Primary diffusely infiltrative adenocarcinoma of the colon and rectum

Primary diffusely infiltrative colorectal adenocarcinoma is rare. About 100 cases have been reported in the literature. The mucosal alterations in this type of tumor and their clinicopathological characteristics in relation to survival are not clear.

We retrospectively reviewed 30 cases of primary diffusely infiltrative colorectal adenocarcinoma operated upon in a single institution.

Eighteen (60%) of these 30 patients were women. The average age at diagnosis was 47.4 (SD, 19.3) years. Eighteen tumors (60%) were located in the rectum. The tumors could be classified into two major types. A type 1 tumor had minimal mucosal alteration and no discrete ulcer. A type 2 tumor was associated with a discrete ulcer. The type 1 tumor was more frequently associated with intracellular or extracellular mucin production and stage IV disease. Hematogenous spread (including peritoneal carcinomatosis) was more frequently seen in type 1 than in the type 2 tumors (61% vs. 18%, p = 0.013). The overall median cancer-specific survival time was 15 (SE, 3; 95% confidence interval, 10-21) months. TNM stage is the only significant factor in predicting outcome (p = 0.016). When compared with stages II and III, the odds of death for stage IV was 2.9 (95% confidence interval: 1.1-7.4).

Diffusely infiltrative colorectal cancer can be separated into two subtypes according to the presence of a discrete ulcer. The type 1 tumor (without a discrete ulcer) was associated with a higher frequency of hematogenous spread. TNM Stage was the only important clinicopathological factor in determining outcome.