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Liao X, Schmidt AL, Zhang D, Li P, Wang X, Ko HM, Choi WT, Alpert L, Hao Y, Kovar-Peltz S, Polydorides AD, Wanjari P, Mastro J, Wang P. Clinicopathologic and Molecular Characterization of Inflammatory Bowel Disease-Associated Neuroendocrine Carcinomas and Mixed Neuroendocrine-Non-Neuroendocrine Neoplasms. Mod Pathol 2024; 37:100566. [PMID: 39025404 DOI: 10.1016/j.modpat.2024.100566] [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: 05/23/2024] [Revised: 06/27/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
The pathogenesis of neuroendocrine carcinomas (NECs) and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) in the gastrointestinal tract remains poorly understood. This study aims to characterize the clinicopathologic and molecular features of NEC/MiNEN in patients with inflammatory bowel disease (IBD). Eighteen surgically resected IBD-associated intestinal carcinomas with a minimum of 30% neuroendocrine component were collected from 6 academic centers and compared with a control group of 12 IBD-associated carcinomas lacking neuroendocrine differentiation. Both groups exhibited a male predominance and similar age distribution. The NEC/MiNEN group was more likely to have a higher percentage of Crohn disease (9/18 vs 1/12; P = .024), occur in the rectum (9/18 vs 3/12) and small intestine (4/18 vs 0/12) (P < .01), be diagnosed on resection without a preceding biopsy (6/18 vs 0/12; P = .057), and have unidentifiable precursor lesions (10/18 vs 1/12; P = .018) than the control group. Synchronous carcinoma, advanced tumor stage (pT3 and pT4), and lymph node metastasis occurred at similar rates; however, the NEC/MiNEN group had a higher incidence of angiovascular invasion (14/18 vs 4/12; P = .024), distant metastasis (8/18 vs 1/12; P = .049), mortality (8/18 vs 2/12; P = .058), and worse survival (Kaplan-Meier; P = .023) than the control group. All tested cases were mismatch repair proficient. A Ki-67 proliferation index ranged from 25% to 100%. Next-generation sequencing in 11 NEC/MiNEN cases revealed low tumor mutational burdens but complex genetic abnormalities commonly involving TP53 (9/11; 82%), FBXW7 (4/11; 36%), and APC (3/11; 27%) genes, with the other genetic alterations randomly occurring in 1 or 2 cases. The neuroendocrine component, which shared similar molecular alterations as the nonneuroendocrine component, was subcategorized into intermediate (G3a) and high grade (G3b); the higher grade correlated with more genetic alterations. In conclusion, IBD-associated NEC/MiNEN shows diverse histologic features, variable precursor lesions, intricate genetic abnormalities, and aggressive biologic behavior. The classification and grading of gastrointestinal NEC/MiNEN may be refined for better clinical management.
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Affiliation(s)
- Xiaoyan Liao
- Department of Pathology, University of Rochester Medical Center, Rochester, New York.
| | - Alicia L Schmidt
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Dongwei Zhang
- Department of Pathology, Indiana University, Indianapolis, Indiana
| | - Peizi Li
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xintong Wang
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Huaibin M Ko
- Department of Pathology, Columbia University, New York, New York
| | - Won-Tak Choi
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Lindsay Alpert
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Yansheng Hao
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | - Sierra Kovar-Peltz
- Department of Pathology, University of Rochester Medical Center, Rochester, New York
| | | | - Pankhuri Wanjari
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Julius Mastro
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, Illinois
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2
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Sciarra A, Uccella S, Hiroz P, Fournier I, Soubeyran V, Finzi G, La Rosa S. Gastric Amphicrine Carcinoma Showing Neuroendocrine and Pancreatic Acinar Cell Differentiation. Lesson from a Challenging Case Opening New Perspectives in the Diagnostic Work-Up of Gastric Neuroendocrine Neoplasms. Endocr Pathol 2023; 34:349-357. [PMID: 37249796 DOI: 10.1007/s12022-023-09773-1] [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] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Amphicrine carcinomas are epithelial neoplasms composed of cells with co-existing exocrine-neuroendocrine phenotype and are challenging lesions from both diagnostic and therapeutic perspectives.Here, we report the case of a 63-year-old male patient with a gastric nodule that was endoscopically biopsied, revealing histological features of a type 3 well-differentiated gastric neuroendocrine tumor (NET). At imaging, the lesion was single and limited to the stomach, but did not present In-111Octreotide uptake, despite SSTR2A immunohistochemical expression. The patient underwent a wedge resection of the gastric wall, with a final pathological diagnosis of amphicrine carcinoma with pancreatic acinar cell and neuroendocrine features (pT1b). Predictive immunohistochemistry showed microsatellite stability and negative HER2 status. Hotspot targeted deep sequencing of 57 genes showed no somatic mutation, in agreement with the low mutational burden reported for gastric amphicrine carcinomas. Due to a low stage of the tumor and the poor performance status of the patient, no additional oncological treatment was administered. The patient was disease-free after 18 months.This unusual case highlights the importance of considering amphicrine carcinoma in the diagnostic work-up of gastric type 3 NET. This can be done by including in the immunohistochemical panel non-neuroendocrine markers, such as the pancreatic acinar cell and glandular ones. Correct pathological diagnosis is pivotal to determine the appropriate staging (NET vs exocrine one) for surgical and oncological management.
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Affiliation(s)
- Amedeo Sciarra
- Histopathology, Central Institute, Valais Hospital, Avenue du Grand-Champsec 86, CH-1951, Sion, Switzerland.
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy.
| | - Silvia Uccella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanule, Milan, Italy
- Pathology Service, IRCCS, Humanitas Research Hospital, Rozzano, Milano, Italy
| | | | - Ian Fournier
- General Surgery, Valais Hospital, Sion, Switzerland
| | | | - Giovanna Finzi
- Unit of Pathology, Department of Oncology, ASST Sette Laghi, Varese, Italy
| | - Stefano La Rosa
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
- Unit of Pathology, Department of Oncology, ASST Sette Laghi, Varese, Italy
- Hereditary Cancer Research Center, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
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3
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Paseiro-Crespo G, García-Nebreda M, Roldán Cortés D, De la Peña Navarro I, Álvaro Cifuentes E, Marqués Medina E, Abad-Motos A. Primary Pure Pancreatic -Type Acinar Cell Carcinoma of the Stomach: A Rare Entity with a Difficult Diagnosis and Review of the Literature. Int J Surg Pathol 2022; 30:528-538. [PMID: 35068223 DOI: 10.1177/10668969211065763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Acinar cell carcinoma is an uncommon tumour, representing only 1% to 2% of all exocrine pancreatic tumours. Pancreatic-type acinar cell carcinoma can occur in other organs, including the stomach, but it is extraordinarily rare. We report a case of a 51-year-old woman with a pancreatic-type pure acinar carcinoma of the stomach coexisting with a large cell B lymphoma synchronously, and a literature review of gastric carcinomas with pancreatic cell differentiation. At present there is a preoperative underdiagnosis of these tumours that could be minimized by including this entity in the differential diagnosis of gastric cancer and by performing immunohistochemical analysis with neuroendocrine markers and exocrine pancreatic enzymes.
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Affiliation(s)
- Gloria Paseiro-Crespo
- 145708Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid. Madrid, Spain
| | - María García-Nebreda
- 145708Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid. Madrid, Spain
| | | | | | - Edurne Álvaro Cifuentes
- 145708Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid. Madrid, Spain
| | - Elia Marqués Medina
- 145708Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid. Madrid, Spain
| | - Ane Abad-Motos
- 145708Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid. Madrid, Spain
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4
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Lin DL, Wang LL, Zhao P, Ran WW, Wang W, Zhang LX, Han M, Bao H, Liu K, Wu X, Shao Y, Xing XM. Gastrointestinal Goblet Cell Adenocarcinomas Harbor Distinctive Clinicopathological, Immune, and Genomic Landscape. Front Oncol 2021; 11:758643. [PMID: 34804955 PMCID: PMC8603204 DOI: 10.3389/fonc.2021.758643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Goblet cell adenocarcinoma (GCA) is a rare amphicrine tumor and difficult to diagnose. GCA is traditionally found in the appendix, but extra-appendiceal GCA may be underestimated. Intestinal adenocarcinoma with signet ring cell component is also very rare, and some signet ring cell carcinomas are well cohesive, having some similar morphological features to GCAs. It is necessary to differentiate GCA from intestinal adenocarcinomas with cohesive signet ring cell component (IACSRCC). The goal of this study is to find occurrence of extra-appendiceal GCA and characterize the histological, immunohistochemical, transcriptional, and immune landscape of GCA. We collected 12 cases of GCAs and 10 IACSRCCs and reviewed the clinicopathologic characters of these cases. Immunohistochemical stains were performed with synaptophysin, chromogranin A, CD56, somatostatin receptor (SSTR) 2, and Ki-67. Whole transcriptome RNA-sequencing was performed, and data were used to analyze differential gene expression and predict immune cell infiltration levels in GCA and IACSRCC. RNA-sequencing data for colorectal adenocarcinoma were gathered from TCGA data portal. Of the 12 patients with GCA, there were 4 women and 8 men. There were three appendiceal cases and nine extra-appendiceal cases. GCAs were immunohistochemically different from IACSRCC. GCA also had different levels of B-cell and CD8+ T-cell infiltration compared to both colorectal adenocarcinoma and cohesive IACSRCCs. Differential gene expression analysis showed distinct gene expression patterns in GCA compared to colorectal adenocarcinoma, with a number of cancer-related differentially expressed genes, including upregulation of TMEM14A, GOLT1A, DSCC1, and HSD17B8, and downregulation of KCNQ1OT1 and MXRA5. GCA also had several differentially expressed genes compared to IACSRCCs, including upregulation of PRSS21, EPPIN, RPRM, TNFRSF12A, and BZRAP1, and downregulation of HIST1H2BE, TCN1, AC069363.1, RP11-538I12.2, and REG4. In summary, the number of extra-appendiceal GCA was underestimated in Chinese patients. GCA can be seen as a distinct morphological, immunohistochemical, transcriptomic, and immunological entity. The classic low-grade component of GCA and the immunoreactivity for neuroendocrine markers are the key points to diagnosing GCA.
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Affiliation(s)
- Dong-Liang Lin
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Li Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wen-Wen Ran
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Long-Xiao Zhang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ming Han
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Hua Bao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Kaihua Liu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Xue Wu
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yang Shao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China.,School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Xing
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
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5
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Case report: Novel PIK3CA and AXIN1 mutations in acinar cell carcinoma of the stomach arising from pancreatic heterotopia. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Zhang P, Li Z, Li J, Li J, Zhang X, Lu Z, Sun Y, Li Y, Zhou J, Wang X, Peng Z, Shen L, Lu M. Clinicopathological features and lymph node and distant metastasis patterns in patients with gastroenteropancreatic mixed neuroendocrine-non-neuroendocrine neoplasm. Cancer Med 2021; 10:4855-4863. [PMID: 34109756 PMCID: PMC8290235 DOI: 10.1002/cam4.4031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
Objective Owing to its rarity and heterogeneity, the biological behavior and optimal therapeutic management of mixed neuroendocrine‐non‐neuroendocrine neoplasm (MiNEN) have not been established. Herein, we aimed to evaluate the clinicopathological characteristics and metastatic patterns of MiNEN. Methods Continuous clinicopathological data of MiNEN patients treated at our hospital were retrospectively collected and analyzed. Results This study had enrolled 169 patients since January 2010 to January 2020. Pathological components were assessed in 129 patients with MiNEN (76.3%), and a focal (non‐)neuroendocrine component was observed in 40 patients (23.7%; <30% of the tumor). Among the enrolled patients, 80 underwent surgical removal of the primary tumor and lymph nodes (LNs), and 34 with distant metastasis underwent biopsy of both primary tumor and metastatic lesions. In patients with LN metastasis, 68.8% (55/80) exhibited a pure component of either neuroendocrine (NE) or adenocarcinoma/squamous carcinoma (AS) in metastatic LNs, while 20% (16/80) showed different components in different LNs, and only 11.2% (9/80) exhibited both NE and AS components in the same LN. In patients with distant metastases, 26.5% (9/34) possessed coexisting NE and AS components in the distant metastases, 70.6% (24/34) were regarded as a pure NE component, and 2.9% (1/34) were comprised of a pure AS component. Conclusion Lymph node and distant metastases exhibited distinct metastatic patterns in patients with MiNEN. The major pathological component in regional LNs may have influenced the proportion of the two components within the primary tumor, but distant metastases were dominated by the NE component.
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Affiliation(s)
- Panpan Zhang
- Department of Early Drug Development Centre, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jie Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jian Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaotian Zhang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihao Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yu Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan Li
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jun Zhou
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xicheng Wang
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhi Peng
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ming Lu
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
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7
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Ooe Y, Watanabe K, Hashimoto I, Takenaka S, Ojima T, Yamamoto S, Fujii H. Title: pancreatic-type mixed acinar neuroendocrine carcinoma of the stomach: a case report and review of the literature. Diagn Pathol 2021; 16:11. [PMID: 33531019 PMCID: PMC7852210 DOI: 10.1186/s13000-021-01070-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The majority of gastrointestinal tumors are adenocarcinomas. Rarely, there are other types of tumors, such as acinar cell carcinoma, and these are often called pancreatic-type acinar cell carcinomas. Among these tumors, some are differentiated into neuroendocrine components. A few of them are MiNENs. CASE PRESENTATION The patient was an 80-year-old male who was referred to our hospital for treatment of a pedunculated gastric tumor. It was 5 cm in diameter and detected in the upper gastric body with upper GI endoscopy conducted to investigate anemia. In the biopsy, although hyperplasia of gastric gland cells was noted, no tumor cells were found. Retrospectively, the diagnosis was misdiagnosed. An operation was arranged because bleeding from the tumor was suspected as a cause of anemia and because surgical resection was considered to be desirable for accurate diagnosis. Hence, laparoscopic and endoscopic cooperative surgery was performed. In the pathological examination, several types of epithelial cells that proliferated in the area between the mucosa and deep inside the submucosa were observed. These consisted of acinar-glandular/trabecular patterns and solid. A diagnosis of pancreatic-type acinar cell carcinoma of the stomach with NET G2 and G3 was made based on characteristic cellular findings and the results of immunostaining tests. Each of them consisted of more than 30% of the lesion; a diagnosis of pancreatic-type mixed acinar neuroendocrine carcinoma (pancreatic-type MiNEN) of the stomach or a type of gastric MiNEN was obtained. Anemia was resolved after the operation, and the patient was discharged from the hospital without perioperative complications. CONCLUSIONS Pancreatic-type ACC of the stomach that is differentiated into neuroendocrine tumors is very rare. Hence, we report this case along with a literature review.
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Affiliation(s)
- Yuka Ooe
- Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan.
| | - Kishichiro Watanabe
- Watanabe's Consultancy for Pathological Diagnosis, 1007 Surpass Sakurada-cho Ichibankan 3-30-1 Sakurada-cho, Kanazawa, Ishikawa, 920-0057, Japan
| | - Isaya Hashimoto
- Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan
| | - Satoshi Takenaka
- Department of Surgery, Suzu General Hospital, 1-1 Nonoemachi, Suzu, Ishikawa, 927-1213, Japan
| | - Toshihiko Ojima
- Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan
| | - Seiichi Yamamoto
- Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan
| | - Hisatake Fujii
- Department of Surgery, Toyama Nishi General Hospital, 1019 Shimokutsuwada, Fuchumachi, Toyama, Toyama, 939-2716, Japan
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Hanamatsu Y, Saigo C, Asano N, Kito Y, Nakada K, Takeda Y, Takeuchi T. A Case of Gastric Amphicrine Signet-Ring Cell Carcinoma. CLINICAL PATHOLOGY 2019; 12:2632010X19880535. [PMID: 31637369 PMCID: PMC6787873 DOI: 10.1177/2632010x19880535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Abstract
“Amphicrine” (in Greek, amphi- means “both” or “double”) refers to cells
that synchronously exhibit the endocrine and exocrine phenotypes. Gastric amphicrine
carcinoma is very rare, and only a few case reports are found in the English literature;
thus, its pathobiological features remain unclear. Here, we report a case of amphicrine
gastric carcinoma. A woman in her sixth decade of life presented with anemia and underwent
upper endoscopy, followed by histopathological examination of biopsy specimens. She
appeared to have gastric cancer with a tumor measuring 5.0 cm × 4.0 cm in size.
Subsequently, the patient underwent total gastrectomy with lymph node dissection.
Histopathological examination revealed a poorly cohesive carcinoma that sparsely coexisted
with signet-ring cell carcinoma cells with regional lymph node metastasis. Interestingly,
synaptophysin immunoreactivity with the coexistence of Alcian blue was found in individual
signet-ring cell carcinoma cells. Furthermore, the present amphicrine carcinoma cells
immunohistochemically expressed CD44 variant 9, a functional cancer stem cell marker. We
believe that the present case findings may support the idea of multipotent stem cells
being an origin of amphicrine gastric cancers.
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Affiliation(s)
- Yuki Hanamatsu
- Department of Pathology and Translational Research, Gifu University School of Medicine, Seki, Japan
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University School of Medicine, Seki, Japan
| | - Nami Asano
- Department of Pathology, Chuno Kosei Hospital, Seki, Japan
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University School of Medicine, Seki, Japan
| | | | - Yohei Takeda
- Department of Surgery, Chuno Kosei Hospital, Seki, Japan
| | - Tamotsu Takeuchi
- Department of Pathology and Translational Research, Gifu University School of Medicine, Seki, Japan
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9
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Fujita Y, Uesugi N, Sugimoto R, Eizuka M, Matsumoto T, Sugai T. Gastric mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) with pancreatic acinar differentiation: a case report. Diagn Pathol 2019; 14:38. [PMID: 31077220 PMCID: PMC6511127 DOI: 10.1186/s13000-019-0815-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background Gastric mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are infrequently encountered in routine practice. Some gastric neuroendocrine carcinomas (NECs) have a variety of differentiation patterns; however, pancreatic acinar differentiation in gastric NECs is rare. The molecular abnormalities of NECs with pancreatic acinar differentiation are not well understood. Case presentation A 67-year-old male with a gastric MiNEN with pancreatic acinar differentiation without any symptoms. The tumor consisted of two components, including both glandular and solid histological features. Although the former component was a common type of adenocarcinoma, the latter showed endocrine differentiation and expressed pancreatic acinar enzymes immunohistochemically. A positive signal with the anti-BCL10 antibody, which detects one of the pancreatic acinar enzymes, was also present specifically in the latter component. We also examined TP53 genomic mutations, DNA methylation status, and allelic imbalance (AI), which is an indicator of tumor aggressiveness. Although both components of this tumor showed no genomic mutation and a low methylation epigenotype, the frequency of AI was higher in the acinar-endocrine component than in the adenocarcinomatous component. The finding of AI indicated the progression of the conventional adenocarcinoma to an acinar-endocrine component and identified the aggressive potential of the acinar-endocrine component. Conclusions We report a rare case of gastric MiNEN with pancreatic acinar differentiation. AI analysis revealed tumor progression and aggressiveness. In addition, the usefulness of the anti-BCL10 antibody for detecting the acinar-endocrine component was suggested.
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Affiliation(s)
- Yasuko Fujita
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Noriyuki Uesugi
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Ryo Sugimoto
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Makoto Eizuka
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.
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10
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Cazacu IM, Luzuriaga Chavez AA, Nogueras Gonzalez GM, Saftoiu A, Bhutani MS. Malignant Transformation of Ectopic Pancreas. Dig Dis Sci 2019; 64:655-668. [PMID: 30415408 DOI: 10.1007/s10620-018-5366-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
Malignant transformation of ectopic pancreas tissue is a diagnostic challenge as clinical symptoms and radiographic features of these tumors are non-specific. Given the rarity of these lesions, it is usually neither suspected nor included in the diagnostic workup of different tumors. We conducted a comprehensive literature review regarding malignancy arising from ectopic pancreas for a better understanding of its frequency, clinicopathological features, and prognosis. A literature search was performed in three major databases: PubMed, Cochrane, and Web of Science. Fifty-four well-documented cases of malignant ectopic pancreas were identified in the published literature. Our analysis provided the following observations: (1) there was a slight predominance of males over females; (2) most patients with malignant transformation of ectopic pancreas were middle-aged; (3) most commonly, the tumor was located in the stomach; (4) most tumors were adenocarcinomas; (5) most frequently, the malignancy arose within a type I heterotopia according to Heinrich classification; (6) macroscopically, a subepithelial-like appearance was most frequently observed; and (7) improved prognosis for ectopic pancreatic malignancies in comparison with reported survival data for orthotopic pancreatic cancer. Even if the majority of cases of ectopic pancreas are incidental findings and malignant transformation is a rare event, pancreatic heterotopy should be considered as a source of potentially malignant lesions.
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Affiliation(s)
- Irina M Cazacu
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adriana Alexandra Luzuriaga Chavez
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Graciela M Nogueras Gonzalez
- Department of Biomathematics and Biostatistics, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 66 1 Mai Blvd., 200638, Craiova, Romania
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA.
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11
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Nie L, Li M, He X, Feng A, Wu H, Fan X. Gastric mixed adenoneuroendocrine carcinoma: correlation of histologic characteristics with prognosis. Ann Diagn Pathol 2016; 25:48-53. [PMID: 27806846 DOI: 10.1016/j.anndiagpath.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/11/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
Gastric mixed adenoneuroendocrine carcinomas (MANECs) are rare, with both the exocrine and neuroendocrine components exceeding 30% volume. Several classifications for MANECs have been proposed, yet they have not been clinically evaluated. The aim of this study was to evaluate the correlation between tumor grade, histologic characteristics, and prognosis of gastric MANECs. We collected eligible 14 cases in our series and 31 cases in the literature and compared the prognostic difference among gastric MANECs with different histologic characteristics. Gastric MANECs could be divided into subgroups according to tumor grade of the neuroendocrine component and adenocarcinoma types. The high grade and large proportion of neuroendocrine component correlated with aggressive behavior and a tendency of poor clinical outcome. Gastric MANECs with a poorly differentiated adenocarcinoma showed a significant lower survival rate than did MANECs with a differentiated adenocarcinoma or mucin-producing carcinoma (P = .0008). Gastric MANECs were a heterogeneous group with different tumor grades, histologic subtypes, combination patterns, and patient outcomes. Previous classifications were evaluated. This study proves that histologic characteristics correlate with clinical outcomes. Our findings are complements to the latest prognostic classification.
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Affiliation(s)
- Ling Nie
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Mingna Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Xiaofeng He
- Department of Cardiothoracic Surgery, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Anning Feng
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Hongyan Wu
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiangshan Fan
- Department of Pathology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
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12
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13
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Ishii N, Araki K, Yokobori T, Tsukagoshi M, Igarashi T, Watanabe A, Kubo N, Hirai K, Shirabe K, Kuwano H. Presence of Cytokeratin 19-Expressing Cholangiocarcinoma-Like Tumour in a Liver Metastatic Lesion of Rectal Neuroendocrine Tumour. Case Rep Gastroenterol 2016; 10:431-439. [PMID: 27721729 PMCID: PMC5043256 DOI: 10.1159/000446641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 12/12/2022] Open
Abstract
Introduction Tumours with adenocarcinoma and neuroendocrine components have often been reported, although the reason underlying the dual components remains unclear. Case Presentation A 43-year-old woman with multiple liver metastatic lesions of rectal neuroendocrine tumour underwent primary tumour resection and subsequent liver transplantation. Pathological examination indicated a cholangiocarcinoma-like tumour with gland formation, adjacent to a liver metastatic lesion of the neuroendocrine tumour. This tumour comprised atypical columnar epithelium, and stained positively for neuroendocrine markers and the ductal marker cytokeratin 19, indicating amphicrine properties and a partial cholangiocarcinoma phenotype – features not observed in the primary and metastatic neuroendocrine tumours. Conclusion The presence of adenocarcinoma only at the metastatic site indicated that neuroendocrine tumour cells acquired stemness and differentiated into adenocarcinoma through metastasis, or that the adenocarcinoma newly arose from the adjacent epithelium influenced by the neuroendocrine tumour. We propose a novel mechanism for the pathogenesis of mixed tumours in neuroendocrine tumours.
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Affiliation(s)
- Norihiro Ishii
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan; Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Kenichiro Araki
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan; Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Takehiko Yokobori
- Department of Molecular Pharmacology and Oncology, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Mariko Tsukagoshi
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan; Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Takamichi Igarashi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Akira Watanabe
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan; Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Norio Kubo
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan; Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Keitaro Hirai
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan
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14
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A case of hyperfunctioning pancreatic mixed adenoneuroendocrine carcinoma (MANEC) arising from ectopic pancreatic tissue in the liver. Radiol Case Rep 2015; 9:1011. [PMID: 27190559 PMCID: PMC4861888 DOI: 10.2484/rcr.v9i4:1011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We report the case of a hyperfunctioning mixed adenoneuroendocrine carcinoma (MANEC) arising from ectopic pancreatic tissue in the liver. To our knowledge, the imaging appearance of a MANEC in the liver has never been reported. Literature on MANEC and its imaging features, including its appearance on the MR hepatobiliary phase and differential considerations, are reviewed and discussed.
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15
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Strassen U, Hofauer B, Matsuba Y, Becker K, Mansour N, Knopf A. Bronchogenic cancer: It still exists. Laryngoscope 2015; 126:638-42. [PMID: 26371793 DOI: 10.1002/lary.25660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Branchial cleft cysts rank among the most common differential diagnoses of cystic cervical masses. Rarely, classic cystic structures exhibit a squamous cell carcinoma differentiation that represents a bronchogenic carcinoma. The existence of bronchogenic carcinoma is controversial due to the lack of systematic immunohistologic workup. The present study aimed to identify the clinical and immunohistologic features of bronchogenic carcinoma to clearly distinguish this entity from other cystic cervical masses. METHODS Immunohistologic (epidermal growth factor receptor; cytokeratin 5, 6, 7, 13; and p16) and epidemiologic assessments were performed for branchial cleft cysts (n = 63), bronchogenic carcinomas (n = 5), cystic metastasized oropharyngeal carcinomas (n = 97), and carcinomas of unknown primary (n = 51). The study was conducted as a retrospective case series study with comparison. RESULTS The patients with bronchogenic carcinomas differed significantly in age and in the number of involved lymph nodes compared with the cystic metastasized oropharyngeal carcinoma (and carcinoma of unknown primary) patients. Regular histologic wall structures were only observed in the bronchogenic carcinomas and branchial cleft cysts. Solitary cytokeratin-7 staining was only observed in the bronchogenic carcinomas, and all of the bronchogenic carcinomas were p16 negative. CONCLUSIONS The existence of bronchogenic carcinoma seems to be plausible based on clinical findings. Cytokeratin-7 and p16 staining might be helpful in the diagnostic workflow. LEVEL OF EVIDENCE 4 Laryngoscope, 126:638-642, 2016.
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Affiliation(s)
- Ulrich Strassen
- Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Yumiko Matsuba
- Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Karen Becker
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Naglaa Mansour
- Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology/Head and Neck Surgery, Technical University of Munich, Munich, Germany
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16
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Abstract
Amphicrine carcinoma is a peculiar tumor in which the cells have both exocrine and neuroendocrine differentiation, with mucus and neuroendocrine granules within the cytoplasm. In the 2010 WHO classification of tumors of the digestive tract, they have been included in the intermediate-grade malignant category of mixed adenoneuroendocrine carcinomas (MANECs). These tumors are extremely rare in the gastrointestinal tract. Four cases have been reported in the stomach, three in the pancreas, and one in the liver. To the best of our knowledge, this report describes the first case of amphicrine carcinoma in the ampullary region.
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17
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Management and disease outcome of type I gastric neuroendocrine tumors: the Mount Sinai experience. Dig Dis Sci 2015; 60:996-1003. [PMID: 25399327 DOI: 10.1007/s10620-014-3410-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The incidence of gastric neuroendocrine tumors (NETs) has increased tenfold since the 1970s. Our aim was to describe the clinicopathologic profile, management, and outcomes of type I gastric NETs at The Mount Sinai Hospital. METHODS From existing databases of the Mount Sinai Division of Gastrointestinal Pathology and the Carcinoid Cancer Foundation, we identified 56 patients with type I gastric NETs seen at The Mount Sinai Hospital from 1993 to 2012. We generated a comprehensive dataset encompassing demographic, clinical, endoscopic, and pathologic factors. Survival information was determined from medical records and the Social Security Death Index. Tumor-node-metastasis staging was conducted, and tumors were graded based on mitotic counts and Ki67 index. RESULTS Median NET size was 3.0 mm; 55.8 % displayed multifocal disease. Stages I, II, III, and IV disease were observed in 83.8, 10.8, 5.4, and 0 %, respectively. Tumors were either low (69.7 %) or intermediate (30.3 %) grade. Furthermore, 3.6 % of patients developed gastric dysplasia, and 5.5 % had gastric adenocarcinoma. Patients underwent endoscopy every 15 months, while 28.6 % underwent polypectomy, 32.7 % somatostatin therapy, and 46.4 % surgical resection. 5- and 10-year disease-specific survival was 100 %. CONCLUSIONS Most patients received annual endoscopic surveillance, with a minority undergoing surgical resection, though outcomes remained excellent independent of therapeutic approach. We identified a very low but real rate of loco-regional spread, despite the generally indolent behavior of type I gastric NETs. Several patients demonstrated concurrent dysplasia or adenocarcinoma, underscoring the efficacy of regular endoscopic management not only for gastric NETs, but also for dysplasia and adenocarcinoma.
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18
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The PAS positive material in gastric cancer cells of signet ring type is not mucin. Exp Mol Pathol 2014; 96:274-8. [PMID: 24589859 DOI: 10.1016/j.yexmp.2014.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 02/21/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study is to assess the exocrine and neuroendocrine properties of tumour cells in diffuse gastric cancer with signet ring cell differentiation. MATERIAL AND METHODS Mucin mRNA and protein expressions (MUC1, 2, 3, 4, 5AC, 6 and MUC13) were assessed by immunohistochemistry and in situ hybridization. The neuroendocrine properties were evaluated by protein and mRNA expression of the general neuroendocrine markers chromogranin A and synaptophysin. RESULTS No MUC expression was observed in signet ring tumour cells including the amorphous substance in any of the nine cases. All cases showed immunoreactivity to synaptophysin, and seven out of nine cases immunoreactivity to chromogranin A in signet ring and non-signet ring tumour cells. Chromogranin A mRNA expression was observed in tumour cells in all samples with retained mRNA. CONCLUSIONS The lack of MUC protein and mRNA in signet ring tumour cells suggests the amorphous substance is not mucin. The lack of MUC mRNA expression in non-signet ring tumour cells questions exocrine differentiation in this tumour group. The abundant protein expression of the general neuroendocrine markers CgA and synaptophysin, and mRNA expression in tumour cells strengthens the hypothesis that this tumour group may be of neuroendocrine origin.
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Abstract
Acinar cell carcinoma is an uncommon carcinoma of the exocrine pancreas. On very rare occasions it has been reported in ectopic sites, sometimes with, but usually without contiguous heterotopic pancreatic tissue. Whilst mixed and composite glandular tumours have also been described, pure pancreatic-type acinar cell carcinomas arising in the stomach are very rare.
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20
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The prevalence of pancreatic acinar differentiation in gastric adenocarcinoma: report of a case and immunohistochemical study of 111 additional cases. Am J Surg Pathol 2012; 36:402-8. [PMID: 22082608 DOI: 10.1097/pas.0b013e318238369e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Although pancreatic acinar metaplasia in the gastric mucosa is well recognized in chronic gastritis, gastric carcinoma with acinar differentiation is very rare. We encountered a case of gastric adenocarcinoma with prominent histologic and immunohistochemical features of pancreatic acinar differentiation in the absence of identifiable heterotopic pancreatic tissue. Distinct glandular and diffuse patterns of adenocarcinoma were also present, and there was focal mucin production. The tumor strongly expressed pancreatic exocrine enzymes trypsin and chymotrypsin, and focal neuroendocrine staining was also present. To investigate the prevalence of acinar differentiation in histologically typical gastric cancers, we performed immunohistochemical staining for trypsin and chymotrypsin on a tissue microarray containing 111 conventional gastric adenocarcinomas (60 intestinal, 28 mixed, 22 diffuse type, and 1 undifferentiated). No obvious morphologic evidence of acinar differentiation was identified in any of the 111 cases. Although some cases showed equivocal staining for at least 1 pancreatic exocrine enzyme on the initial tissue microarray sections, repeat immunohistochemical staining on representative whole-tissue sections failed to reproduce positive staining. Thus, acinar differentiation is rare in gastric adenocarcinomas, other than in histologically unusual cases such as the one we report, and in others from the literature, which are reviewed.
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21
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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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Huang Q, Gold JS, Shi J, Fan X, Wu H, Feng A, Zhou Q. Pancreatic acinar-like adenocarcinoma of the proximal stomach invading the esophagus. Hum Pathol 2011; 43:911-20. [PMID: 22055400 DOI: 10.1016/j.humpath.2011.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/25/2011] [Accepted: 07/27/2011] [Indexed: 12/30/2022]
Abstract
The aim of this study was to systematically investigate clinicopathologic features of the recently described pancreatic acinar-like adenocarcinoma of the proximal stomach invading the esophagus (n = 43). Patient median age was 66 years (range, 51-90 years). The male-to-female ratio was 7.6. Grossly, pancreatic acinar-like adenocarcinoma tumors were nonencapsulated with the median size of 5.5 cm (range, 2-10.5). Bormann's types 1 to 4 tumors were in 7%, 9%, 67%, and 16% cases, respectively. Frank necrosis, hemorrhage, and cysts were rare or absent. Lymphovascular (81%), perineural (74%), and lymph node (81%) invasions were more common in the pancreatic acinar-like adenocarcinoma than in the non-pancreatic acinar-like adenocarcinoma (n = 94) groups. Microscopically, pancreatic acinar-like adenocarcinoma tumors showed acinar (78%), micropapillary (12%), microcystic, solid, trabecular, and mixed neuroendocrine or signet ring (33%) patterns of growth. No adenosquamous differentiation was noted in the pancreatic acinar-like adenocarcinoma group. Nuclei were round to oval with thickened nuclear membrane, stippled chromatin, and single prominent nucleoli. Mitotic figures were variable. The cytoplasm was moderate, eosinophilic, finely granular, and diffusely immunoreactive to the α1-chymotrypsin antibody in all cases to various degrees. Tumor stroma was nondesmoplastic, delicate, and fibrovascular. Pancreatic acinar-like adenocarcinoma tumors staged pI, pII, pIII, and pIV were in 2%, 21%, 70%, and 7% of cases, respectively. The median number of follow-up months after surgery was 29. The 2-year survival rate was 67%, lower than that (73%) in the non-pancreatic acinar-like adenocarcinoma group. A worse overall survival trend was found for patients in the pancreatic acinar-like adenocarcinoma than in non-pancreatic acinar-like adenocarcinoma groups, but the difference was not statistically significant. Age older than 75 years and overall pathology stage were independent risk factors.
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Affiliation(s)
- Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing 210008, China.
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23
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Lowery MA, Klimstra DS, Shia J, Yu KH, Allen PJ, Brennan MF, O'Reilly EM. Acinar cell carcinoma of the pancreas: new genetic and treatment insights into a rare malignancy. Oncologist 2011; 16:1714-20. [PMID: 22042785 DOI: 10.1634/theoncologist.2011-0231] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acinar cell carcinoma (ACC) of the pancreas is a rare neoplasm, accounting for 1% of all pancreatic neoplasms. There remains a lack of data regarding the use of systemic therapy in this disease. We present a series of 40 consecutive cases of ACC of the pancreas treated at Memorial Sloan-Kettering Cancer Center, with an emphasis on evaluation of activity of new therapeutic agents. METHODS Patients reviewed at our institution from January 2000 through January 2011 were identified from an institutional database with prior institutional review board approval. Pathology was confirmed in all cases as ACC or a closely related entity. RESULTS Forty patients were identified; 29 were male (73%). The median age at diagnosis was 65 years (range, 16-87 years). The median overall survival (OS) time for patients with localized, resectable disease was 56.9 months and the OS time for patients with metastatic ACC (n = 18) was 19.6 months. Six patients with metastatic or recurrent ACC had a partial response to chemotherapy and five patients had stable disease for ≥6 months on systemic chemotherapy. Clinical observation was made of a patient with ACC and hereditary nonpolyposis colorectal cancer and a patient with ACC and a BRCA1 germline mutation. CONCLUSIONS ACC is moderately chemoresponsive to agents that have activity in pancreatic adenocarcinoma and colorectal carcinoma. A potential association between germline mutations in DNA mismatch repair genes and ACC warrants further evaluation.
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Affiliation(s)
- Maeve A Lowery
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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24
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Ganesan K, Achmad E, Sirlin CB, Bouvet M, Datnow B, Weidner N, Peterson MR. Amphicrine carcinoma of the liver. Ann Diagn Pathol 2011; 15:355-7. [DOI: 10.1016/j.anndiagpath.2010.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 05/07/2010] [Indexed: 11/28/2022]
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25
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Lee HH, Jung CK, Jung ES, Song KY, Jeon HM, Park CH. Mixed exocrine and endocrine carcinoma in the stomach: a case report. J Gastric Cancer 2011; 11:122-5. [PMID: 22076213 PMCID: PMC3204483 DOI: 10.5230/jgc.2011.11.2.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/05/2011] [Indexed: 12/11/2022] Open
Abstract
We report a rare case of the coexistence of a gastric small cell neuroendocrine carcinoma with a gastric adenocarcinoma. A 62-year-old man presented with epigastric soreness for 1 month. Esophagogastroduodenoscopy revealed a Borrmann type I tumor at the lesser curvature of the lower body of the stomach. The patient underwent a distal gastrectomy with D2 lymph node dissection and the resected specimen exhibited a 3.5×3.5 cm sized, fungating lesion. Two separated, not intermingling, lesions with non-adenocarcinoma components encircled by well differentiated adenocarcinoma components were identified microscopically. The non-adenocarcinoma component showed neuroendocrine features, such as a solid and trabecular pattern, and the tumor cells showed a high nuclear grade with minimal cytoplasm, indistinct nucleoli, and positive response for synaptophysin, CD56. The final pathological diagnosis was a gastric mixed exocrine-endocrine carcinoma (MEEC) composed of an adenocarcinoma and small cell neuroendocrine carcinoma of the collision type.
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Affiliation(s)
- Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, The Catholic University of Korea, School of Medicine, Seoul, Korea
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26
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Bartley AN, Rashid A, Fournier KF, Abraham SC. Neuroendocrine and mucinous differentiation in signet ring cell carcinoma of the stomach: evidence for a common cell of origin in composite tumors. Hum Pathol 2011; 42:1420-9. [PMID: 21419473 DOI: 10.1016/j.humpath.2010.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/24/2010] [Accepted: 12/02/2010] [Indexed: 11/15/2022]
Abstract
Composite tumors are rare neoplasms containing a mixture of 2 different cellular components present in roughly equal proportions. It is hypothesized that composite tumors arise from a multipotential stem cell with subsequent bidirectional differentiation. We present an unusual composite tumor of the stomach composed equally of signet ring cell carcinoma and low-grade neuroendocrine carcinoma. Twenty-one additional patients with signet ring cell carcinomas of the stomach were studied to determine the prevalence of neuroendocrine differentiation by morphology and immunohistochemistry for synaptophysin and chromogranin A. Immunohistochemistry for mucins 5AC and 2 was performed to assess for divergent differentiation toward foveolar and intestinal mucin phenotypes, respectively, and to evaluate for any potential relationship with neuroendocrine differentiation. We found morphologic evidence of neuroendocrine carcinoma in 4 (19%) of 21 consecutive signet ring carcinomas. E-cadherin immunostaining was subsequently performed on these 4 tumors plus the index case. All 5 tumors demonstrated concordance between the signet ring and neuroendocrine components. There was no distinct relationship to mucin 5AC/mucin 2 profiles, with the exception that all 11 intramucosal signet ring cell carcinomas from 4 patients with germ line cadherin 1 gene mutations were composed exclusively of mucin 5AC+ signet ring cells that lacked intestinal mucin and neuroendocrine differentiation. The concordant E-cadherin status in the neuroendocrine and signet ring cell tumor components and the frequent admixture of mucin 5AC+ cells with foveolar differentiation and mucin 2+ cells with intestinal differentiation may support the hypothesis that composite tumors arise from a common stem cell with bilineage or multilineage differentiation.
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Affiliation(s)
- Angela N Bartley
- Department of Anatomic Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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27
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Colonic carcinoma with a pancreatic acinar cell differentiation. A case report. Virchows Arch 2009; 455:527-31. [PMID: 19908063 DOI: 10.1007/s00428-009-0852-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 09/23/2009] [Accepted: 10/16/2009] [Indexed: 02/08/2023]
Abstract
A case of a colonic carcinoma showing a pancreatic acinar cell differentiation is described for the first time. A 65-year-old woman underwent surgical resection for an ulcerated protruding tumour of 4 x 2.5 cm in size on the anterior wall of the sigmoid colon. Histologically, tumour cells were organized in acinar structures resembling pancreatic acini and in solid nests and ribbons or diffusely infiltrated as poorly cohesive cells. Lymph nodes and femur metastases displayed the same histological features. The ultrastructural analysis of the primary tumour indicated the presence of zymogen-like granules in the cytoplasm of tumour cells. Immunohistochemically, both acinar and diffuse patterns of growth showed an intense staining for trypsin, chymotrypsin and BCL10 and a weaker immunoreactivity for lipase and carboxyl ester hydrolase. Most tumour cells were cytokeratin 20, CDX2 and p53 positive; whereas, mucin (MUC)2 immunoreactivity was observed only in the signet ring cells present in the diffuse pattern and chromogranin A in rare isolated tumour cells. No immunoreactivity was observed for cytokeratin 7, MUC1, MUC5AC, pancreatic amylase or PDX1. There was no evidence of a pancreatic acinar cell carcinoma or of heterotopic pancreatic tissue. A colonic origin ought to be suspected when a metastatic carcinoma of unknown primary shows an acinar differentiation.
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Kusafuka K, Bando E, Muramatsu K, Ito H, Tanizawa Y, Kawamura T, Mochizuki T, Terashima M, Nakajima T. Pancreatic-type mixed acinar-endocrine carcinoma with alpha-fetoprotein production arising from the stomach: a report of an extremely rare case. Med Mol Morphol 2009; 42:167-74. [DOI: 10.1007/s00795-009-0446-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/03/2009] [Indexed: 12/30/2022]
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Stojsic Z, Brasanac D, Stojiljkovic M, Babic D, Randjelovic T, Terzic T. Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas. Pathol Oncol Res 2009; 15:503-10. [DOI: 10.1007/s12253-008-9145-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 12/22/2008] [Indexed: 01/06/2023]
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Hervieu V, Lombard-Bohas C, Dumortier J, Boillot O, Scoazec JY. Primary acinar cell carcinoma of the liver. Virchows Arch 2008; 452:337-41. [PMID: 18193278 DOI: 10.1007/s00428-007-0556-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/09/2007] [Accepted: 12/01/2007] [Indexed: 12/19/2022]
Abstract
We report a case of acinar cell carcinoma primary to the liver. The tumor was diagnosed in a 35-year-old woman complaining of abdominal pain and asthenia; serum alpha-fetoprotein (AFP) levels were increased at 6,000 IU/mL; imaging studies showed a hypervascular mass located in the left lobe of the liver. A left lobectomy was performed. The tumor had a heterogeneous appearance. In well-differentiated areas, tumor cells formed acinar structures, had a pyramidal shape and a highly eosinophilic, granular cytoplasm, PAS diastase resistant. In less-differentiated areas, tumor cells were endocrinelike. The immunohistochemical study showed that tumor cells expressed trypsin. Alpha-fetoprotein and alphal-antritrypsin were detected in about 30% of cells; HepPar1 was present in 15% of cells. Chromogranin A and synaptophysin were detected in rare cells. After surgery, serum AFP levels quickly returned to normal; no evidence of recurrence or metastasis was observed during follow-up. The final diagnosis, based on histological, immunohistochemical, and ultrastructural arguments, was extra-pancreatic acinar cell carcinoma, primary to the liver. This unusual lesion is likely to be the result of an abnormal differentiation pathway involving a transformed multipotential progenitor cell.
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Affiliation(s)
- Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France
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Abstract
Colonic composite tumors are uncommon masses composed of endo- and exocrine cells. Treatment is similar to that of adenocarcinomas. We report the case of a 44-year-old woman who consulted for abdominal pain. A computed tomography (CT) scan showed a tumor at the splenic flexure bowel and 2 hepatic nodules, suggesting metastases. Preoperative biopsies confirmed an adenocarcinoma. The patient underwent surgery, which confirmed the CT findings. Extended right colectomy was performed, followed by an ileal-sigmoid anastomosis, resection of a diaphragm segment, and resection of both hepatic metastases. The patient made a good postoperative recovery. Histological analysis showed moderately differentiated tubular adenocarcinoma combined with a poorly differentiated neuroendocrine carcinoma and metastases in 25 of 28 lymph nodes. The 2 hepatic metastases showed areas of poorly differentiated neuroendocrine carcinoma. The patient is currently asymptomatic and is undergoing chemotherapy.
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Affiliation(s)
- Jean M Butte
- Departamento de Cirugía Digestiva, División de Cirugía, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile
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Nugent SL, Cunningham SC, Alexiev BA, Bellavance E, Papadimitriou JC, Hanna N. Composite signet-ring cell/neuroendocrine carcinoma of the stomach with a metastatic neuroendocrine carcinoma component: a better prognosis entity. Diagn Pathol 2007; 2:43. [PMID: 17988399 PMCID: PMC2174438 DOI: 10.1186/1746-1596-2-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 11/07/2007] [Indexed: 11/30/2022] Open
Abstract
Background Mixed (composite) exocrine-neuroendocrine cell carcinomas are defined as an intimate admixture of neoplastic glandular exocrine and neuroendocrine cell types. Although gastric adenocarcinoma containing a small number of neuroendocrine cells is a relatively frequent occurrence, gastric neoplasms containing equal proportions of both cell types are rare. Case Presentation We present a case of composite exocrine (signet-ring cell)-neuroendocrine cell carcinoma, in which the neoplastic signet-ring cell exocrine and neuroendocrine constituents occurred in fairly equivalent amounts, whereas only the neuroendocrine carcinoma portion of the tumor represented the metastatic component. Light microscopy, immunohistochemical and electron microscopic findings are described, and the literature is reviewed. Conclusion This study confirms the ability of pluripotent precursor cells to differentiate into either adenocarcinoma or neuroendocrine tumor and, justifying the designation of composite exocrine-neuroendocrine cell carcinoma as the appropriate classification for this tumor. The protracted clinical course further supports the notion that composite signet-ring cell/neuroendocrine carcinoma tumors behave relatively less aggressively than the pure forms of the former cell type.
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Affiliation(s)
- Summer L Nugent
- Department of Pathology, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
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Volante M, Righi L, Asioli S, Bussolati G, Papotti M. Goblet cell carcinoids and other mixed neuroendocrine/nonneuroendocrine neoplasms. Virchows Arch 2007; 451 Suppl 1:S61-9. [PMID: 17684764 DOI: 10.1007/s00428-007-0447-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 06/06/2007] [Indexed: 01/06/2023]
Abstract
Within the spectrum of neuroendocrine tumors arising in different organs, intermediate and controversial entities exist displaying a coexistence of neuroendocrine and nonneuroendocrine cell populations, and that are grouped under terms such as "goblet cell carcinoid", "mixed endocrine-exocrine carcinoma", "combined carcinomas", or "adenocarcinoma with neuroendocrine differentiation". These tumors may display variable amounts of the two components, potentially ranging from 1 to 99%, and variable structural patterns, ranging from single scattered neuroendocrine cells to a well-defined neuroendocrine tumor cell component organized in typical organoid, trabecular, or solid growth patterns. Although variably included in the site-specific World Health Organization classification schemes, clear definitions and diagnostic features are still missing, as well as a definite knowledge of their biological properties and histogenesis. In the present report, the main characteristics of tumors showing mixed neuroendocrine and nonneuroendocrine features will be described, using morphological patterns and site of origin as schematic guidelines. Moreover, molecular and clinical aspects, which might help to understand their possible histogenesis and biological behavior, will be reviewed.
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Affiliation(s)
- Marco Volante
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Regione Gonzole10, 10043, Orbassano, Torino, Italy.
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Huang Q, Zhang LH. The histopathologic spectrum of carcinomas involving the gastroesophageal junction in the Chinese. Int J Surg Pathol 2007; 15:38-52. [PMID: 17172496 DOI: 10.1177/1066896906295998] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Carcinomas involving the gastroesophageal junction are common in China. The histopathologic characteristics of these cancers have not been systematically investigated. Reported are 41 such resected cancers from Chinese patients (30 men, 11 women). Their mean age was 62 years. The mean tumor size was 4.4 cm (range, 2 to 9 cm), and 58% were poorly differentiated. An unusual spectrum of tumor differentiation was observed, including adenocarcinomas (83%), adenosquamous (32%), colloid (2%), signet-ring (10%), squamous (5%), oncocytic (7%), pancreatic acinar (12%), and neuroendocrine (5%) carcinomas. Cancers with multiple types of differentiation in the same tumor were identified in 37 cases (90%). The adjacent gastric cardiac mucosa showed hyperplasia, oncocytic, and pancreatic acinar metaplasia, and mild chronic inflammation. Dysplasia was uncommon (n = 6). Barrett esophagus was not identified. Carcinomas involving the gastroesophageal junction in the Chinese are morphologically distinct, heterogeneous, and may be of esophageal origin.
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Affiliation(s)
- Qin Huang
- Department of Pathology and Laboratory Medicine, Boston Veterans Affairs Health Care System, West Roxbury, Massachusetts and Brown Medical School, Providence, Rhode Island, USA.
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Current World Literature. Curr Opin Oncol 2007; 19:65-9. [PMID: 17133115 DOI: 10.1097/cco.0b013e328012d5fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Volante M, Rindi G, Papotti M. The grey zone between pure (neuro)endocrine and non-(neuro)endocrine tumours: a comment on concepts and classification of mixed exocrine-endocrine neoplasms. Virchows Arch 2006; 449:499-506. [PMID: 17033797 DOI: 10.1007/s00428-006-0306-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 08/28/2006] [Indexed: 12/18/2022]
Abstract
Terms such as "mixed endocrine-exocrine carcinoma" (MEEC) and "adenocarcinoma with neuroendocrine (NE) differentiation" (ADC-NE) identify tumours belonging to the spectrum of neoplasms with divergent exocrine and (neuro)endocrine differentiation. These tumours display variable quantitative extent of the two components, potentially ranging from 1 to 99%, and variable structural patterns, ranging from single scattered NE cells to a well-defined NE tumour cell population organized in organoid, trabecular or solid growth patterns. In the present report, the grey zone of tumours/carcinomas with mixed NE and non-NE features is explored for various organs. From a practical point of view, MEECs differ from carcinomas with focal NE differentiation by (1) the extension of each component (more than 30%) and (2) the structural pattern of the NE component, either organoid for well-differentiated or solid/diffuse for poorly differentiated cases. In MEECs, the most aggressive cell population drives the clinical behaviour. Conversely, ADC-NE generally do not show a different clinical outcome, compared to the corresponding conventional forms, except for prostatic adenocarcinoma, in which NE cells are a negative prognostic factor. The recognition of MEECs may be of relevance for a targeted therapeutic strategy, foreseeing the use of biotherapies similar to those proposed for pure NE tumours.
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Affiliation(s)
- Marco Volante
- Department of Clinical and Biological Sciences, University of Turin and San Luigi Hospital, Regione Gonzole10, 10043 Orbassano-Torino, Italy
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Abstract
Mixed endocrine tumors are tumors composed of at least two distinct tumor populations, one of which is endocrine. Because of their rarity and unusual presentation, endocrine mixed tumors raise many problems of diagnosis, management and therapy. Three main types of endocrine mixed tumors are recognized: The existence of these various types has been confirmed by recent molecular studies, even if the same studies have also shown that the histogenesis of a mixed endocrine tumor cannot be predicted from its histological features. Composite tumors are the less rare mixed tumors. The recent WHO classification recommends to restrict the term of composite endocrine tumor to the epithelial tumors containing at least 30% of obviously tumoral endocrine cells; some authors recommend to use higher thresholds, of at least 50%, in order to avoid overdiagnosis. The endocrine component is usually well differentiated, easily identified by its suggestive histological features; the endocrine nature of tumor cells is confirmed by the immunodetection of specific endocrine and neuro-endocrine markers (such as chromogranin A and synaptophysin). In some cases, the endocrine component is poorly differentiated: the demonstration of neuro-endocrine markers is necessary to confirm the diagnosis. Mixed tumors can occur in every anatomical site; they are more frequent in organs containing endocrine cells in the normal state (especially the digestive tract and the pancreas), but they can also be observed in organs devoid of endocrine cells (such as the mammary gland). The management of mixed endocrine tumors must take into account the more aggressive component. Mixed tumors containing a well differentiated endocrine component and an adenocarcinomatous component are to be treated like adenocarcinomas. Mixed tumors containing a poorly differentiated endocrine component must be considered as poorly differentiated endocrine carcinomas.
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Affiliation(s)
- Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, 3 place d'Arsonval, 69437 Lyon cedex
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Abstract
The fascinating, but often unpredictable, biology of neuroendocrine tumors (NETs) make the management of these malignancies a real challenge. The more recent development of high-throughput genomic and proteomic techniques, have opened a window to an increased knowledge of the biology of NETs. This review will discuss genes thought to play a role in the context of NE tumor biology, with particularly attention to those that may be potential new diagnostic and prognostic markers, as well as therapeutic targets. NETs constitute a heterogeneous group of neoplasm that may arise in virtually every topographic localization in the body, as a consequence of malignant transformation of various types of NE cells. Since NETs arising in the gastroenteropancreatic (GEP) or bronchopulmonary system are by far the most common, this review focuses on these entities, but lines are drawn to other NETs as well. Although large-scale gene expression analysis undoubtly have raised interesting new hypothesis concerning genes thought to play a role in tumor biology, discrepancies observed between studies and various platforms used, emphasizes the need to not only standardize the way microarray data are reported, but also to introduce standards in sample taking, processing and study design. In addition, the recognition of the complexity of the human proteome, with regard to generation of multiple isoforms from one gene, has created additional challenges. However,some goals have been reached already, as new knowledge has been translated into development of novel promising therapeutics.
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Affiliation(s)
- Eva Hofsli
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim N-7489, Norway.
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