Patologické hodnocení vzorků kolorektálního karcinomu: pokročilé a časné léze

English version

Autoři: Annika Resch; Nora I. Schneider; Cord Langner
Působiště autorů: Institute of Pathology, Medical University of Graz, Graz, Austria
Vyšlo v časopise: Čes.-slov. Patol., 51, 2015, No. 1, p. 12-22
Kategorie: Přehledový článek

Souhrn

U pacientů s lokálně omezeným kolorektálním karcinomem je metodou volby resekce, v některých případech však mohou být časné nádory řešeny také endoskopickým zákrokem bez nutnosti operace. U pokročilých kolorektálních karcinomů hraje při klinickém rozhodování o optimální léčbě zásadní roli přesné určení stadia včetně histopatologického posouzení lymfatických uzlin. Počet odstraněných lymfatických uzlin závisí na rozsahu a kompletnosti chirurgického zákroku, pečlivosti patologa při vyšetření uzlin, ale také na demografických parametrech pacienta, lokalizaci nádoru a jeho biologických vlastnostech. Současná doporučení udávají, že při histopatologickém vyšetření by mělo být standardně nalezeno alespoň 12 uzlin. U nemocných s nádory bez uzlinových metastáz může pro posouzení rizika recidivy sloužit celá řada histologických parametrů - kromě histologické typizace, zhodnocení invaze krevních a lymfatických cév také identifikace bujení nádoru na periferii (tumor budding), nekrózy a kvantifikace protinádorové zánětlivé odpovědi, která byla v několika studiích ověřena jako příznivý prognostický faktor. V případě karcinomu rekta hraje významnou roli postižení radiálního (cirkumferentního) resekčního okraje a rozsah chirurgického odstranění mezorekta. Časný (či povrchový) kolorektální karcinom je definován jako invazivní adenokarcinom postihující, avšak nepřesahující submukózu. Při vyšetření je třeba věnovat pozornost celé řadě znaků, jejichž přítomnost ukazuje na nutnost radikálního chirurgického řešení. Vedle posouzení kompletnosti excize je vyžadováno vyhodnocení parametrů predikujících přítomnost uzlinových metastáz, jako jsou hloubka invaze submukózy, grade a přítomnost dalších rizikových faktorů, jako angioinvaze či tumor budding. Kombinace těchto parametrů umožní stratifikovat nemocné do skupin s nízkým a vysokým rizikem.

Klíčová slova:
kolorektální karcinom – časný kolorektální karcinom – uzlinová metastáza – histopatologické parametry – rizikové faktory – prognóza

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