Clinicopathological significance of the 'keloid-like' collagen and myxoid stroma in advanced rectal cancer

Histopathology. 2002 Apr;40(4):327-34. doi: 10.1046/j.1365-2559.2002.01376.x.


Aim: To establish the histological categorization of fibrotic stroma which reflects the biological behaviour of advanced rectal cancer.

Methods and results: Six hundred and twenty-seven surgically resected cases of advanced rectal carcinoma were examined. We histologically categorized fibrotic stroma in the invasive frontal region into three groups: type A, multiple fine and mature fibres were stratified into layers; type B, broad bands of eosinophilic hyalinized collagen ('keloid-like' collagen) were intermingled; type C, myxoid stroma. Type A stroma was observed in 63% of patients, type B stroma in 25%, type C stroma in 12%. The incidence of type A stroma decreased in accordance with Dukes stage (98% in Dukes A; 73% in B; 41% in C1; 29% in C2) and conversely, there was an increase of C type (0% in Dukes A; 4% in B; 20% in C1; 54% in C2). Stroma type had a significant correlation with long-term survival (80% of 5-year survival in type A stroma; 54% in type B; 26% in type C). Based on multivariate analysis, it was found that the stromal pattern had independent prognostic value, together with nodal involvement, growth pattern, and lymphocyte infiltration.

Conclusions: Tumour fibrotic stroma may play an important role as a regulator of neoplastic behaviour. Pathological categorization of the fibrotic stroma is helpful for predicting the prognostic outcome of patients with rectal carcinoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Collagen / metabolism*
  • Collagen Type I / metabolism
  • Female
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Rectal Neoplasms / classification
  • Rectal Neoplasms / metabolism
  • Rectal Neoplasms / pathology*
  • Regression Analysis
  • Survival Rate


  • Collagen Type I
  • Collagen