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Poorly Cohesive Carcinoma of the Nonampullary Small Intestine: A Distinct Histologic Subtype With Prognostic
Alessandro Vanoli1,2, Camilla Guerini1, Federica Grillo3
1Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia.
The American Journal of Surgical Pathology
|October 10, 2021
Summary
This study identifies nonampullary small bowel poorly cohesive carcinomas (SB-PCCs) as a distinct subtype of small bowel adenocarcinoma. These tumors have unique features and a worse prognosis, supporting their separation from other small bowel adenocarcinomas.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Poorly cohesive carcinomas (PCCs) are known in the stomach but understudied in the small bowel.
- Nonampullary small bowel poorly cohesive carcinomas (SB-PCCs) lack extensive clinicopathologic data.
- Existing classifications do not fully address distinct small bowel PCC subtypes.
Purpose of the Study:
- To analyze clinicopathologic and immunophenotypic features of SB-PCCs.
- To compare SB-PCCs with other small bowel adenocarcinomas (SBAs), including SBAs-NOS and mixed subtypes.
- To provide evidence for the WHO 2019 classification of SB-PCCs.
Main Methods:
- Retrospective analysis of 15 SB-PCCs.
- Comparison with 95 SBAs-Not Otherwise Specified (NOS) and 27 mixed-poorly-cohesive-glandular-SBAs.
- Evaluation of E-cadherin expression and mismatch repair deficiency.
Main Results:
- SB-PCCs showed younger patient age, association with Crohn disease, and higher rates of lymphovascular/perineural invasion compared to SBAs-NOS.
- Loss of E-cadherin was observed in most SB-PCCs.
- Both SB-PCCs and mixed subtypes had significantly worse cancer-specific survival than SBAs-NOS.
Conclusions:
- SB-PCCs represent a distinct entity within nonampullary small bowel adenocarcinomas.
- The findings support the WHO 2019 classification recognizing SB-PCCs.
- Separating SB-PCCs and mixed subtypes from SBAs-NOS is recommended for better patient management and prognosis.
