the (primary) tumour. | A '''tumour deposit''' is a microscopic or macroscopic tumour nodule in the lymphatic drainage bed of the (primary) tumour. The term is applied in [[colorectal adenocarcinoma]] and has also been described in [[gastric cancer]].<ref name=pmid23184289>{{Cite journal | last1 = Lee | first1 = HS. | last2 = Lee | first2 = HE. | last3 = Yang | first3 = HK. | last4 = Kim | first4 = WH. | title = Perigastric tumor deposits in primary gastric cancer: implications for patient prognosis and staging. | journal = Ann Surg Oncol | volume = 20 | issue = 5 | pages = 1604-13 | month = May | year = 2013 | doi = 10.1245/s10434-012-2692-9 | PMID = 23184289 }}</ref> | ||
It is also known as '''discoutinuous extramural extension''' and ''' | It is also known as '''discoutinuous extramural extension''' and '''peritumoural deposit'''. | ||
Conceptually, tumour deposits are like the ''[[in-transit metastases]]'' of [[malignant melanoma]]<ref name=pmid19136930>{{Cite journal | last1 = Puppa | first1 = G. | last2 = Ueno | first2 = H. | last3 = Kayahara | first3 = M. | last4 = Capelli | first4 = P. | last5 = Canzonieri | first5 = V. | last6 = Colombari | first6 = R. | last7 = Maisonneuve | first7 = P. | last8 = Pelosi | first8 = G. | title = Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases. | journal = Mod Pathol | volume = 22 | issue = 3 | pages = 410-5 | month = Mar | year = 2009 | doi = 10.1038/modpathol.2008.198 | PMID = 19136930 }}</ref> and [[dermatopathology]]. | Conceptually, tumour deposits are like the ''[[in-transit metastases]]'' of [[malignant melanoma]]<ref name=pmid19136930>{{Cite journal | last1 = Puppa | first1 = G. | last2 = Ueno | first2 = H. | last3 = Kayahara | first3 = M. | last4 = Capelli | first4 = P. | last5 = Canzonieri | first5 = V. | last6 = Colombari | first6 = R. | last7 = Maisonneuve | first7 = P. | last8 = Pelosi | first8 = G. | title = Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases. | journal = Mod Pathol | volume = 22 | issue = 3 | pages = 410-5 | month = Mar | year = 2009 | doi = 10.1038/modpathol.2008.198 | PMID = 19136930 }}</ref> and [[dermatopathology]]; however, it is important to note that on a practical level the specific (morphologic/clinical) definitions of ''tumour deposit'' and ''in-transit metastasis'' are different. | ||
==General== | ==General== | ||
Definition - TNM/AJCC 7th edition:<ref name=pmid21555695/> | Significance: | ||
*Poor prognosticator. | |||
**Can be understood as a type of invasive front/border, e.g. ''well-circumscribed border'' versus ''infiltrative border''.<ref name=pmid24112678/> | |||
==Definition== | |||
Definition - TNM/AJCC 8th edition for colorectal cancer: | |||
"Tumor deposits are defined as discrete tumor nodules within the lymph drainage area of the primary carcinoma without identifiable lymph node tissue or identifiable vascular or neural structure. The shape, contour, and size of the deposit are not considered in these designations." | |||
Definition - TNM/AJCC 7th edition for colorectal cancer:<ref name=pmid21555695/> | |||
*Microscopic or macroscopic nodule in the lymphatic drainage bed of the tumour. | *Microscopic or macroscopic nodule in the lymphatic drainage bed of the tumour. | ||
**No standardized distance (from tumour) criteria are defined.<ref name=pmid24112678>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Hashiguchi | first2 = Y. | last3 = Shimazaki | first3 = H. | last4 = Shinto | first4 = E. | last5 = Kajiwara | first5 = Y. | last6 = Nakanishi | first6 = K. | last7 = Kato | first7 = K. | last8 = Maekawa | first8 = K. | last9 = Nakamura | first9 = T. | title = Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. | journal = Am J Surg | volume = | issue = | pages = | month = Oct | year = 2013 | doi = 10.1016/j.amjsurg.2013.04.009 | PMID = 24112678 }}</ref> | **No standardized distance (from tumour) criteria are defined.<ref name=pmid24112678>{{Cite journal | last1 = Ueno | first1 = H. | last2 = Hashiguchi | first2 = Y. | last3 = Shimazaki | first3 = H. | last4 = Shinto | first4 = E. | last5 = Kajiwara | first5 = Y. | last6 = Nakanishi | first6 = K. | last7 = Kato | first7 = K. | last8 = Maekawa | first8 = K. | last9 = Nakamura | first9 = T. | title = Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. | journal = Am J Surg | volume = | issue = | pages = | month = Oct | year = 2013 | doi = 10.1016/j.amjsurg.2013.04.009 | PMID = 24112678 }}</ref> | ||
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*#*Round nodules of tumour are considered lymph nodes that are replaced by tumour. | *#*Round nodules of tumour are considered lymph nodes that are replaced by tumour. | ||
Notes: | |||
* | *The definition of ''tumour deposit'' has changed significantly between the TMN/AJCC fifth, sixth, seventh editions.<ref name=pmid21555695/> | ||
*Lesions that are ''not'' in the drainage bed of the tumour are [[Colorectal_cancer_staging#Metastasis_stage|metastatic disease]], pM1b. | |||
===Ueno criteria=== | ===Ueno criteria=== | ||
Ueno ''et al.'' propose that a tumour deposit is either:<ref name=pmid24112678/> | Ueno ''et al.'' propose that a tumour deposit is either:<ref name=pmid24112678/> | ||
#>=2 mm from the tumour front. | #>=2 mm from the tumour front. | ||
#>=2 mm (radially) from the deepest aspect of the muscularis propria, if the tumour is not present in the plane of section. | #>=2 mm (radially) from the deepest aspect of the muscularis propria, if the tumour is not present in the plane of section. | ||
==Staging== | |||
Staging implications in [[colorectal cancer]]: | |||
*Tumour deposits are '''not''' counted as (positive) lymph nodes<ref name=pmid21555695>{{Cite journal | last1 = Nagtegaal | first1 = ID. | last2 = Tot | first2 = T. | last3 = Jayne | first3 = DG. | last4 = McShane | first4 = P. | last5 = Nihlberg | first5 = A. | last6 = Marshall | first6 = HC. | last7 = Påhlman | first7 = L. | last8 = Brown | first8 = JM. | last9 = Guillou | first9 = PJ. | title = Lymph nodes, tumor deposits, and TNM: are we getting better? | journal = J Clin Oncol | volume = 29 | issue = 18 | pages = 2487-92 | month = Jun | year = 2011 | doi = 10.1200/JCO.2011.34.6429 | PMID = 21555695 }}</ref> and in the context of positive lymph nodes do not change the [[Colorectal_cancer_staging#Nodal_stage|N stage]]. | |||
**If no positive lymph nodes are present, the N stage is pN1c. | |||
*The T stage is ''not'' affected by tumour deposits.<ref name=pmid21555695/> | |||
==See also== | ==See also== | ||