![]() 7īlocks of tissue had been fixed in 10% buffered formalin, processed in the usual manner, and embedded in paraffin wax. In all cases included in our study there was sufficient tumour material for assessment (at least two tumour blocks) and the patient had not received preoperative radiotherapy or chemotherapy.Īll cases had been reported at the time of receipt using a proforma, based on the minimum data set drafted by the Royal College of Pathologists, which specifically asked whether extramural vascular invasion (invasion of veins external to the muscularis propria of the bowel wall) was present or not. Curative and palliative resections were included in the cohort. Thirty nine randomly selected cases of colon cancer and 36 randomly selected cases of rectal cancer surgically resected at the Glasgow Royal Infirmary, UK between the years 19 were examined retrospectively. To assess the sensitivity of detection of venous invasion using an elastica special stain, which highlights veins, and compare this with the incidence found in serial H&E sections. To undertake an audit of the original general pathologists’ ability to detect venous invasion in a routine reporting setting, by comparing the incidence of venous invasion reported in the original pathology report with that found in our study on freshly cut haematoxylin and eosin (H&E) stained sections of each tumour. The aims of our present retrospective study of colorectal cancer resections were: The use of elastic tissue stains in microscopic assessment has been proposed as being a more sensitive means of revealing venous invasion within the tumour, but has failed to gain widespread acceptance-for example, this technique is not recommended in the pathology guidelines for reporting colorectal cancers, produced by the Royal College of Pathologists. Elastic fibres are present in the adventitia of veins (but not lymphatics) and elastica stains can be used to highlight the presence of veins and their adjacent arteries. ![]() 1– 6 This wide range may result from selection bias of advanced cases in some series, 6 or variations in the methods of pathological analysis performed. The prevalence of venous invasion in previous studies has ranged between 10% and 90%. Using macroscopic dissection, venous invasion was detected in 61% of cases, and of this cohort 71% had synchronous liver metastases. 1 In a postmortem review they examined 170 patients who had died of rectal cancer. Pathological assessment of venous invasion was largely ignored until Brown and Warren highlighted its prognostic implications in 1938. This observation is independent of Dukes’s stage and degree of differentiation. It is well established that blood vessel invasion, found in the tumour at the time of resection, is associated with a significantly increased risk of visceral metastases and a decrease in overall survival time. ![]() Venous invasion is an important prognostic indicator in colorectal cancer. Intramural venous invasion was seen in eight cases on H&E sections and 30 cases on elastica stained sections.Ĭonclusion: The use of elastica stained serial sections to detect venous invasion in tumours should be recommended in guidelines for the reporting of colorectal carcinomas. It was present in 32 cases when elastica stained sections were analysed. Results: Extramural venous invasion had been noted in 14 of the pathology reports and was seen in 18 cases when only the H&E sections were viewed in the study. The incidence of both intramural and extramural venous invasion was recorded and compared with that seen when the tumours were originally reported. Methods: Serial sections from the 75 cases of colorectal carcinoma were stained by haematoxylin and eosin (H&E) only and elastica counterstained with H&E. The use of special stains to aid its detection in pathology specimens is not currently universally recommended.Īims: To determine whether an elastica stain significantly increases the incidence of detection of vascular invasion compared with routinely stained sections. Background: Venous invasion by tumour is an independent prognostic indicator of both prognosis and risk of development of distant metastases in colorectal carcinoma. ![]()
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