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By David P. Kelsen MD, John M. Daly MD, Scott E. Kern MD, Bernard Levin MD, Joel E. Tepper MD, Eric Van Cutsem MD PhD
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Principles and Practice of Gastrointestinal Oncology
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However, a tissue diagnosis based on the morphologic evaluation of a tissue section stained with hematoxylin and eosin (H&E) is the gold standard for the diagnosis of malignancy. The first task of the pathologist is to differentiate a reactive process from neoplasia. Second, benign neoplasia must be distinguished from a malignant process that is characterized by the invasion and destruction of local tissues as well as the potential for metastasis. Sometimes, the differentiation between a primary tumor and a metastasis is not possible with an H&E stain.
For example, more than 95% of adenocarcinomas of the colon are CK20 positive but CK7 negative. This may assist with the distinction from ovarian cancer, which is usually CK7 positive and CK20 negative. CDX2 is a homeobox domain-containing transcription factor important in the development and differentiation of the intestine. It serves as a sensitive and specific marker for colorectal adenocarcinoma and is also helpful in distinguishing adenocarcinomas of the papilla from those arising in the pancreas and biliary tree (11).
For example, the prognosis of advanced gastric cancer (spread beyond submucosa or at least T2) is poor, and even after curative resection, the 5-year survival rate ranges from 26% to 35% (4). The emerging knowledge on the molecular pathogenesis of gastrointestinal neoplasias has lead to the exploration of molecular alterations that could be used to improve diagnosis and management. For example, KIT alterations distinguish gastrointestinal stromal tumor (GIST) from other benign or malignant types of stromal tumors, whereas the immunohistochemical detection of proteins encoded by the mismatch repair genes, notably MSH2, MLH1, and MSH6, have been linked with hereditary forms of colorectal cancer.