96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

Abstracts
cessary accuracy in the differentiation of CU associated IEN and could
therefore only be used with care in this setting.
FR-P-070
Inter-observer variability in the diagnosis of colorectal polyps under
special consideration of serrated lesions – a European study
T .T . Rau1 , A . Agaimy1 , A . Gehoff2 , C . Geppert1 , K . Jung3 , K . Knobloch1 ,
C . Langner4 , A . Lugli5 , I . Nagtegaal6 , J . Rüschoff2 , X . Saegert7 , M . Sarbia8 ,
M . Vieth9 , A . Hartmann1 1 2 University Hospital Erlangen, Institute of Pathology, Erlangen, Institute
of Pathology Nordhessen, Kassel, 3Department of medical statistics, Göttingen,
4Medical University Graz, Institute of Pathology, Graz, Austria, 5Uni versity Bern, Institute of Pathology, Bern, Switzerland, 6UDC St . Radboud,
Institute of Pathology, Nijmegen, Netherlands, 7Catholic University Leuven,
Institute of Pathology, Leuwen, Belgium, 8Institute for Pathology and Cytology,
München, 9Institute of Pathology, Bayreuth
Aims. A huge number of different criteria in the diagnosis of serrated
lesions of the colon are known from the literature. In 2010, a German
consensus conference redefined and simplified criteria for the diagnosis
of SSA, hyperplastic polyp, traditional serrated adenoma and mixed
polyps. As a scientific amendment we aimed to reflect their appliance in
daily practice and to prove their ability to achieve inter-observer concordance.
Methods. Consecutive colorectal polyps of one month (n=1926) were
analysed within a dedicated GI pathology institute (9). All consecutively
diagnosed serrated adenomas such as TSA, SSAs and mixed polyps were
included. To complete the diagnostic spectrum of colorectal lesions a
consecutive number of hyperplastic polyps and classical adenomas were
added and completed with a few probes of normal colonic mucosa to
reach a study set of 200 lesions. Virtual microscopy was enabled with
a Zeiss Mirax Scanner. Hard drives were sent to 10 pathologists with
GI experience in 5 European countries in three rounds. The first round
blanked, the second providing clinical data, the third round after a conference
meeting agreeing upon the recently proposed German consensus
guidelines (Virchow’s Archive, 2010 Sep;457(3):291–7).
Results. Distribution of gender, age and localization highlighted predominance
for certain lesions, but no exclusiveness. Kappa-statistics revealed
a basically moderate average agreement (κ=0.56) in the first round.
Providing clinical data a slight increase could be achieved (κ=0.63),
which was nearly equal to the values under the use of German consensus
criteria (κ=0.61). Single criteria of SSA and TSA diagnosis showed a divergence
in inter-observer reliability (from κ=0.06 to κ=0.82).
Conclusions. Using the simplified German consensus guidelines for serrated
lesions the inter-observer certainty of diagnosing serrated lesions
is maintained. Using the degree of concordance the single criteria of SSA
and TSA diagnosis could be assembled in a hierarchical algorithm. Training
in the diagnosis of TSA and mixed polyp seems to be most promising
to increase quality in GI pathology.
FR-P-071
Role of VEGF-B in the progression of colorectal cancer
C . Jayasinghe1 , N . Simiantonaki1 , C .J . Kirkpatrick2 1Gummersbach Hospital, Institute of Pathology, Gummersbach,
2University Medical Center, Institute of Pathology, Mainz
Aims. The relevance of VEGF-B, a VEGF (vascular endothelial growth
factor) family member, in the progression of colorectal cancer is unclear.
Methods. Therefore, using immunohistochemistry we have investigated
the expression of this VEGFR (VEGF receptor) -1 ligand in 91 non-metastatic
(n=38), lymphogenously metastatic (n=26) and haematogenously
metastatic (n=27) colorectal carcinomas.
106 | Der Pathologe · Supplement 1 · 2012
Results. Independent of the metastatic status,VEGF-B was expressed in
endothelial as well as epithelial cells in colorectal carcinomas. In 89% of
the cases with or without distant metastasis a vascular expression was
found. In contrast, only 62% of the nodal-positive tumors had a VEGF-B
positive vasculature. In relation to the non-metastatic (p=0.01) and haematogenously
metastatic (p=0.027) cases this difference was statistically
significant. Concerning the topological staining distribution, in 2/3 of
the cases a homogenous pattern was seen without differences in immunostaining
between the intratumoral vessels and the vascular fraction
throughout the invasive tumor margin. Using the general endothelial
marker, CD31, and the lymphatic endothelium-specific marker, D2-40,
all VEGF-B positive vessels were of blood but not of lymphatic vascular
origin. Interestingly, distal of the tumor a vascular VEGF-B expression
was not demonstrable. Positive endothelial VEGF-B expression was not
correlated with the metastatic status. In 46% of the investigated cases an
epithelial VEGF-B expression was also seen, in 30%, 46% and 67% of the
tumors without, with lymph node and with distant metastasis, respectively.
In this context positive VEGF-B immunoreactivity was correlated
with haematogenous metastasis (p=0.006). The epithelial VEGF-B immunostaining
positivity was independent of the grade of the tumor cell
dissociation and localization of tumor necrosis.
Conclusions. These morphological observations provide evidence for a
probable pathobiological significance of VEGF-B in the tumor progression
of colorectal cancer, especially in the case of haematogenous metastasis.
FR-P-072
Is there a rationale to record lymphatic invasion in node-positive
colorectal cancer?
N . Schneider1 , J . Betge1 , M .J . Pollheimer1 , R .A . Lindtner1 , P . Kornprat2 ,
P . Rehak3 , C . Langner1 1 2 Medical University of Graz, Institute of Pathology, Graz, Austria, Medical
University of Graz, Department of Surgery, Graz, Austria, 3Medical University
of Graz, Research Unit for Biomedical Engineering & Computing, Graz,
Austria
Aims. The invasion of tumour cells into lymphatic channels represents
a crucial step in the metastatic process. The detection of lymphatic invasion
in histological slides has been associated with decreased survival
and higher recurrence rates. Our study aimed to evaluate prognostic significance
of lymphatic invasion in colorectal cancer when lymph node
metastasis is already present.
Methods. 168 patients with node-positive colorectal cancer (colon, n=98;
rectum, n=70) were retrospectively evaluated. Lymphatic invasion was
assessed on H&E stained slides. Presence of lymphatic invasion was correlated
with different pathological variables applying the chi square test.
Progression-free and cancer-specific survivals were assessed using the
Kaplan-Meier method.
Results. Lymphatic invasion was detected in 95 (57%) cases. There was
a significant association of lymphatic invasion with the number of examined
tissue blocks: 1–3 blocks (n=50): 46% presence of L1, 4–5 blocks
(n=68): 53% presence of L1, and 6 or more blocks (n=50): 72% presence
of L1 (p=0.02). Furthermore, L1 was associated with poor tumour differentiation
(p=0.009) and the number of involved lymph nodes (p