Peritumoural lymphocytic response

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Peritumoural lymphocytic response. H&E stain.

Peritumoural lymphocytic response is an uncommon finding in colorectal carcinoma that is associated with a better prognosis and microsatellite instability.[1]

It is also known as Crohn's like reaction,[2] Crohn's-like lymphoid reaction and Crohn-like response.[3]

General

Microscopic

There are two sets of criteria (Ueno and Graham). The Ueno criteria have a better inter-rater reproducibility than the older Graham criteria[4] and are less complicated.

Ueno criteria (2013)

Required criteria:[5]

  • Non-MALT lymphoid aggregates (peritumoural) >= 1 mm.

Ignore:

  1. Muscosa-associated lymphoid tissue (MALT) = mucosal lymphoid aggregates, submucosal lymphoid aggregates adjacent to the musuclaris mucosae.
  2. Lymph nodes - these have a (fibrous) capsule.
  3. Irregular shape (not round).

Graham criteria (1990)

Required criteria:[4]

  • Peritumoral:
    1. Lymphoid aggregates with germinal centres focally.
    2. Stellate fibrosis.
    3. No previous clinical and pathologic evidence of Crohn's disease.

Note:

Images

See also

References

  1. 1.0 1.1 Harrison, JC.; Dean, PJ.; el-Zeky, F.; Vander Zwaag, R. (Jan 1995). "Impact of the Crohn's-like lymphoid reaction on staging of right-sided colon cancer: results of multivariate analysis.". Hum Pathol 26 (1): 31-8. PMID 7821914.
  2. Ogino, S.; Nosho, K.; Irahara, N.; Meyerhardt, JA.; Baba, Y.; Shima, K.; Glickman, JN.; Ferrone, CR. et al. (Oct 2009). "Lymphocytic reaction to colorectal cancer is associated with longer survival, independent of lymph node count, microsatellite instability, and CpG island methylator phenotype.". Clin Cancer Res 15 (20): 6412-20. doi:10.1158/1078-0432.CCR-09-1438. PMID 19825961.
  3. URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2012/Colon_12protocol_3200.pdf. Accessed on: 14 September 2012.
  4. 4.0 4.1 Graham, DM.; Appelman, HD. (May 1990). "Crohn's-like lymphoid reaction and colorectal carcinoma: a potential histologic prognosticator.". Mod Pathol 3 (3): 332-5. PMID 2362940.
  5. Ueno, H.; Hashiguchi, Y.; Shimazaki, H.; Shinto, E.; Kajiwara, Y.; Nakanishi, K.; Kato, K.; Maekawa, K. et al. (Apr 2013). "Objective Criteria for Crohn-like Lymphoid Reaction in Colorectal Cancer.". Am J Clin Pathol 139 (4): 434-41. doi:10.1309/AJCPWHUEFTGBWKE4. PMID 23525613.