Mucinous and Signet Ring Cell Differentiation Affect Patterns of Metastasis in Colorectal Carcinoma and Influence Survival

Taher Reza Kermanshahi, Deepa Magge, Haroon Choudry, Leksmi Ramalingam, Benjamin Zhu, James Pingpank, Steven Ahrendt, Matthew Holtzman, Herbert Zeh, David Bartlett, Amer Zureikat, Reetesh K. Pai

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Peritoneal metastasis in colorectal carcinoma is associated with a dismal prognosis; however, features that correlate with patterns of metastatic spread are not well characterized. We analyzed the clinicopathologic and molecular features of 166 patients with colorectal carcinomas stratified by metastases to the peritoneum or liver. Mucinous and signet ring cell differentiation were more frequently observed in colorectal carcinoma with peritoneal dissemination compared to colorectal carcinoma with liver metastasis (mucinous differentiation: 62% vs 23%, P <.001; signet ring cell differentiation: 21% vs 0%, P <.0001). The significant association of mucinous differentiation with peritoneal dissemination compared with liver metastasis was identified in patients with both synchronous and metachronous development of metastasis (P <.01). In contrast, colorectal carcinomas with liver metastasis were more frequently low-grade (90% vs 72%, P =.005) and associated with dirty necrosis (81% vs 56%, P =.001) compared with colorectal carcinomas with peritoneal dissemination. No significant differences were identified between colorectal carcinoma with peritoneal metastasis versus liver metastasis with respect to KRAS mutations, BRAF mutation, or high levels of microsatellite instability. Patients with tumors involving the peritoneum had a significantly worse overall survival in comparison to patients with liver metastasis lacking peritoneal involvement (P =.02). When including only those patients with peritoneal metastasis, the presence of any mucinous or signet ring cell differentiation was associated with a significantly worse overall survival (P =.006). Our findings indicate that mucinous and signet ring cell differentiation may be histologic features that are associated with an increased risk of peritoneal dissemination and poor overall survival in patients with peritoneal metastasis.

Original languageEnglish (US)
Pages (from-to)108-117
Number of pages10
JournalInternational Journal of Surgical Pathology
Volume25
Issue number2
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

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Cell Differentiation
Colorectal Neoplasms
Neoplasm Metastasis
Survival
Liver
Peritoneum
Microsatellite Instability
Mutation
Necrosis

Keywords

  • colorectal carcinoma
  • liver
  • metastases
  • mucinous
  • peritoneum
  • signet ring cell

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Mucinous and Signet Ring Cell Differentiation Affect Patterns of Metastasis in Colorectal Carcinoma and Influence Survival. / Kermanshahi, Taher Reza; Magge, Deepa; Choudry, Haroon; Ramalingam, Leksmi; Zhu, Benjamin; Pingpank, James; Ahrendt, Steven; Holtzman, Matthew; Zeh, Herbert; Bartlett, David; Zureikat, Amer; Pai, Reetesh K.

In: International Journal of Surgical Pathology, Vol. 25, No. 2, 01.04.2017, p. 108-117.

Research output: Contribution to journalArticle

Kermanshahi, TR, Magge, D, Choudry, H, Ramalingam, L, Zhu, B, Pingpank, J, Ahrendt, S, Holtzman, M, Zeh, H, Bartlett, D, Zureikat, A & Pai, RK 2017, 'Mucinous and Signet Ring Cell Differentiation Affect Patterns of Metastasis in Colorectal Carcinoma and Influence Survival', International Journal of Surgical Pathology, vol. 25, no. 2, pp. 108-117. https://doi.org/10.1177/1066896916664990
Kermanshahi, Taher Reza ; Magge, Deepa ; Choudry, Haroon ; Ramalingam, Leksmi ; Zhu, Benjamin ; Pingpank, James ; Ahrendt, Steven ; Holtzman, Matthew ; Zeh, Herbert ; Bartlett, David ; Zureikat, Amer ; Pai, Reetesh K. / Mucinous and Signet Ring Cell Differentiation Affect Patterns of Metastasis in Colorectal Carcinoma and Influence Survival. In: International Journal of Surgical Pathology. 2017 ; Vol. 25, No. 2. pp. 108-117.
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abstract = "Peritoneal metastasis in colorectal carcinoma is associated with a dismal prognosis; however, features that correlate with patterns of metastatic spread are not well characterized. We analyzed the clinicopathologic and molecular features of 166 patients with colorectal carcinomas stratified by metastases to the peritoneum or liver. Mucinous and signet ring cell differentiation were more frequently observed in colorectal carcinoma with peritoneal dissemination compared to colorectal carcinoma with liver metastasis (mucinous differentiation: 62{\%} vs 23{\%}, P <.001; signet ring cell differentiation: 21{\%} vs 0{\%}, P <.0001). The significant association of mucinous differentiation with peritoneal dissemination compared with liver metastasis was identified in patients with both synchronous and metachronous development of metastasis (P <.01). In contrast, colorectal carcinomas with liver metastasis were more frequently low-grade (90{\%} vs 72{\%}, P =.005) and associated with dirty necrosis (81{\%} vs 56{\%}, P =.001) compared with colorectal carcinomas with peritoneal dissemination. No significant differences were identified between colorectal carcinoma with peritoneal metastasis versus liver metastasis with respect to KRAS mutations, BRAF mutation, or high levels of microsatellite instability. Patients with tumors involving the peritoneum had a significantly worse overall survival in comparison to patients with liver metastasis lacking peritoneal involvement (P =.02). When including only those patients with peritoneal metastasis, the presence of any mucinous or signet ring cell differentiation was associated with a significantly worse overall survival (P =.006). Our findings indicate that mucinous and signet ring cell differentiation may be histologic features that are associated with an increased risk of peritoneal dissemination and poor overall survival in patients with peritoneal metastasis.",
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AU - Ramalingam, Leksmi

AU - Zhu, Benjamin

AU - Pingpank, James

AU - Ahrendt, Steven

AU - Holtzman, Matthew

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AU - Bartlett, David

AU - Zureikat, Amer

AU - Pai, Reetesh K.

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AB - Peritoneal metastasis in colorectal carcinoma is associated with a dismal prognosis; however, features that correlate with patterns of metastatic spread are not well characterized. We analyzed the clinicopathologic and molecular features of 166 patients with colorectal carcinomas stratified by metastases to the peritoneum or liver. Mucinous and signet ring cell differentiation were more frequently observed in colorectal carcinoma with peritoneal dissemination compared to colorectal carcinoma with liver metastasis (mucinous differentiation: 62% vs 23%, P <.001; signet ring cell differentiation: 21% vs 0%, P <.0001). The significant association of mucinous differentiation with peritoneal dissemination compared with liver metastasis was identified in patients with both synchronous and metachronous development of metastasis (P <.01). In contrast, colorectal carcinomas with liver metastasis were more frequently low-grade (90% vs 72%, P =.005) and associated with dirty necrosis (81% vs 56%, P =.001) compared with colorectal carcinomas with peritoneal dissemination. No significant differences were identified between colorectal carcinoma with peritoneal metastasis versus liver metastasis with respect to KRAS mutations, BRAF mutation, or high levels of microsatellite instability. Patients with tumors involving the peritoneum had a significantly worse overall survival in comparison to patients with liver metastasis lacking peritoneal involvement (P =.02). When including only those patients with peritoneal metastasis, the presence of any mucinous or signet ring cell differentiation was associated with a significantly worse overall survival (P =.006). Our findings indicate that mucinous and signet ring cell differentiation may be histologic features that are associated with an increased risk of peritoneal dissemination and poor overall survival in patients with peritoneal metastasis.

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