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Tömböl Z, Tőke J, Tóth G, Varga Z, Balázs E, Tóth E, Gergely L, Danihel Ľ, Medvecz M, Borka K, Tóth M. Multiple bronchial carcinoids associated with Cowden syndrome. Endocrine 2024; 84:880-884. [PMID: 38353885 PMCID: PMC11208178 DOI: 10.1007/s12020-024-03693-8] [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: 08/27/2023] [Accepted: 01/10/2024] [Indexed: 06/27/2024]
Abstract
Cowden syndrome (CS) is a rare genetic condition due to the various germline mutations in the phosphatase and tensin homologue on chromosome ten (PTEN) tumour suppressor gene. As a result, CS is characterised by an increased risk of developing various benign and malignant tumours, such as thyroid, breast, endometrial and urogenital neoplasms, as well as gastrointestinal tract tumours. However, the neuroendocrine tumour association with CS is not elucidated yet. We present a case of a 46-year-old male patient diagnosed with testicular seminoma and follicular thyroid cancer in his medical history. Our patient met the clinical diagnostic criteria of Cowden syndrome. Genetic analysis established the clinical diagnosis; a known heterozygous PTEN mutation was detected [PTEN (LRG_311t1)c.388 C > T (p.Arg130Ter)]. Incidentally, he was also seen with multiple pulmonary lesions during his oncological follow-up. A video-assisted thoracoscopic left lingula wedge resection and later resections from the right lung were performed. Histological findings revealed typical pulmonary carcinoid tumours and smaller tumorlets. Somatostatin receptor SPECT-CT, 18F-FDG-PET-CT and 18F-FDOPA-PET-CT scans and endoscopy procedures could not identify any primary tumours in other locations. Our patient is the first published case of Cowden syndrome, associated with multifocal pulmonary carcinoids. Besides multiple endocrine neoplasia type 1, we propose Cowden syndrome as another hereditary condition predisposing to multiple pulmonary tumorlets and carcinoid tumours.
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Affiliation(s)
- Zsófia Tömböl
- Department of Medicine and Oncology, ENETS Center of Excellence, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Division of Endocrinology, 2nd Department of Medicine, Health Center, Hungarian Defense Forces, Budapest, Hungary
| | - Judit Tőke
- Department of Medicine and Oncology, ENETS Center of Excellence, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Géza Tóth
- Department of Endocrinology, Szent Lázár County Hospital, Salgótarján, Hungary
| | - Zsolt Varga
- Medical Imaging Centre, Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary
| | - Eszter Balázs
- Medical Imaging Centre, Department of Radiology, Semmelweis University, Budapest, Hungary
| | - Erika Tóth
- National Institute of Oncology, Department of Surgical and Molecular Pathology, Tumour Pathology Center, Budapest, Hungary
| | - Lajos Gergely
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovak Republic
| | - Ľudovít Danihel
- Institute of Pathological Anatomy, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, ERN-Skin HCP, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Borka
- Department of Pathology, Forensic and Insurance Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Miklós Tóth
- Department of Medicine and Oncology, ENETS Center of Excellence, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
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Vocino Trucco G, Righi L, Volante M, Papotti M. Updates on lung neuroendocrine neoplasm classification. Histopathology 2024; 84:67-85. [PMID: 37794655 DOI: 10.1111/his.15058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
Lung neuroendocrine neoplasms (NENs) are a heterogeneous group of pulmonary neoplasms showing different morphological patterns and clinical and biological characteristics. The World Health Organisation (WHO) classification of lung NENs has been recently updated as part of the broader attempt to uniform the classification of NENs. This much-needed update has come at a time when insights from seminal molecular characterisation studies revolutionised our understanding of the biological and pathological architecture of lung NENs, paving the way for the development of novel diagnostic techniques, prognostic factors and therapeutic approaches. In this challenging and rapidly evolving landscape, the relevance of the 2021 WHO classification has been recently questioned, particularly in terms of its morphology-orientated approach and its prognostic implications. Here, we provide a state-of-the-art review on the contemporary understanding of pulmonary NEN morphology and the potential contribution of artificial intelligence, the advances in NEN molecular profiling with their impact on the classification system and, finally, the key current and upcoming prognostic factors.
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Affiliation(s)
| | - Luisella Righi
- Department of Oncology, University of Turin, Turin, Italy
| | - Marco Volante
- Department of Oncology, University of Turin, Turin, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
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Ezzat S, de Herder WW, Volante M, Grossman A. The Driver Role of Pathologists in Endocrine Oncology: What Clinicians Seek in Pathology Reports. Endocr Pathol 2023; 34:437-454. [PMID: 37166678 PMCID: PMC10733199 DOI: 10.1007/s12022-023-09768-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
Endocrine neoplasia represents an increasingly broad spectrum of disorders. Endocrine neoplasms range from incidental findings to potentially lethal malignancies. In this paper, we cover the impact of pathology in the interpretation of the clinic-pathological, genetic, and radiographic features underpinning these neoplasms. We highlight the critical role of multidisciplinary interactions in structuring a rational diagnostic and efficient therapeutic plan and emphasize the role of histopathological input in decision-making. In this context, standardized pathology reporting and second opinion endocrine pathology review represent relevant tools to improve the overall diagnostic workup of patients affected by endocrine tumors in every specific scenario. In fact, although a relevant proportion of cases may be correctly identified based on clinical presentation and biochemical/imaging investigations, a subset of cases presents with atypical findings that may lead to an inappropriate diagnosis and treatment plan based on a wrong pathological diagnosis if all pieces of the puzzle are not correctly considered. Pathologists have a responsibility to actively guide clinicians before and during surgical procedures to prevent unnecessary interventions. In all areas of endocrine pathology, pathologists must understand the complexity of tissue preservation and assay sensitivities and specificities to ensure the optimal quality and interpretation of diagnostic material. Finally, pathologists are central actors in tumor tissue biobanking, which is an expanding field in oncology that should be promoted while adhering to strict ethical and methodological standards.
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Affiliation(s)
- Shereen Ezzat
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wouter W de Herder
- Department of Internal Medicine, Sector of Endocrinology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco Volante
- Department of Oncology, University of Turin, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Ashley Grossman
- Barts and the London School of Medicine, University of London, London, UK
- Green Templeton College, University of Oxford, Oxford, UK
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Fournel L. Time to Reach a Consensus on the Minimal Diagnostic Criteria of DIPNECH. Ann Thorac Surg 2023; 115:547. [PMID: 35331711 DOI: 10.1016/j.athoracsur.2022.02.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Ludovic Fournel
- Department of Thoracic Surgery, Cochin Hospital, 27 rue du Fbg Saint Jacques, 75014, Paris, France.
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Tassi V, Daddi N, Mete O. Not All Multifocal Pulmonary Neuroendocrine Cell Proliferations Represent Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia. Ann Thorac Surg 2023; 115:547-548. [PMID: 35597259 DOI: 10.1016/j.athoracsur.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/08/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Valentina Tassi
- Thoracic Surgery Unit, Bologna University School of Medicine, S. Orsola-Malpighi Hospital, Via Massarenti 9, Pavillion 23rd, Bologna, Italy 40138
| | - Niccolò Daddi
- Thoracic Surgery Unit, Bologna University School of Medicine, S. Orsola-Malpighi Hospital, Via Massarenti 9, Pavillion 23rd, Bologna, Italy 40138.
| | - Ozgur Mete
- Department of Pathology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Maki Y, Okada K, Nakamura R, Hirano Y, Fujiwara T, Yamasaki R, Ichimura K, Matsuura M. A case of multiple lung carcinoid tumors localized in the right lower lobe. Respir Med Case Rep 2022; 38:101679. [PMID: 35656094 PMCID: PMC9151731 DOI: 10.1016/j.rmcr.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
Typical pulmonary carcinoid (TC) tumors are low-grade neuroendocrine tumors and usually detected as indolent solitary tumors. We herein report a case of multiple pulmonary carcinoid tumors and tumorlets localized in the right lower lobe with no underlying lung disorders suggesting diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). A 28-year-old man with multiple 1-to-8-mm pulmonary nodules in the peripheral pulmonary parenchyma of the right lower lobe was referred to our hospital. The patient underwent a surgical biopsy. Pathological examination revealed multiple nodules composed of spindle cells, and immunohistochemistry revealed staining for chromogranin A, synaptophysin, and CD56, suggesting neuroendocrine tumors. He was diagnosed as having multiple TC tumors and tumorlets. Neuroendocrine cell hyperplasia (NECH) was also observed on some bronchioles. A follow-up CT scan after 6 months showed no changes in the sizes of the nodules and no new lesions. The present case was histopathologically compatible with DIPNECH but it occurs mainly in elderly women. The patient might be in an early stage of DIPNECH before progression to symptomatic DIPNECH. In conclusion, clinicians should consider the possibility of carcinoid tumors and tumorlets in cases with multiple pulmonary nodules even if they are localized in one lobe.
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Affiliation(s)
- Yuho Maki
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
- Corresponding author. Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Kazuhiro Okada
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ryuji Nakamura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yutaka Hirano
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Rie Yamasaki
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouichi Ichimura
- Department of Pathology, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Motoki Matsuura
- Department of Thoracic Surgery, Hiroshima City Hospital Organization Hiroshima Citizens Hospital, Hiroshima, Japan
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