8. Based on: Jass JR. Histopathology 2007;50:113-130. MS: microsatellite; CIMP: CpG island methylator phenotype; TSA: traditional serrated adenoma Ex adenoma, TIL R>L F>M Neg MSI-H (HNPCC) Ex adenoma, dirty necrosis, tumor budding L>R M>F APC TP53 (KRAS) Neg MSS Ex villous adenoma (kras+) or serrated adenoma L>R M>F KRAS+ Low MSI- L or MSS Ex serrated polyps (TSA), serrated, mucinous, HG non-circumscribed, (TIL) R>L F>M BRAF+ High MSI- L or MSS Ex serrated polyps (sessile), serrated, mucinous , HG circumscribed, TIL R>L F>M BRAF+ High MSI-H (sporadic) Morphology Loc M / F Other CIMP MSI / MSS
23. How many LNs? As many as possible ! 8574 T3N0M0 CRC from the SEER database Cserni G, et al . Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas? J Surg Oncol 2002; 81:63-69.
24.
25. Distance from the tumour as qualitative feature Cserni G, et al . Distance of lymph nodes from the tumor, an important feature in colorectal cancer specimens. Arch Pathol Lab Med 2001; 125:246-249. Tumour + 1-1 cm 2 cm 2 cm 3 cm 3 cm D C B A B C D 100 cases of CRC Mean: 17 LN / case
26. An example A B A B B C C C No fraction D in this specific case
27.
28.
29.
30.
31.
32.
33.
34. Suspected VI in muscularis pr NOT VI! Unsuspected VI in submucosa VI!
35.
36.
37.
38.
39. G 3 – Good quality - mesorectal plane (complete TME)