dirty necrosis

dirty necrosis (large intestine)

A term of art referring to the microscopic appearance typically seen in the centre of a focus of metastatic colorectal adenocarcinoma, which is characterised by a proliferation of complex, obviously malignant glands, cylindrical to ovoid in shape, with abundant eosinophilic nuclear debris.
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Regardless of CIMP status, the 2 MSI-H subtypes showed a more frequent right-sided colon location, less frequent dirty necrosis, more frequent Crohn-like lymphoid reaction, more frequent mucinous histology, and less frequent KRAS mutation than the CIMP-0,L/non-MSI-H subtype.
(%) (n = 464, 63%) (n = 174, 24%) Age, average, y 61.4 61.1 Female 179 (39) 66 (38) Right-sided colon location 99 (21) 44 (25) Stage III or IV 241 (52) 89 (51) Distant metastasis 81 (18) 25 (14) Nodal metastasis 222 (48) 86 (49) Poor differentiation 6 (1) 8 (5) Dirty necrosis (c) 431 (93) 155 (89) Crohn-like lymphoid 238 (51) 81 (47) reaction (c) Luminal serration (c) 10 (2) 12 (7) Mucin production (c) 85 (18) 53 (31) Medullary appearance (c) 0 0 BRAF mutation (n = 730) 19 (4) 13 (8) KRAS mutation (n = 696) 107 (24) 53 (32) TP53 loss or 370(82) 138 (81) overexpression (d) (n = 719) KRT20 loss (e) (n = 727) 17 (4) 7 (4) CDX2 loss (e) (n = 727) 7 (2) 11 (6) CIMP-L,0/ CIMP-H/ MSI-H, Non-MSI-H, No.
In some areas, the glands were dilated with lining cells showing intracellular mucin production, and many glands contained central necrosis with neutrophils and cellular debris, reminiscent of the dirty necrosis seen in primary colonic adenocarcinomas.
Dirty necrosis and/or columnar cells with basal nuclei could also be of help.
The evaluated histologic parameters included the presence of dirty necrosis, columnar cell morphology with basally located nuclei, microacinar architecture, lymphovascular involvement, mucin production, and presence of prominent nucleoli (easily discernible at x20 objective magnification).
Of the 6 histologic parameters, the presence of dirty necrosis, seen in 5 (100%) of 5 cases of CRCa and 2 (18%) of 11 cases of PCa, and the presence of columnar cells with basal nuclei, seen in 5 (100%) of 5 cases of CRCa and 1 (9%) of 11 cases of PCa, were the most useful parameters.