This Article Abstract Full Text Full Text (PDF) Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ng, C S Articles by Arends, M J Search for Related Content PubMed PubMed Citation Articles by Ng, C S Articles by Arends, M J

Histopathological correlates of abnormal pericolic fat on CT in the assessment of colorectal carcinoma

Departments of ¹Radiology, ²Surgery and ³Pathology, Addenbrooke's NHS Trust and the University of Cambridge, Cambridge, UK

View larger version (59K): [in a new window]   Figure 1. (a) 70-year-old man with change in bowel habit. CT shows bowel wall thickening in the proximal transverse colon with normal pericolic fat (arrow). Histopathology of the resected specimen showed a pT4 tumour invading the omentum, together with an extramuscular tissue reaction (grade 2 fibrosis and grade 2 inflammation). (b) 75-year-old woman with anaemia. CT shows bowel wall thickening in the ascending colon with abnormal pericolic fat (arrow). Histopathology of the resected specimen showed a pT2 tumour, together with an extramuscular tissue reaction (grade 2 fibrosis and grade 1 inflammation).

View larger version (75K): [in a new window]   Figure 2. (a) 76-year-old woman with anaemia. CT showed a caecal carcinoma with abnormal pericolic fat. The photomicrograph shows infiltration of colorectal cancer (C) beyond the muscularis propria (M), i.e. stage pT3, Dukes' B, together with a grade 2 host fibrotic tissue reaction (F). There was also a grade 1 inflammatory reaction (not shown), giving an overall pericolic tissue reaction score of 3. (P, uninvolved adipocytes). This case illustrates how invasion of malignant glands excites a fibrotic reaction directly in the adjacent pericolic tissue. Scale bar (upper left)=1 mm. (b) 80-year-old woman with rectal bleeding. CT showed a sigmoid carcinoma with normal pericolic fat. The photomicrograph shows colorectal cancer (C) superficially invading the muscularis propria (M), i.e. stage pT2, Dukes' A. There was an associated grade 2 host fibrotic reaction (F) and grade 2 chronic inflammatory reaction (I) in the underlying pericolic fat (P), giving an overall pericolic tissue reaction score of 4. This case illustrates that there may be a substantial fibrotic and inflammatory response within the pericolic tissue even though the invasive cancer lies 3–4 mm remote from the pericolic fatty tissue. Scale bar (left side)=1 mm.

View larger version (22K): [in a new window]   Figure 3. Largest lymph node size measured histopathologically by lymph node status (tumour-involved vs tumour-free). Box plot showing median, interquartile range, and maximum and minimum values.

View larger version (69K): [in a new window]   Figure 4. (a) 51-year-old woman with right iliac fossa pain. CT showed a caecal carcinoma with abnormal pericolic fat. Histopathology of the resected specimen found 2 out of 10 lymph nodes (LN) were involved by tumour, one of which (illustrated) was partially involved by colorectal cancer (C). Despite involvement by metastatic cancer, this small node is not enlarged. The largest involved node in this case measured 8 mm, smaller than the largest uninvolved node (13 mm). Scale bar (top right)=1 mm. (b) 45-year-old woman with abdominal pain. CT showed a caecal carcinoma (there was insufficient intraabdominal fat to allow satisfactory evaluation of the pericolic fat). Histopathology of the resected specimen found 3 out of 11 nodes were involved by tumour, the largest of which was 25 mm, and 8 out of 11 uninvolved nodes, the largest of which was 30 mm, as illustrated. This photomicrograph shows 25% of the latter (tumour-free) lymph node containing reactive follicular hyperplasia. Scale bar (top right)=1 mm (same magnification as Figure 4a for comparison).