Neoplastic Disease of the Lower Gastrointestinal Tract

The last issue of Pathology Case Reports focused on nonneoplastic diseases of the gastrointestinal tract and, in this issue, we turn our attention to neoplasms. Because some neoplastic lesions arise in the setting of inflammatory disease, we begin this issue with a selection on adenoma-like lesions in the setting of inflammatory bowel disease and how they compare and contrast with sporadic adenomas. Dr. Harpaz from Mount Sinai Hospital in New York has ample experience dealing with these precursor lesions. In the era of interesting tyrosine kinase therapies for stromal tumors, we next present one of the traps in dealing with spindle cell lesions in the lower tract, namely the capacity of some of the tumor types other than gastrointestinal stromal tumors to express CD117/c-kit, together with a brief commentary on several types of spindle cell tumors in the gastrointestinal tract. Although oft ignored, the anus sometimes harbors unusual tumor types, a topic covered by Dr. Hobbs from the Armed Forces Institute of Pathology. Dr. Hobbs presents a case of anal gland carcinoma, a CK7-reactive tumor, and discusses the criteria for diagnosis of this rare tumor type. Because this issue ranges from the exotic to the practical, Dr. Carolyn Compton, who has been instrumental in the development of the current staging criteria for colorectal carcinoma, discusses some of the problem areas that are of daily importance to us all. She points out differences in staging criteria in prior and current use, some of which remain controversial. Probably the “hottest” topic in the daily caseload with which we are confronted involves both invasive carcinomas that are microsatellite unstable and the type of polyps that tend to be the precursors of such tumors. In the next few years, it seems likely that we as pathologists will be guiding our clinicians through management of a “new” set of colorectal polyps that has been under our noses all along, in particular the set that superficially resembles hyperplastic polyps but has the capacity to enter a divergent pathway toward invasive carcinoma. We are all fairly well-versed in the adenoma carcinoma sequence in most cases of colorectal carcinoma, but now we must become similarly well-versed in an alternate pathway involving lesions that are serrated and likely to have genetic alterations in the mismatch repair pathway of carcinogenesis. Dr. Jeremy Jass is a pioneer in the area of mismatch repair-associated colorectal cancers, and Dr. Kenneth Batts summarizes our current understanding of serrated polyps in their precancerous states. We hope this issue of Pathology Case Reports serves as an excellent blend of the practical and the cutting edge!FIGURE: No Caption AvailableFIGURE: No Caption Available

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