Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by...

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Colitis-associated cancer exhibits a higher prevalence of poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc) compared to sporadic tumors.
• These histologic subtypes are associated with a poor prognosis, but their specific invasiveness and clinical manifestations in ulcerative colitis-associated neoplasms (UCANs) remain unclear.

Purpose of the Study:

• To determine the prevalence of the por/sig/muc component in UCANs.
• To investigate the association of this component with tumor invasiveness.
• To clarify the clinicohistologic and endoscopic features of UCANs with por/sig/muc components.

Main Methods:

• Retrospective observational study.
• Inclusion of patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma between 1997 and 2022.
• Division of patients into groups based on the presence or absence of a por/sig/muc component.

Main Results:

• Thirty-five patients had UCAN with a por/sig/muc component, and 66 had UCAN without it.
• The 5-year survival rate was significantly lower in the por/sig/muc group (67%) compared to the tubular group (96%), linked to advanced stage and deep invasion.
• Preoperative biopsy detected the por/sig/muc component in only 40% of lesions, despite its prevalence increasing with tumor stage.

Conclusions:

• UCANs with por/sig/muc components demonstrate a tendency for deep invasion and are frequently underdiagnosed preoperatively.
• Endoscopists must recognize that UCANs may harbor unrecognized por/sig/muc components.
• Careful consideration of optimal treatment strategies is crucial for these aggressive neoplasms.