Small bowel carcinomas in celiac or Crohn's disease: Distinctive histophenotypic, molecular and histogenetic patterns

A. Vanoli, A. Di Sabatino, M. Martino, C. Klersy, F. Grillo, C. Mescoli, G. Nesi, U. Volta, D. Fornino, O. Luinetti, P. Fociani, V. Villanacci, F.P. D'Armiento, R. Cannizzaro, G. Latella, C. Ciacci, L. Biancone, M. Paulli, F. Sessa, M. RuggeR. Fiocca, G.R. Corazza, E. Solcia

Research output: Contribution to journalArticlepeer-review


Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and/or pancreatobiliary-type) mucosa, often through dysplastic polypoid growths of metaplastic phenotype. In conclusion, despite their common origin in a chronically inflamed mucosa, celiac disease-associated and Crohn's disease-associated small bowel carcinomas differ substantially in histological structure, phenotype, microsatellite instability/tumor-infiltrating lymphocyte status, Wnt pathway activation, mucosal precursor lesions and prognosis. © 2017 USCAP, Inc All rights reserved.
Original languageEnglish
Pages (from-to)1453-1466
Number of pages14
JournalModern Pathology
Issue number10
Publication statusPublished - 2017


  • beta catenin
  • common acute lymphoblastic leukemia antigen
  • cytokeratin 20
  • cytokeratin 7
  • mucin 2
  • mucin 5AC
  • mucin 6
  • transcription factor Cdx2
  • transcription factor Sox9
  • Wnt protein
  • Article
  • cancer prognosis
  • carcinogenesis
  • celiac disease
  • controlled study
  • Crohn disease
  • disease association
  • dysplasia
  • gene expression
  • histogenesis
  • histology
  • human
  • human tissue
  • immunohistochemistry
  • major clinical study
  • microsatellite instability
  • phenotype
  • priority journal
  • retrospective study
  • small intestine carcinoma
  • survival analysis
  • tumor associated leukocyte
  • Wnt signaling


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