الفهرس 
The Anatomy of colorectum
Risk FactorsOnly 14 pages are availabe for public view
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Abstract
Colorectal carcinoma (CRC) is considered a major cause of cancer related morbidity and mortality worldwide. In terms of incidence, CRC is the third most commonly occurring cancer in men (after lung and prostate cancer) and the second in women after (breast cancer). In Egypt, CRC ranks the 7th most common cancer both in males and females representing 3.47% of male cancers and 3% of female cancers.
Karyopherin α2(KPNA2) is one of members of the karyopherin αs family that play an important role in regulation of translocation of proteins weighting more than 50 KDa from the cytoplasm in to the nucleus. KPNA2 has been reported as a marker of poor prognosis in several solid tumors. It has been reported that KPNA2 could potentially participate in carcinogenesis. Several reports studied the association between KPNA2 expression and tumor proliferation, tumor grading, staging, vascular invasion and perineural invasion donating high KPNA2 expression associated with high grading, staging, high proliferation, vascular and perineural invasion in several solid tumors.
The proliferating cell nuclear antigen (PCNA) belongs to the class of proliferation markers that detect proliferating nature of the cell. It is important to measure proliferation as it has been regarded as an indicator of malignancy meaning that a high proliferation rate is associated with increased malignancy and adverse prognosis. PCNA has been described as important prognostic factor in several neoplasms. PCNA level is thought to be related to Adverse histopathological parameters including grading, staging, vascular and perineural invasion.
The aim of the current work was to study different histopathological patterns of the available cases of colorectal carcinoma, study the immunohistochemical expression of KPNA2 and PCNA in the available cases of colorectal carcinoma and study the relation between the immunohistochemical expression of both KPNA2 and PCNA and different histopathological parameters to evaluate their significance in predicting the tumor biologic behavior and prognosis. Also correlate the relation between KPNA2 immunohistochemical expression and PCNA immunohistochemical expression to evaluate the role of KPNA2 as proliferative marker.
The present work was carried out on 60 cases of colorectal carcinoma. Cases were retrospectively retrieved from the archives of Tanta department of Pathology and private laboratories. All cases included in this research were subjected to histopathological haematoxylin and eosin staining and immunohistochemical staining for KPNA2 and PCNA proteins. The patterns of expression were estimated, in which positivity was indicated by nuclear staining of both KPNA2 and PCNA and non-specific cytoplasmic staining.
The score (0-9) of KPNA2 immunostaining were obtained for each case. Cases were classified into high and low expression cases and the score ≥ 4 mean high KPNA2 expression. As regard PCNA, cases were classified into PCNA positive and PCNA negative with the tumor considered being positive for PCNA when it showed at least 60% of positive tumor cells.The results obtained were:
1-Clinical results:
Concerning to colorectal carcinoma cases, the mean age of carcinoma incidence was 54.7 years with male predominance (66.7%). The most common site was the right colon (43.3%) followed by the right colon (41.7%) then the rectum. Most of tumors were
5cm (51.7%). Fungating masses exhibited (40%) then ulcerative (31.7%) followed by infiltrating masses (28.3%).
2-Histopathological results:
The most common histopathological type of colorectal carcinoma was conventional adenocarcinoma representing 65% followed by mucinous adenocarcinoma representing 20% and signet ring carcinoma representing 6.7%. Most studied CRC cases were grade II representing 46.7% of all cases. Nineteen cases (31.7%) showed vascular invasion and thirteen cases (21.7%) showed perineural invasion. Colorectal carcinoma cases were staged according to AJCC (2017) TNM Staging.
3-Immunohistochemical results of KPNA2 immunostaining:
Thirty-six cases (60%) were high KPNA2 expression and twenty-four cases (40%) were low KPNA2 expression. The KPNA2 immunohistochemical score in the studied colorectal carcinoma cases showed statistically significant relation with histopathological grade, depth of invasion, lymph node status, perineural invasion and vascular invasion but didn’t show statistically significant relation with histopathological type.