Clinicopathological differences of laterally spreading tumors arising in the colon and rectum

Laterally spreading tumors (LST) have been recognized worldwide. The aim of our retrospective study was to evaluate the clinicopathological differences of LST arising in the colon and rectum.

We investigated the clinical records of consecutive patients with LST that were endoscopically or surgically resected at our hospital between February 2006 and March 2011. LST were classified into three types: granular-homogenous (LST-GH), granular-nodular mixed (LST-GM), and nongranular (LST-NG) types. We also defined the hardly elevated flat lesion with a dilated pit pattern that occurs at the margins of LST as the "skirt." The clinicopathological characteristics of the LST arising in the colon and rectum, including the presence of the skirt, were compared.

A total of 496 colorectal LST in 435 patients were examined. LST-GM was predominant in the rectum, whereas LST-NG was predominant in the colon (p < 0.001). The mean tumor size was larger in the rectum (39.3 ± 17.9 mm) than the colon (25.8 ± 13.6 mm) (p < 0.001). Low-grade dysplasia frequency was lower in the rectum than the colon (4 vs. 37%, p < 0.001). The skirt was identified in 15 lesions (3.0%), with a higher incidence in the rectum than the colon (17 vs. 0.5%, p < 0.001). The skirt was found only in LST-GM.

A greater proportion of LST-GM, greater mean size, and lower incidence of low-grade dysplasia were found in rectal LST. The skirt was a novel and unique finding, primarily observed in rectal LST-GM cases.