Clinicopathologic Features of Untreated Colorectal Cancer with Acellular Mucin-Only Lymph Nodes

Lymph nodes (LNs) containing only acellular mucin are considered negative for metastasis in treated colorectal cancers (CRCs). However, no data exist on how to stage these LNs in untreated CRCs. We collected 63 untreated CRC cases with LNs containing only acellular mucin from 27 US institutions and 23 additional cases from the Dutch Nationwide Pathology Databank. The practice patterns of pathologists in handling such cases, as well as the clinicopathological features of these cases, were analyzed. The survival of the study group was compared with 2 control groups: 102 pN0 and 76 pN1 untreated CRC cases. US and Dutch pathologists demonstrated similar practice patterns in assigning the pN stage and in the use of additional studies. Tumors in the study group were more likely to be located in the right colon, exhibit mucinous features, and be mismatch repair deficient compared with tumors in the pN0 and pN1 control groups. Compared with the pN1 control group, the study group showed significantly lower frequencies of lymphovascular invasion, local recurrence, and distant metastasis. No patient in the study group died of CRC, similar to the pN0 group. In contrast, the pN1 group had a significantly higher risk of CRC-related death. These findings suggest that LNs containing only acellular mucin in untreated CRCs should be interpreted as negative and staged as pN0, in line with current practice in neoadjuvant-treated CRCs.