Phenotype of microsatellite unstable colorectal carcinomas: Well-differentiated and focally mucinous tumors and the absence of dirty necrosis correlate with microsatellite instability

Joel K. Greenson, Joseph D. Bonner, Ofer Ben-Yzhak, Hector I. Cohen, Ines Miselevich, Murray B. Resnick, Philippe Trougouboff, Lynn D. Tomsho, Evelyn Kim, Marcelo Low, Ronit Almog, Gad Rennert, Stephen B. Gruber

Research output: Contribution to journalArticlepeer-review

217 Scopus citations

Abstract

The phenotypic markers of colorectal carcinomas with microsatellite instability have been widely studied and include mucinous or poor differentiation, prominent host response, a circumscribed growth pattern, histologic heterogeneity, and right-sided location. As part of a population-based case-control study of colorectal cancer in northern Israel, we reviewed the pathology and microsatellite status of 528 consecutively diagnosed colorectal cancers. Phenotypic analysis was performed by one pathologist (J.K.G.) and included assessment of grade, mucinous histology (>50%, or focal), histologic heterogeneity, growth pattern, necrosis, and host response. Microsatellite status was determined on microdissected portions of formalin-fixed, paraffin-embedded tissue using a panel of 5 NCI consensus primers. Fifty-two of 528 colorectal carcinomas were microsatellite unstable (9.85%). Multivariate analysis found that >2 tumor infiltrating lymphocytes per high power field (p <0.0001), the lack of dirty necrosis (p = 0.0054), a Crohn's-like host response (p = 0.0064), right-sided location (p = 0.032), well or poor differentiation (p = 0.037), and any mucinous differentiation (p = 0.039) were independent predictors of microsatellite instability. Tumor infiltrating lymphocytes were the single best histologic predictor of microsatellite instability. The absence of dirty necrosis and the presence of well-differentiated tumors and tumors with only focal mucinous differentiation were also important markers for microsatellite instability that have not been emphasized previously. The combination of >2 tumor infiltrating lymphocytes per high power field and/or any mucinous differentiation and/or the absence of dirty necrosis identified all MSI-H tumors in this study.

Original languageEnglish
Pages (from-to)563-570
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume27
Issue number5
DOIs
StatePublished - 1 May 2003
Externally publishedYes

Keywords

  • Colorectal neoplasia
  • Differentiation
  • Dirty necrosis
  • Microsatellite instability
  • Mucinous
  • Tumor infiltrating lymphocytes

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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