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Acta Endoscopica

, Volume 35, Issue 4, pp 607–620 | Cite as

Histopathologie des adénomes et cancers colorectaux superficiels: que devrait connaître un endoscopiste à ce sujet?

  • Anne Jouret
  • K. Geboes
Article
  • 37 Downloads

Histopathology of adenomas and early colorectal cancers: what should an endoscopist know about it?

Résumé

Les cancers colorectaux sont une cause importante de mortalité et de morbidité au monde. Il est actuellement bien établi que la plupart des cancers colorectaux proviennent d’adénomes. Ces lésions se présentent sous différents aspects microscopiques — tubuleux, villeux ou festonnés — et sont le siège d’atypies intra-épithéliales de degrés de sévérité variables. La conduite à tenir concernant les lésions précurseurs dans le cadre de maladies inflammatoires coliques (MICI), est légèrement différente de la conduite à tenir lorsqu’on met en évidence des lésions précurseurs isolées.

Les cancers superficiels colorectaux sont des lésions invasives limitées à la sous-muqueuse (pT1 de la classification TNM).

Macroscopiquement, les cancers colorectaux superficiels et leurs précurseurs se présentent comme des lésions polypoïdes élevées ou des lésions planes et peuvent être traités par résection endoscopique. Une prise en charge très précise des pièces opératoires est cependant nécessaire pour optimaliser la mise en évidence de facteurs de mauvais pronostic (métastases lymphatiques, tumeur résiduelle, etc.) qui entraîneraient une laparotomie. Les lésions précurseurs n’étant pas nécessairement homogènes, la totalité de la lésion doit être réséquée et examinée. De simples biopsies ne sont pas valables.

Summary

Colorectal cancer is a major cause of morbidity and mortality worldwide. It is now well established that most colorectal carcinomas arise from adenomas. Such lesions present many different microscopic features as tubulous, villous or serrated adenomas and are characterized by intraepithelial neoplasia with different degrees of severity. In some conditions such as inflammatory bowel diseases, precursor lesions and their management are slightly different from those occurring in sporadic cases.

Early colorectal cancer is an invasive lesion limited to the submucosa (pathologic T category p T1 in the TNM classification.

Macroscopically, early colorectal cancer and its precursor lesions present as elevated polyps or flat lesions. It can be treated by endoscopic resection. Nevertheless, careful handling of the specimen is required in order to optimally identify the factors which may predict an adverse outcome (lymph node metastasis, residual tumour…) which should lead to laparotomy. Because precursor lesions are not necessarily homogeneous, the entire lesion should be removed and examined. Simple biopsies are not reliable.

Mots-clés

adénome adénome plan DALM cancer colorectal superficiel néoplasie intra-épithéliale polype festonné 

Key-words

adenoma DALM early colorectal carcinoma flat adenoma intraepithelial neoplasia serrated polyp 

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Anne Jouret
    • 1
  • K. Geboes
    • 2
  1. 1.Service d’Anatomie pathologiqueCHR
  2. 2.Département de PathologieHôpital UniversitaireKuleuvenBelgique

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