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Ziogas IA, Rallis KS, Tasoudis PT, Moris D, Schulick RD, Del Chiaro M. Management and outcomes of mixed adenoneuroendocrine carcinoma of the ampulla of Vater: A systematic review and pooled analysis of 56 patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:682-687. [PMID: 36646615 DOI: 10.1016/j.ejso.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/31/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Tumors of mixed neuroendocrine and nonneuroendocrine histology are classified as collision, combined, or amphicrine and can occur in most organs, including the hepato-pancreato-biliary tract. Given the rarity of mixed adenoneuroendocrine carcinoma (MANEC) of the ampulla of Vater, the patient characteristics, management, and outcomes remain unclear. We sought to systematically review the worldwide literature on ampullary MANECs. METHODS Eligible studies were identified through a systematic search of the MEDLINE (via PubMed), Scopus, and Cochrane Library databases (end-of-search-date: January 5th, 2022), according to the PRISMA 2020 statement. RESULTS A total of 39 studies reporting on 56 patients with ampullary MANEC were included. The median age was 63.0 (interquartile range [IQR]: 51.0-69.0) years and 55.6% were male (n = 25/45). Most had combined tumors (64.4%; n = 29/45), followed by collision (24.4%; n = 11/45), and amphicrine tumors (11.1%; n = 5/45). More than half had lymph node metastasis (56.8%; n = 25/44), yet only 7.9% had distant metastasis (n = 3/38). Tumor resection (i.e., mostly pancreaticoduodenectomy) was performed in 96.3% (n = 52/54), followed by adjuvant chemotherapy in 61.8% (n = 21/34). Nearly half experienced disease recurrence (47.2%; n = 17/36) over a median follow-up of 12.0 (IQR: 3.0-16.0) months, and 42.1% (n = 16/38) died over a median follow-up of 12.0 (IQR: 4.0-18.0) months. The most common cause of death was disease progression/recurrence in 81.3% (n = 13/16). CONCLUSION Early diagnosis and management of ampullary MANEC is challenging yet crucial to improve outcomes since many patients are diagnosed at an advanced disease stage and have unfavorable outcomes. Multicenter granular data are warranted to further understand and improve outcomes in these patients.
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Affiliation(s)
- Ioannis A Ziogas
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Kathrine S Rallis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Panagiotis T Tasoudis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Richard D Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
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2
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Fukushima N, Furukawa K, Takano Y, Suzuki T, Yoshinobu M, Hanyu K, Kobayashi S. Multiple large cell neuroendocrine carcinomas in the rectum and descending colon presented with liver metastasis: A case report. Asian J Endosc Surg 2022; 15:405-409. [PMID: 35001529 DOI: 10.1111/ases.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
Colorectal large cell neuroendocrine carcinoma (LCNEC) is rare and multiple LCNECs have not been previously reported. We encountered a case of multiple LCNECs in the rectum and the descending colon. A 66-year-old man presented with anal pain. Colonoscopy showed an ulcerated infiltrating tumor in the rectum, and 0.5 cm of erosion in the descending colon. A biopsy revealed LCNEC in both regions. Abdominal computed tomography revealed irregularly enhanced wall thickening at the rectum and hepatic metastases. Due to the diagnosis of LCNEC, laparoscopic abdominoperineal resection of the rectum was performed. Histopathological examination showed a poorly differentiated, LCNEC in both regions. Immunohistochemical examination demonstrated that the tumor cells were positive for chromogranin and synaptophysin. LCNEC was confirmed, and systemic chemotherapy with cisplatin/irinotecan was initiated. To our knowledge, this is the first case report that describes multiple LCNECs in the rectum and descending colon.
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Affiliation(s)
- Naoko Fukushima
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Surgery, Takatsu General Hospital, Tokyo, Japan.,Department of Proctology, Clinic of Kajigaya, Tokyo, Japan
| | - Kenei Furukawa
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Proctology, Clinic of Kajigaya, Tokyo, Japan
| | - Yuta Takano
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Surgery, Takatsu General Hospital, Tokyo, Japan
| | - Toshiaki Suzuki
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Surgery, Takatsu General Hospital, Tokyo, Japan
| | - Mitsuyama Yoshinobu
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Surgery, Takatsu General Hospital, Tokyo, Japan
| | - Ken Hanyu
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Proctology, Clinic of Kajigaya, Tokyo, Japan
| | - Susumu Kobayashi
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.,Department of Surgery, Takatsu General Hospital, Tokyo, Japan
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3
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Tsakiraki Z, Delides A, Damaskou V, Psarogiorgou S, Athanasiadis I, Spathis A, Giotakis E, Panayiotides IG. Palatine tonsil metastasis of cecal mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN): A unique case. Clin Case Rep 2021; 9:e04460. [PMID: 34295485 PMCID: PMC8283843 DOI: 10.1002/ccr3.4460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/16/2021] [Accepted: 06/01/2021] [Indexed: 11/09/2022] Open
Abstract
This case demonstrates the importance of understanding that patients with malignant neoplasms may exhibit metastases in unexpected sites and illustrates the necessity of a thorough clinical examination and pathologic correlation.
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Affiliation(s)
- Zoi Tsakiraki
- 2 Department of PathologyNational and Kapodistrian University of AthensSchool of Medicine“Attikon” University HospitalAthensGreece
| | - Alexander Delides
- 2 Department of Otorhinolaryngology – Head and Neck SurgeryNational and Kapodistrian University of AthensSchool of Medicine“Attikon” University HospitalAthensGreece
| | - Vasileia Damaskou
- 2 Department of PathologyNational and Kapodistrian University of AthensSchool of Medicine“Attikon” University HospitalAthensGreece
| | - Sofia Psarogiorgou
- Department of Pathology417 Army Veteran’s Fund Hospital of AthensAthensGreece
| | | | - Aris Spathis
- 2 Department of PathologyNational and Kapodistrian University of AthensSchool of Medicine“Attikon” University HospitalAthensGreece
| | - Evangelos Giotakis
- Ear, Nose, Throat, Head and Neck DepartmentHippokration University HospitalAthensGreece
| | - Ioannis G. Panayiotides
- 2 Department of PathologyNational and Kapodistrian University of AthensSchool of Medicine“Attikon” University HospitalAthensGreece
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4
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Li X, Li D, Sun X, Lv G. Mixed adenoneuroendocrine carcinoma (MANEC) of the ampulla of Vater in a Chinese patient: A case report. J Int Med Res 2020; 48:300060520947918. [PMID: 32833541 PMCID: PMC7448144 DOI: 10.1177/0300060520947918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumour of the gastrointestinal tract with both epithelial and neuroendocrine components. We describe a case of a 57-year-old man who presented with yellow sclera and dark urine. Contrast-enhanced computed tomography (CT) showed enlargement of the intra and extrahepatic bile ducts and a neoplastic lesion at the end of the common bile duct which was indistinguishable from the adjacent head of the pancreas and duodenum. A pancreaticoduodenectomy was performed and histopathological examination of resected samples showed that tumour was a complex lesion with adenocarcinoma and neuroendocrine components positive for neuroendocrine markers (chromogranin A and synaptophysin) with a Ki-67 labelling index of 40%. The patient was diagnosed with MANEC in the ampulla of Vater with a neuroendocrine carcinoma component of approximately 70%. Ampullary MANECs are highly aggressive tumours with a high risk for distant metastases and a poor prognosis. Therefore, establishing a standard therapeutic strategy is crucial.
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Affiliation(s)
- Xu Li
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Dezhao Li
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Xiaodong Sun
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Guoyue Lv
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
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5
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Qiu S, Pellino G, Warren OJ, Mills S, Goldin R, Kontovounisios C, Tekkis PP. Mixed adenoneuroendocrine carcinoma of the colon and rectum. Acta Chir Belg 2018; 118:273-277. [PMID: 29911510 DOI: 10.1080/00015458.2018.1482697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mixed adenoneuroendocrine carcinoma (MANEC) are rare cancers of the gastrointestinal (GI) and pancreatobiliary tract. They are characterized by the presence of a combination of epithelial and neuroendocrine elements, where each component represents at least 30% of the tumour. Review of literature and consolidation of clinicopathological data. Sixty-one cases of colorectal MANEC have been reported in literature and one seen in this centre. The median age of the patients affected was 61.9 ± 12.4 years (20-94 years). Male to female ratio is 1.0:1.2. Presentations were similar to other colorectal malignancies. 58.0% of colorectal MANECs were found in the right colon, 8.1% cases in the transverse, 16.1% in the left colon, 16.1% in the rectum. These tumours appeared invasiveness 79.1% were T3-T4. Over 90% of cases were presented with metastatic disease. The majority of patient underwent surgical resection of the primary cancer (96.6%). Of these, 10 operations (17.9%) were emergency operations due to obstruction, perforation, or bleeding. Three patients received first line palliative care. In eight cases (13.8%), patients underwent adjuvant chemotherapy. The median overall survival after diagnosis was 10 ± 2.4 months (95% CI: 5.37-14.64 months). MANECs are rare but aggressive colorectal cancers. Surgical resection of localized disease with adjuvant chemotherapy appears to significantly improve survival in small case series. Further understanding through the sharing of experiences is required.
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Affiliation(s)
- S. Qiu
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - G. Pellino
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - O. J. Warren
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - S. Mills
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - R. Goldin
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - C. Kontovounisios
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
| | - P. P. Tekkis
- Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK
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6
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Common Hepatic Duct Mixed Adenoneuroendocrine Carcinoma Masquerading as Cholangiocarcinoma. Case Rep Gastrointest Med 2016; 2016:4827050. [PMID: 27375908 PMCID: PMC4914726 DOI: 10.1155/2016/4827050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 12/19/2022] Open
Abstract
Bile duct mixed adenoneuroendocrine carcinoma (MANEC) is a rare entity. It is defined as having mixed elements of both neuroendocrine tumors (NET) and an adenocarcinoma element, the lesser component forming at least 30% of the tumor. It is a subtype of neuroendocrine carcinoma (NEC) showing both gland-forming epithelial tumor cells and neuroendocrine cells. It is generally misdiagnosed as cholangiocarcinoma on imaging studies. The preoperative pathological workup from the endoscopic retrograde cholangiography brush cytology usually misses the NET/NEC component since it often lies deeper in the tumor. However, it is reported that it is the NEC component that defines the prognosis of the tumor; hence, it is vital to identify the NEC component. We present a rare case of common hepatic duct (CHD) MANEC that was preoperatively misdiagnosed as cholangiocarcinoma.
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7
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Minaya-Bravo AM, Garcia Mahillo JC, Mendoza Moreno F, Noguelares Fraguas F, Granell J. Large cell neuroendocrine - Adenocarcinona mixed tumour of colon: Collision tumour with peculiar behaviour. What do we know about these tumours? Ann Med Surg (Lond) 2015; 4:399-403. [PMID: 26635955 PMCID: PMC4637338 DOI: 10.1016/j.amsu.2015.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/20/2015] [Accepted: 10/01/2015] [Indexed: 12/17/2022] Open
Abstract
Introduction Mixed glandular-endocrine carcinomas are rare tumours of gastrointestinal tract (MANEC). They are more frequent in stomach and hardly one hundred cases have been described in colon. According to Lewis, they are classified into collision (side by side pattern), composite (intermingled) or amphicrine (neuroendocrine and glandular features inside a same cell). Collision tumours are related to biclonal theory: two simultaneous cancerogenic events. Conversely, multidirectional differentiation from a stem cell is accepted as origin of composite tumours. The aim of this paper is to analyse the behaviour of these tumours, with an especial concern about how these tumours metastasise, and the different theories about carcinogenesis. Presentation of case We report a rare case of collision adenocarcinoma-large cell neuroendocrine tumour of colon that after a three-year period of follow-up has presented a retroperitoneal recurrence that features adenocarcinoma and large cell neuroendocrine components. Discussion After an exhaustive review of the English literature, we found that only two cases of collision tumour of colon with metastases showing glandular and endocrine components have been described up to date, so we report the third case, and the first happening in transverse colon. Conclusion We conclude that not all collision tumours follow the biclonal theory and more studies are needed to clarify the origin of these neoplasms, and consequently, to reach an adequate treatment. MANEC are defined as mixed adenoneuroendocrine carcinoma. They are divided into composite and collision. The poorest differentiated component will determine the prognosis. Metastases occur frequently at liver and nodes. Colon is a very rare place.
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Affiliation(s)
- Ana María Minaya-Bravo
- Principe de Asturias Hospital, Department of General Surgery, Carretera Alcala, Meco s/n, CP 28805, Alcala de Henares, Madrid, Spain
| | | | - Fernando Mendoza Moreno
- Principe de Asturias Hospital, Department of General Surgery, Alcala de Henares, Madrid, Spain
| | | | - Javier Granell
- Principe de Asturias Hospital, Department of General Surgery, Alcala de Henares, Madrid, Spain
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8
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Serra S, Chetty R. Amphicrine (mixed adenoneuroendocrine carcinoma) of the duodenum and coexistent metastatic well differentiated neuroendocrine tumour. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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9
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Nakayama Y, Torigoe T, Minagawa N, Uehara T, Yamaguchi K. Synchronous occurrence of advanced neuroendocrine carcinoma and tubular adenocarcinoma of the rectum. Case Rep Gastroenterol 2013; 7:117-21. [PMID: 23626511 PMCID: PMC3617976 DOI: 10.1159/000350252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This report presents a rare case with the synchronous occurrence of advanced neuroendocrine carcinoma (NEC) and tubular adenocarcinoma of the rectum. A 52-year-old Japanese male presented with general fatigue and bloody stool. Endoscopic examination showed an ulcerated lesion of the lower rectum. The pathological diagnosis of biopsy specimens from this lesion indicated moderately differentiated adenocarcinoma. He was referred to the surgical outpatient clinic with advanced rectal cancer. Barium enema indicated two lesions in the upper and lower rectum. Computed tomography revealed multiple hepatic metastases. A low anterior resection was performed with lymph node dissection. The resected specimen indicated an elevated lesion with ulceration in the upper rectum and an ulcerated lesion in the lower rectum. Histopathological and immunohistochemical analyses revealed NEC from the upper rectum and moderately differentiated tubular adenocarcinoma from the lower rectum. These two lesions were completely separated from each other. Therefore, this case demonstrates the synchronous occurrence of advanced NEC and tubular adenocarcinoma in the rectum.
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Affiliation(s)
- Yoshifumi Nakayama
- Department of Surgery 1, School of Medicine, Kitakyushu, Japan ; Department of Gastroenterological and General Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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10
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Colorectal neuroendocrine carcinomas and adenocarcinomas share oncogenic pathways. A clinico-pathologic study of 12 cases. Eur J Gastroenterol Hepatol 2012; 24:1430-7. [PMID: 23114745 DOI: 10.1097/meg.0b013e3283583c87] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Neuroendocrine carcinomas (NECs) are rare neoplasms with an increasing incidence. Oncogenetic pathways of colorectal NEC are still poorly understood, and no treatment standards are available for these rare tumors. METHODS We analyzed retrospectively the clinical records and histology of 12 patients with colorectal NEC. KRAS and BRAF mutations were investigated after the dissection of exoendocrine and neuroendocrine components. ALK alterations and EML4-ALK transcripts were detected by in-situ hybridization and determination of fusion transcripts, respectively. RESULTS At the time of diagnosis, the mean age of the patients was 60 years (40-79) and 10 patients had synchronous metastases. A transient response occurred in two patients and one patient treated with cisplatin-etoposide or fluoropyrimidine-oxaliplatin, respectively. Tumor progression-related death occurred in 11 of 12 patients. Ten tumors contained an exocrine component, accounting for 5-70% of the tumor, and the other two contained an amphicrine component. BRAF/KRAS mutations were found in six of 10 tumors, corresponding to BRAF(V600E) (n=2) or KRAS(G12D) (n=2), KRAS(G12V) or KRAS(G13D). DNA was obtained from both exocrine and endocrine components in seven cases, and the BRAF/KRAS status was identical in all cases. Split of the ALK locus was detected in a minority of tumor cells in two of eight cases, but EML4-ALK transcripts were absent. CONCLUSION The association of an exocrine component in all cases and the similar profile of BRAF/KRAS mutations indicate that colorectal NEC may correspond to a high-grade transformation of colorectal carcinoma. New chemotherapy regimens using targeted therapies should be assessed in these tumors.
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La Rosa S, Marando A, Sessa F, Capella C. Mixed Adenoneuroendocrine Carcinomas (MANECs) of the Gastrointestinal Tract: An Update. Cancers (Basel) 2012; 4:11-30. [PMID: 24213223 PMCID: PMC3712682 DOI: 10.3390/cancers4010011] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 01/07/2012] [Accepted: 01/12/2012] [Indexed: 12/12/2022] Open
Abstract
The systematic application of immunohistochemical techniques to the study of tumors has led to the recognition that neuroendocrine cells occur rather frequently in exocrine neoplasms of the gut. It is now well known that there is a wide spectrum of combinations of exocrine and neuroendocrine components, ranging from adenomas or carcinomas with interspersed neuroendocrine cells at one extreme to classical neuroendocrine tumors with a focal exocrine component at the other. In addition, both exocrine and neuroendocrine components can have different morphological features ranging, for the former, from adenomas to adenocarcinomas with different degrees of differentiation and, for the latter, from well differentiated to poorly differentiated neuroendocrine tumors. However, although this range of combinations of neuroendocrine and exocrine components is frequently observed in routine practice, mixed exocrine-neuroendocrine carcinomas, now renamed as mixed adenoneuroendocrine carcinomas (MANECs), are rare; these are, by definition, neoplasms in which each component represents at least 30% of the lesion. Gastrointestinal MANECs can be stratified in different prognostic categories according to the grade of malignancy of each component. The present paper is an overview of the main clinicopathological, morphological, immunohistochemical and molecular features of this specific rare tumor type.
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Affiliation(s)
- Stefano La Rosa
- Department of Pathology, Ospedale di Circolo, viale Borri 57, 21100 Varese, Italy
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0332-270-601; Fax: +39-0332-270-600
| | - Alessandro Marando
- Department of Surgical and Morphological Sciences, University of Insubria, via O. Rossi 9, 21100 Varese, Italy; E-Mails: (A.M.); (F.S.); (C.C.)
| | - Fausto Sessa
- Department of Surgical and Morphological Sciences, University of Insubria, via O. Rossi 9, 21100 Varese, Italy; E-Mails: (A.M.); (F.S.); (C.C.)
| | - Carlo Capella
- Department of Surgical and Morphological Sciences, University of Insubria, via O. Rossi 9, 21100 Varese, Italy; E-Mails: (A.M.); (F.S.); (C.C.)
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12
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Kim YN, Park HS, Jang KY, Moon WS, Lee DG, Lee H, Lee MR, Kim KR. Concurrent large cell neuroendocrine carcinoma and adenocarcinoma of the ascending colon: a case report. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:157-61. [PMID: 21829772 PMCID: PMC3145888 DOI: 10.3393/jksc.2011.27.3.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 01/28/2011] [Indexed: 01/13/2023]
Abstract
Large cell neuroendocrine carcinomas of the colon are rare and represent only a small percentage of all colonic endocrine tumors. Here, we report a case of a colonic large cell neuroendocrine carcinomas concurrent with a colonic adenocarcinoma. A 70-year-old man presented with acute abdominal pain. A spiral computed tomography scan of the abdomen revealed eccentric wall thickening on the ascending colon. An explorative laparotomy and a right hemicolectomy were performed. Grossly, two separated masses were observed in the proximal ascending colon. One was a 7.4 × 5.1 cm ulcerative fungating lesion, and the other was a 2.8 × 1.9 cm polypoid lesion. Microscopically, the ulcerative fungating lesion showed a well-differentiated neuroendocrine morphology with necrosis and increased mitosis. Most of the tumor cells had large, vesicular nuclei with eosinophilic nucleoli, variable amounts of eosinophilic cytoplasm, and immunoreactivity for chromogranin A and synaptophysin. The polypoid lesion was a well-differentiated adenocarcinoma that had invaded the submucosa. We diagnosed these lesions as a concurrent large cell neuroendocrine carcinoma and an adenocarcinoma of the ascending colon.
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Affiliation(s)
- Yo Na Kim
- Department of Pathology, Research Institute for Endocrine Science, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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13
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Radhi J, Ara S, Ruo L. Hepatic Metastasis of Composite Adenocarcinoma and Neuroendocrine Carcinoma. J Gastrointest Cancer 2011; 43 Suppl 1:S25-7. [PMID: 21519810 DOI: 10.1007/s12029-011-9281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jasim Radhi
- Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton, ON, Canada.
| | - Shamim Ara
- Department of Pathology and Molecular Medicine, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Leyo Ruo
- Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada
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14
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Kuratate S, Inoue S, Chikakiyo M, Kaneda Y, Harino Y, Hirose T, Yagi T, Saitoh S, Sumitomo M, Fujino R, Satake N. Coexistent poorly-differentiated neuroendocrine cell carcinoma and non-invasive well-differentiated adenocarcinoma in tubulovillous adenoma of the rectum: report of a case. THE JOURNAL OF MEDICAL INVESTIGATION 2010; 57:338-44. [PMID: 20847536 DOI: 10.2152/jmi.57.338] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 74-years old man was referred to our hospital for treatment of a rectal mass. Colonoscopy revealed villous tumor covering all the lower rectal lumen. Biopsy yielded a diagnosis of adenoma. CT examination showed tumor shadows of the rectum and the liver. Pelvic MRI examination showed a 10.5×8×7 cm tumor with high signal intensity on the T2 weighted images in the rectum. Rectosigmoidectomy with lymph node dissection was performed with the diagnosis of rectal cancer that metastasized to the liver. Histological and immuno- histochemical features showed coexistent poorly-differentiated small cell neuroendocrine cell (NEC) carcinoma and non-invasive well-differentiated adenocarcinoma in tubulovillous adenoma. However the chemotherapy with FOLFOX and Bevacizumab was performed postoperatively, the patient died in cancer 3 months after surgery. Rectal poorly-differentiated NEC carcinomas are thought to be a tumor with a high malignant potential. Recently, the UICC TNM classifications of malignant tumors, 7th edition and the Guidelines for colorectal NEC tumors of European Neuroendocrine Tumor Society have been published. They would be evaluated, and effective multimodal therapy for NEC carcinomas should be established.
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Affiliation(s)
- Shinji Kuratate
- Department of Surgery, Tokushima Prefectural Central Hospitalk, Tokushima, Japan
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15
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Mochizuki Y, Omura K, Sakamoto K, Nakanishi S, Satoh K, Marukawa E, Yamaguchi A. A case of primary combined neuroendocrine carcinoma with squamous cell carcinoma in the upper gingiva. ACTA ACUST UNITED AC 2010; 109:e34-9. [PMID: 20303044 DOI: 10.1016/j.tripleo.2009.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 12/02/2009] [Accepted: 12/09/2009] [Indexed: 02/06/2023]
Abstract
Neuroendocrine carcinoma is a rare neoplasm that occurs widely in various organs and tissues. The biological behavior of this tumor in the oral region remains poorly understood. We encountered an extremely rare case of combined neuroendocrine carcinoma with squamous cell carcinoma, occurring at the buccal gingiva in a 62-year-old woman. Left partial maxillectomy was performed. Histological examinations revealed solid nests with extensive necrosis and nuclear palisading at the periphery. The tumor also showed areas of stratified neoplastic squamous differentiation. Immunohistochemically, tumor nests stained positive for synaptophysin, chromogranin, N-CAM (CD56), and neuron-specific enolase. Strong positivity was seen for K14 and K17 in the squamous component and for K7 in the neuroendocrine component. Both components showed K19 staining. Cells with squamous differentiation and K14 staining occasionally expressed p63. The patient showed no evidence of disease as of 23 months postoperatively. Given the aggressive characteristics of neuroendocrine carcinoma, strict follow-up has been performed.
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Affiliation(s)
- Yumi Mochizuki
- Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
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Liang HH, Wang W, Wei PL. Unusual tumor that presented with rectal bleeding. Gastroenterology 2010; 138:e5-6. [PMID: 20114093 DOI: 10.1053/j.gastro.2009.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 05/27/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Hung-Hua Liang
- Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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Adenoendocrine carcinoma of the accessory papilla of the duodenum: report of a case. Surg Today 2009; 39:425-9. [PMID: 19408082 DOI: 10.1007/s00595-008-3874-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 05/14/2008] [Indexed: 10/20/2022]
Abstract
This report describes a very rare case of an adenoendocrine carcinoma of the accessory papilla of the duodenum. A 70-year-old woman was admitted to the hospital complaining of epigastralgia. Gastrointestinal endoscopy showed a protruding tumor with ulceration at the accessory papilla of the duodenum. A biopsy revealed a small-cell carcinoma. Computed tomography showed a highly enhanced tumor in the early phase. No metastatic lesions were shown. Magnetic resonance cholangiopancreatography showed dilatation of the pancreatic duct, but a normal common bile duct. A pyloruspreserving pancreaticoduodenectomy was performed with lymph node dissection. Microscopically, the tumor was a small-cell neuroendocrine carcinoma with adenomatous differentiation. An immunohistochemical analysis showed positive staining for synaptophysin, chromogranin A, CD56, and carbohydrate antigen 19-9. The final diagnosis was an adenoendocrine carcinoma with lymph node metastasis. The postoperative course was uneventful and the patient is now doing well as an outpatient after 14 months of follow-up.
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