MSI-high colorectal cancers have a distinct clinicopathologic phenotype (Kim et al, 1994; Jass et al, 1998; Alexander et al, 2001). MSI-high colorectal cancers are more frequent in younger patients. Most are right-sided (proximal to the splenic flexure), bulky (large) tumors, with an exophytic growth pattern; are poorly differentiated, with signet-ring-cell, mucinous, medullary, or variegated (mixed) histologic subtypes; have an intense lym-phocytic response with Crohn's-like lymphoid reaction (lymphoid follicles with germinal centers at the tumor edge) and peritumoral and intratumoral lymphocytosis; and show an expanding (pushing) invasive pattern at the margins. However, one third of colorectal carcinomas with MSI do not have these histologic characteristics.
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