Mucin expression, p53 overexpression, and peritumoral lymphocytic infiltration of advanced colorectal carcinoma with mucus component: Is mucinous carcinoma a distinct histological entity?

Mucinous carcinoma of the colorectum is conventionally defined as carcinoma with an interstitial mucus component (MC) that occupies more than 50% of the tumor tissue. To examine the validity of this definition, we quantified the ratio between the area of MC and the total area of carcinoma (MC ratio) in 152 advanced colorectal carcinomas, and investigated whether MUC1, MUC2 and MUC5AC mucin expression, frequency of p53 overexpression, and peritumoral lymphocytic infiltration (PLI) of tumors differ in the MC ratio. Samples were classified into MC ratios of >50% (n=30), 10-50% (n=24), <10% (n=22), and 0% (n=76). Carcinomas with MC commonly possessed the MUC2+ phenotype (90.9-100%), and 76.6-83.3% possessed either the MUC2+/MUC5AC+/MUC1+ or the MUC2+/MUC5AC−/MUC1+ phenotype. Carcinoma without MC (MC ratio of 0%) was typically the MUC2− phenotype (89.5%). Frequencies of p53 overexpression of carcinomas with MC were significantly lower compared to those without MC (21-27% vs. 55%). PLI was observed in 0-4% of carcinomas with MC, but was observed in 17% of carcinomas without MC. These results indicate that colorectal carcinomas with MC can be grouped together as goblet cell type (MUC2+) carcinoma. These data also suggest that such carcinomas may have a common genetic background and alteration of immune responsiveness. Therefore, separately classifying carcinomas with an MC ratio of more than 50% as an independent histological type may be invalid, and re-evaluation of the histological classification of colorectal carcinoma may be required.