Colon tumor
Mucinous carcinoma of colon

Author: Raul Gonzalez M.D. (see Authors page)

Revised: 22 September 2015, last major update September 2015

Copyright: (c) 2002-2015,, Inc.

PubMed Search: Mucinous carcinoma [title] colon
Definition / General
  • WHO recognized subtype of colorectal carcinoma with mucin lakes comprising at least 50% of tumor mass
  • Terminology
  • Variably called "colloid carcinoma"
  • Epidemiology
  • Relatively common (10% of all colorectal carcinomas) (Cancer 1976;37:1891)
  • Incidence is stable (Dis Colon Rectum 2005;48:1161)
  • Sites
  • Most commonly arises in the right colon (J Clin Pathol 2012;65:381)
  • Pathophysiology
  • Associated with microsatellite instability (Cancer 2005;103:2023), though most mucinous carcinomas are not MSI-high (Am J Pathol 2001;158:527)
  • Clinical Features
  • Usually presents at more advanced stage (Dis Colon Rectum 1993;36:49) and with greater nodal involvement (Gastroenterol Hepatol 2002;25:534) than standard colorectal carcinoma
  • May recur locally following excision (World J Surg Oncol 2012;10:109)
  • Prognostic Factors
  • May have same (Ann Oncol 2012;23:135) or worse (J Surg Oncol 2000;73:70) prognosis compared to standard colorectal carcinoma
  • Case Reports
  • 11 year old child with colloid carcinoma of rectum (J Postgrad Med 1993;39:218)
  • 77 year old man with large mucinous adenocarcinoma (Dig Surg 2003;20:69)
  • Gross Description
  • Exophytic, gelatinous mass
  • Gross Images
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    Arising in villous adenoma

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    Causing intussusception

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    Cecal tumor

    Micro Description
  • Adenocarcinoma with strips of tumor cells floating in large extracellular mucin lakes comprising at least half of tumor mass
  • Signet ring cells (with intracellular mucin) may also be present but should comprise less than half of tumor
  • Micro Images
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    Pools of mucus

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    Extracellular mucin

    Positive Stains
  • CDX2 (100%), MUC2 (100%), CK20 (98%), beta-catenin (nuclear) (64%), CK7 (19%, usually rectal), MUC6 (5%) (Am J Surg Pathol 2011;35:1830)
  • Molecular / Cytogenetics Description
  • KRAS mutations more common, and TP53 mutations less common, than in standard colorectal carcinomas (Mod Pathol 2006;19:59)
  • Differential Diagnosis
  • Colitis cystica profunda: may form a mass and demonstrate copious extracellular mucin, but epithelium is clearly benign
  • Signet ring carcinoma: more than half of tumor composed of signet ring cells