Original article / research
Year : 2026 Month : April Volume : 15 Issue : 2 Page : PO21 - PO25 Full Version

Clinicopathological Study of Neoadjuvant Therapy in Carcinoma Rectum with Assessment of Pathologic Response: A Cross-sectional Study
Rupali Gangaram Kalsare, Rakeshkumar Ajmera, Indira Gore, Somesh Nilkanth, Kasturi Khot, Anuprita Kulkarni
1. Junior Resident, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India. 2. Associate Professor, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India. 3. Assistant Professor, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India. 4. Assistant Professor, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India. 5. Assistant Professor, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India. 6. Senior Resident, Department of Oncopathology, Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India.
 
Correspondence Address :
Indira Gore,
Government Cancer Hospital, Chhatrapati Sambhajinagar, Maharashtra, India.
E-mail: indiragore1610@gmail.com
 
ABSTRACT
: Introduction: Rectal carcinoma is a major public health problem. It is the third most common carcinoma of the large intestine and the third most common carcinoma in men and women worldwide. Nowadays, there is an increase in the use of chemoradiation, creating uncertain challenges for Surgical Pathologists in observing and evaluating gross, microscopic, and tumour response. Also, it creates difficulties in the assessment and prognostic relevance of pathologic features.

Aim: To study histopathologic changes that occurs after Neoadjuvant Chemoradiation Therapy (NACRT) in carcinoma rectum.

Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Chhatrapati Sambhajinagar (Aurangabad),Maharashtra, India from January 2019 to December 2024. Patients whose post-NACRT carcinoma rectum specimen was received in the department were included. This study emphasises histopathologic changes and response after NACRT in patients with carcinoma rectum. The specimen was adequately sampled and then embedded in paraffin wax. Multiple sections were taken from the tumour area. Sections of 3-5 μm thickness were cut and stained with Haematoxylin and Eosin (H&E) for microscopic examination, all according to standard procedures. Statistical software Statistical Package for Social Sciences (SPSS) version 25 was used to enter and analyse the data. Descriptive statistics such as frequencies and percentages were used to summarise categorical variables like histopathological types, Tumour Regression Grades (TRG), and the presence of features such as lymphovascular invasion, acellular mucin pools.

Results: A total of 34 post-NACRT cases were studied. Out of this, the maximum number of patients was found in the age group 41-50 years, with 12 (35.3%) cases. The youngest case was 25 years, and the oldest case was 76 years, with a mean age of 50.5 years. A maximum number of cases were male, 22 (64.7%), M: F-1.83:1. Acellular pools of mucin were present in five cases (14.7%), and 10 (29.4%) cases had no residual tumour. Moderately differentiated mucinous adenocarcinoma was found in a maximum of 5 (14.7%) cases. Fibrosis (12 cases) and dense lymphoplasmacytic infiltrates (13 cases) were observed. In most cases, 17 (50%) have TRG-3 and have a poor response. Complete response (TRG-0) was seen in 7 (20.5%) cases.

Conclusion: Preoperative chemoradiation induces changes in the gross appearance of the surgical specimen and its pathologic features, which could impact patient management and outcome. Tumour and fibrosis are very difficult to demonstrate on gross examination and, hence, require maximum sampling. The presence of acellular mucin pools represents a completely eradicated tumour. Tumour regression score is a useful method of scoring tumour response after NACRT.
Keywords : Chemoradiation, Rectal carcinoma, Tumour regression score
DOI and Others : DOI: 10.7860/NJLM/2026/79404.2968 Date of Submission: Mar 18, 2025 Date of Peer Review: Jun 11, 2025 Date of Acceptance: Jul 24, 2025 Date of Publishing: Apr 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Apr 04, 2025 • Manual Googling: Jul 03, 2025 • iThenticate Software: Jul 23, 2025 (16%) ETYMOLOGY: Author Origin EMENDATIONS: 8
 
TABLES AND FIGURES