Medullary colorectal carcinoma

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Medullary colorectal carcinoma is a rare type of colorectal carcinoma.

General

  • Rare subtype of colorectal carcinoma.
  • Typically has Microsatellite instability.[1]
  • Prognostic significance dependent on study.
    • A small series suggests the prognosis of medullary carcinoma with MSI is worse that conventional colorectal carcinoma without MSI.[2]
    • A series with 102 cases suggests a better prognosis when compared on the basis of other pathological characteristics.[3]

Gross

  • Well-circumscribed.

Microscopic

Features:

  • Poorly differentiated carcinoma:
    • Noninfiltrative border.
    • Solid pattern/nests.
    • No gland formation.
    • Lymphocytic infiltrate.

DDx:

IHC

Features:[1]

  • CDX2 +ve.
  • Beta-catenin +ve.
  • MLH1 loss of staining.
  • Calretinin (67%-73%)[4][5]

Note:

  • CDX2, beta-catenin, MLH1 useful for differentiating from poorly differentiated colorectal carcinoma.

See also

References

  1. ↑ 1.0 1.1 "Medullary carcinoma of the colon: a case series and review of the literature". In Vivo 28 (3): 311–4. 2014. PMID 24815832.
  2. ↑ "Medullary colonic carcinoma with microsatellite instability has lower survival compared with conventional colonic adenocarcinoma with microsatellite instability". Prz Gastroenterol 12 (3): 208–214. 2017. doi:10.5114/pg.2016.64740. PMC 5672702. PMID 29123583. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672702/.
  3. ↑ "Medullary colorectal carcinoma revisited: a clinical and pathological study of 102 cases". Ann. Surg. Oncol. 22 (9): 2988–96. September 2015. doi:10.1245/s10434-014-4355-5. PMID 25572685.
  4. ↑ "Differentiating the undifferentiated: immunohistochemical profile of medullary carcinoma of the colon with an emphasis on intestinal differentiation". Hum. Pathol. 40 (3): 398–404. March 2009. doi:10.1016/j.humpath.2008.08.014. PMC 2657293. PMID 18992917. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657293/.
  5. ↑ "Cadherin-17 and SATB2 are sensitive and specific immunomarkers for medullary carcinoma of the large intestine". Arch. Pathol. Lab. Med. 138 (8): 1015–26. August 2014. doi:10.5858/arpa.2013-0452-OA. PMID 24437456.
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