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Eren OC, Bagci P, Balci S, Ohike N, Saka B, Sokmensuer C, Leblebici CB, Xue Y, Reid MD, Krasinskas AM, Kooby D, Maithel SK, Sarmiento J, Cheng JD, Taskin OC, Kapran Y, Tarcan ZC, Luchini C, Scarpa A, Basturk O, Adsay NV. Subgrading of G2 Pancreatic Neuroendocrine Tumors as 2A (Ki67 3% to < 10%) Versus 2B (10% to ≤ 20%) Identifies Behaviorally Distinct Subsets in Keeping with the Evolving Management Protocols. Ann Surg Oncol 2024; 31:7001-7011. [PMID: 38955993 DOI: 10.1245/s10434-024-15632-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Grade 1/2 PanNETs are mostly managed similarly, typically without any adjunct treatment with the belief that their overall metastasis rate is low. In oncology literature, Ki67-index of 10% is increasingly being used as the cutoff in stratifying patients to different protocols, although there are no systematic pathology-based studies supporting this approach. METHODS Ki67-index was correlated with clinicopathologic parameters in 190 resected PanNETs. A validation cohort (n = 145) was separately analyzed. RESULTS In initial cohort, maximally selected rank statistics method revealed 12% to be the discriminatory cutoff (close to 10% rule of thumb). G2b cases had liver/distant metastasis rate of almost threefold higher than that of G2a and showed significantly higher frequency of all histopathologic signs of aggressiveness (tumor size, perineural/vascular invasion, infiltrative growth pattern, lymph node metastasis). In validation cohort, these figures were as striking. When all cases were analyzed together, compared with G1, the G2b category had nine times higher liver/distant metastasis rate (6.1 vs. 58.5%; p < 0.001) and three times higher lymph node metastasis rate (20.5 vs. 65.1%; p < 0.001). CONCLUSIONS G2b PanNETs act very similar to G3, supporting management protocols that regard them as potential therapy candidates. Concerning local management, metastatic behavior in G2b cases indicate they may not be as amenable for conservative approaches, such as watchful waiting or enucleation. This substaging should be considered into diagnostic guidelines, and clinical trials need to be devised to determine the more appropriate management protocols for G2b (10% to ≤ 20%) group, which shows liver/distant metastasis in more than half of the cases, which at minimum warrants closer follow-up.
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Affiliation(s)
- Ozgur Can Eren
- Department of Pathology, Koç University, Koç University Hospital, Istanbul, Türkiye
| | - Pelin Bagci
- Department of Pathology, Marmara University, Istanbul, Türkiye
| | - Serdar Balci
- Department of Pathology, Memorial Sisli Hospital, Istanbul, Türkiye
| | - Nobuyuki Ohike
- Department of Pathology, St. Marianna University, Kawasaki, Kanagawa, Japan
| | - Burcu Saka
- Department of Pathology, Koç University, Koç University Hospital, Istanbul, Türkiye
| | - Cenk Sokmensuer
- Department of Pathology, Hacettepe University, Ankara, Türkiye
| | | | - Yue Xue
- Department of Pathology, Northwestern University, Evanston, IL, USA
| | | | | | - David Kooby
- Department of Surgery, Emory University, Atlanta, GA, USA
| | | | - Juan Sarmiento
- Department of Surgery, Emory University, Atlanta, GA, USA
| | | | - Orhun Cig Taskin
- Department of Pathology, Koç University, Koç University Hospital, Istanbul, Türkiye
| | - Yersu Kapran
- Department of Pathology, Koç University, Koç University Hospital, Istanbul, Türkiye
| | - Zeynep Cagla Tarcan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology and ARC-Net Research Centre, University of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology and ARC-Net Research Centre, University of Verona, Verona, Italy
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Volkan Adsay
- Department of Pathology, Koç University, Koç University Hospital, Istanbul, Türkiye.
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Ahn B, Park HJ, Kim HJ, Hong SM. Radiologic tumor border can further stratify prognosis in patients with pancreatic neuroendocrine tumor. Pancreatology 2024; 24:753-763. [PMID: 38796309 DOI: 10.1016/j.pan.2024.05.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Pancreatic neuroendocrine tumor (PanNET), although rare in incidence, is increasing in recent years. Several clinicopathologic and molecular factors have been suggested for patient stratification due to the extensive heterogeneity of PanNETs. We aimed to discover the prognostic role of assessing the tumor border of PanNETs with pre-operative computed tomography (CT) images and correlate them with other clinicopathologic factors. METHODS The radiologic, macroscopic, and microscopic tumor border of 183 surgically resected PanNET cases was evaluated using preoperative CT images (well defined vs. poorly defined), gross images (expansile vs. infiltrative), and hematoxylin and eosin-stained slides (pushing vs. infiltrative). The clinicopathologic and prognostic significance of the tumor border status was compared with other clinicopathologic factors. RESULTS A poorly defined radiologic tumor border was observed in 65 PanNET cases (35.5 %), and were more frequent in male patients (P = 0.031), and tumor with larger size, infiltrative macroscopic growth pattern, infiltrative microscopic tumor border, higher tumor grade, higher pT category, lymph node metastasis, lymphovascular and perineural invasions (all, P < 0.001). Patients with PanNET with a poorly defined radiologic tumor border had significantly worse overall survival (OS) and recurrence-free survival (RFS; both, P < 0.001). Multivariable analysis revealed that PanNET with a poorly defined radiologic border is an independent poor prognostic factor for both OS (P = 0.049) and RFS (P = 0.027). CONCLUSION Pre-operative CT-based tumor border evaluation can provide additional information regarding survival and recurrence in patients with PanNET.
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Affiliation(s)
- Bokyung Ahn
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Chouchane A, Kirchner P, Marinoni I, Sticová E, Jirásek T, Perren A. Pancreatic Neuroendocrine Microtumors (WHO 2022) Are Not Always Low-Grade Neoplasms: A Case with a Highly Increased Proliferation Rate. Endocr Pathol 2024; 35:147-153. [PMID: 38403790 PMCID: PMC11176210 DOI: 10.1007/s12022-024-09802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
Traditionally considered non-functional low proliferative benign neuroendocrine proliferations measuring less than 5 mm, pancreatic (neuro)endocrine microadenomas are now classified as pancreatic neuroendocrine microtumors in the 2022 WHO classification of endocrine and neuroendocrine tumors. This case report discussed the features of an incidentally identified 4.7-mm glucagon-expressing pancreatic neuroendocrine microtumor with MEN1 mutation only, chromosomally stable and an epigenetic alpha-like phenotype. The tumor was associated with an unexplained increased proliferation rate in Ki-67 of 15%. There was no associated DAXX/ATRX deficiency. The presented case challenges the conventional thought of a low proliferative disease of the so-called "pancreatic neuroendocrine microadenomas" and provides additional support to the 2022 WHO classification that also requires grading of these neoplasms. Despite exhibiting molecular features of less aggressive behavior, the case also underscores the biological complexity of pancreatic neuroendocrine microtumors. By recognizing the heterogenous spectrum of neuroendocrine neoplasms, the current case also contributes to ongoing discussions on how to optimize the clinical management of such tumors.
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Affiliation(s)
- Aziz Chouchane
- Institute For Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Philipp Kirchner
- Institute For Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Ilaria Marinoni
- Institute For Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Eva Sticová
- Clinical and Transplant Pathology Centre, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomáš Jirásek
- Department of Pathology, Liberec Regional Hospital, Liberec, Czech Republic
| | - Aurel Perren
- Institute For Tissue Medicine and Pathology, University of Bern, Bern, Switzerland.
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