Abstract
Objectives
Whether the presence of Paneth cells (PCs) in colorectal adenomas indicates an increased risk of colorectal neoplasia or not is controversial. We examined the clinicopathologic features of PC-containing adenomas (PCAs) that were surgically removed, focusing on the risk of developing subsequent colorectal neoplasia on follow-up.
Methods
A retrospective cohort of 154 patients with endoscopically unresectable colorectal adenomas who underwent surgical removal was retrieved. Archived pathology slides were evaluated for the presence of PC, villous features, and high-grade dysplasia. Demographic and clinical data were obtained by reviewing electronic medical records. A minimum 12 months of follow-up was considered valid follow-up data. Fisher’s exact test and Student t test were performed when indicated (P < .05 was considered statistically significant).
Results
PCAs were identified in 84 out of 154 cases (54.5%), commonly in the proximal as compared to distal colorectum (60.7% vs 38.1%, P = .018). There was no significant difference in patient age (mean, 66.0 vs 63.8), gender (M:F, 42:42 vs 35:35), adenoma size (mean, 3.18 cm vs 2.78 cm), villous features (69.0% vs 68.6%), and high-grade dysplasia (44.0% vs 35.7%) between PCA and non-PCA groups. After the mean follow-up duration of 65.8 months (range 12-169), 11 out of 30 patients (36.7%) had recurrent colorectal neoplasia, including 2 adenocarcinomas in the PCA group, as compared to 8 out of 27 (29.6%) in non-PCA group with no adenocarcinoma (P > .05). No statistical difference in the risk of developing colorectal neoplasia was noted between proximal PCA (24%), distal PCA (33.3%), and non-PCA (29.6%) groups.
Conclusion
PCAs are more common in the proximal colon, consistent with normal anatomic distribution of PC in the colon. No association was observed between PCA and high-grade dysplasia or colorectal neoplasia risk in endoscopically unresectable adenomas. PCA location was not a significant marker for future adverse outcomes.
