Paneth Cells in Colonic Adenomas: Association with Higher Adenoma Burden

Abstract

Introduction. The association of Paneth cells with colorectal neoplasms has been demonstrated in several studies and case reports. The frequency of Paneth cell-containing adenomas ranges from 0.2 to 39% in the various published studies. Although adenomas with Paneth cells have already been recognized before, there are no studies in the Philippines, that have been done to evaluate their clinicopathologic features. This study was performed to evaluate the clinicopathologic features of Paneth cell-containing adenomas and their association with adenoma burden.

Methodology. A total of 326 colorectal adenomas from 133 patients diagnosed consecutively from April 2013 to June 2013 at St. Luke’s Medical Center, Quezon City, Philippines, were reviewed. These were checked for the presence of Paneth cells within the adenomatous crypts. The differences in gender and location were analyzed using one tail z-test, while the association of Paneth-cell containing adenomas with adenoma burden was analyzed using univariate odds ratio at 95% confidence interval.

Results. The frequency of Paneth cell-containing adenomas in this study of 326 adenomas is 15% (50 of 326 adenomas). There was no statistical significance in the occurrence of the lesion between male and female patients (32% vs. 15%; p=0.2041). There was also no statistical difference in their occurrence in the proximal and distal colon (18% vs. 14%; p=0.1723). The odds of having multiple adenomas for patients with Paneth cell-containing adenomas are 3.16 times higher than those patients without Paneth cell-containing adenomas (15 patients with one adenoma, 23 patients with more than one adenoma; p=0.0037).

Conclusion. This study has demonstrated the increased odds of harboring multiple adenomas in patients with Paneth-cell containing adenomas.  This may be attributed in part to the fact that there have been recent studies revolving around Paneth cells that have shown that an established pathway of colorectal tumorigenesis, the APC/Wnt/β-catenin pathway, regulates differentiation towards this cell lineage.