Year :
2020
| Month :
November
| Volume :
14
| Issue :
11
| Page :
EC28 - EC32
Full Version
A Study of Significance of Poorly Differentiated Clusters in Colorectal Carcinomas: Association with Histopathological Prognostic Factors
Published: November 1, 2020 | DOI: https://doi.org/10.7860/JCDR/2020/46147.14259
Shailja Maurya, Sapna Patel, Harish Srikantegowda
1. Senior Resident, Department of Pathology, Homi Bhabha Cancer Hospital and MPMMCC, Varanasi, Uttar Pradesh, India.
2. Associate Professor, Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.
3. Professor, Department of General Surgery, JSSAHER, Mysuru, Karnataka, India.
Correspondence Address :
Dr. Shailja Maurya,
1514/2, Civil Line No. 2, Barahiyaveer, Sultanpur-226022, Uttar Pradesh, India.
E-mail: shailjam90@gmail.com
Abstract
Introduction: Colorectal Cancer (CRC) is the third most common cancer worldwide with prevalence rate of 47 million per five years and 1.8 million new cases per year. Routinely differentiation-based histologic grading of CRC is used, but its clinical impact is limited by insufficient prognostic value, inter-observer variability and the difficulty of its application to specific CRC's like mucinous, micropapillary, signet ring cell and medullary carcinomas. To overcome this, Poorly Differentiated Cluster (PDC) based grading have been proposed recently in 2012 by Ueno H et al., PDC is defined as a solid cancer cell nest comprising ≥5 cancer cells, lacking a gland-like structure.
Aim: To compare PDC based grading with conventional World Health Organisation (WHO) grading in resected specimens of colorectal adenocarcinomas and to evaluate the relationship of PDC grading with known prognostic histopathological parameters.
Materials and Methods: The present study was a descriptive study done duration of three years and two months in the Department of Pathology, JSS Medical College and Hospital, Mysuru, Karnataka, India. A total of 60 CRC cases were studied. WHO grading was done according to eighth edition, 2018 of the American Joint Committee on Cancer (AJCC) staging system. Haematoxylin and Eosin (H&E) stained slides were studied by two pathologists and looked for inter-observer variability by k statistics. Finally, both pathologists arrived at a consensus and was subjected for PDC grading and correlated with other prognostic histological markers. The comparison of data was done by Pearson 's Chi-square test and t-test. The p-values <0.05 were considered statistically significant. Fleiss-Cohen 's weighted k statistics was used for the assessment of interobserver variability in tumour grading.
Results: There was significant association between PDC grading and WHO grading with k-value of 0.852 and p-value of 0.001. The maximum cases on PDC grading were of G-II type-29 (48.3%) followed by G-III-25 (41.7%) and G-I-6 (10%). There was increase in G-II and G-III carcinomas, as mucinous adenocarcinoma and signet ring cell carcinomas were also graded with PDC which was not possible with current WHO grading system.
Conclusion: Present study findings suggest that PDC grading is more reproducible and provides better prognostic stratification as it is less subjective than the conventional WHO grading.
Keywords
Carcinoma colon, Crohn’s like lymphoid reaction, Desmoplastic reaction, Inter-observer variability, Mucinous carcinoma, Solid cancer cell nest
DOI: 10.7860/JCDR/2020/46147.14259
Date of Submission: Aug 17, 2020
Date of Peer Review: Aug 31, 2020
Date of Acceptance: Sep 24, 2020
Date of Publishing: Nov 01, 2020
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 22, 2020
• Manual Googling: Sep 24, 2020
• iThenticate Software: Oct 28, 2020 (3%)
ETYMOLOGY: Author Origin
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