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Prognostic relevance and putative histogenetic role of cytokeratin 7 and MUC5AC expression in Crohn's disease-associated small bowel carcinoma.
- Source :
-
Virchows Archiv : an international journal of pathology [Virchows Arch] 2021 Oct; Vol. 479 (4), pp. 667-678. Date of Electronic Publication: 2021 May 08. - Publication Year :
- 2021
-
Abstract
- Most Crohn's disease-associated small bowel carcinomas (CrD-SBCs) are diagnosed in advanced stage and have poor prognosis. To improve diagnosis and therapy, a better knowledge of tumour precancerous lesions, histotypes and prognostic factors is needed. We investigated histologically and immunohistochemically 52 CrD-SBCs and 51 small bowel carcinomas unrelated to inflammatory disease, together with their tumour-associated mucosa, looking for Crohn-selective changes. Histologic patterns and phenotypic markers potentially predictive of CrD-SBC histogenesis and prognosis were analysed. Cytokeratin 7 or MUC5AC-positive metaplastic changes were found in about half of investigated CrD-SBCs, significantly more frequently than in CrD-unrelated SBCs. They correlated with metaplastic changes of their associated mucosa, while being absent in normal ileal mucosa. Histologic patterns suggestive for progression of some cytokeratin 7 and/or MUC5AC-positive metaplastic lesions into cancer of the same phenotype were also observed. Patient survival analyses showed that tumour cytokeratin 7 or MUC5AC expression and non-cohesive histotype were adverse prognostic factors at univariable analysis, while cytokeratin 7 and non-cohesive histotype were also found to predict worse survival in stage- and age-inclusive multivariable analyses. Besides conventional dysplasia, hyperplasia-like non-conventional lesions were observed in CrD-SBC-associated mucosa, with patterns suggestive for a histogenetic link with adjacent cancer. In conclusion the cytokeratin 7 and/or MUC5AC-positive metaplastic foci and the non-conventional growths may have a role in cancer histogenesis, while tumour cytokeratin 7 and non-cohesive histotype may also predict poor patient survival. Present findings are worth being considered in future prospective histogenetic and clinical studies.<br /> (© 2021. The Author(s).)
- Subjects :
- Adenocarcinoma pathology
Crohn Disease metabolism
Crohn Disease pathology
Duodenal Neoplasms pathology
Gene Expression genetics
Gene Expression Regulation, Neoplastic genetics
Humans
Intestinal Mucosa pathology
Intestine, Small pathology
Keratin-7 genetics
Metaplasia pathology
Mucin 5AC genetics
Precancerous Conditions pathology
Prognosis
Survival Analysis
Transcriptome genetics
Carcinoma pathology
Crohn Disease complications
Keratin-7 metabolism
Mucin 5AC metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2307
- Volume :
- 479
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Virchows Archiv : an international journal of pathology
- Publication Type :
- Academic Journal
- Accession number :
- 33963925
- Full Text :
- https://doi.org/10.1007/s00428-021-03109-2