Rare Mucinous Colorectal Adenocarcinoma: Analysis of the Epidemiological Factors in Relation to Survival in Egyptian Patients

Colorectal carcinoma (CRC) is one of the leading causes of cancer related deaths; in Egypt it constitutes 6.5% of all cancers. Previous studies have shown conflicting results on clinicohistopathological features and survival of patients with colorectal mucinous (MA) and non-mucinous adenocarcinoma (NMA). To the best of our knowledge, this study is the first to investigate these features in Egypt. In this work, we studied tumor tissue specimens from 150 patients with colorectal MA and NMA who underwent radical surgery from Jan 2007 to Jan 2012 at Gastroenterology Centre, Mansoura University, Egypt. Their clinicohistopathological parameters and survival were analyzed using established statistical methodologies. Incidence of MA and its subtypes was much higher in Egypt than worldwide incidence. MA was significantly associated with younger age, more depth of invasion, lymph node metastasis, less microscopic abscess formation and less peri-tumoral lymphocytic response (Crohn-like response) than NMA. Both groups were not significantly different "among others" in other clinicopathological parameters including lymphovascular and perineural invasion, association with adenoma and schistosomiasis. Multivariate analyses for disease free and overall survival revealed that mucinous histology is an independent prognostic factor. Among several factors, only distant metastasis and presentation with recurrent disease were independent prognostic factors within MA patients. In conclusion, MA represents a distinct clinicopathological entity with worse survival than NMA. Distant metastasis and presentation with recurrent disease are independent prognostic factors. Further molecular investigations considering genetic features of MA will lead to drug development and better management

Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma

Background In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC. Methods We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis. Results The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012). Conclusions The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments