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Zhong Y, Zhang H, Wang X, Sun Z, Ge Y, Dou W, Hu S. CT and MR imaging features of mixed neuroendocrine-non-neuroendocrine neoplasm of the pancreas compared with pancreatic ductal adenocarcinoma and neuroendocrine tumor. Insights Imaging 2023; 14:15. [PMID: 36690735 PMCID: PMC9871080 DOI: 10.1186/s13244-023-01366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/24/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study aimed to assess the computed tomography (CT) and magnetic resonance imaging (MRI) features of pancreatic mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) and compare them with those of pancreatic ductal adenocarcinoma (PDAC) and neuroendocrine tumor (NET). METHODS Twelve patients with pancreatic MiNEN, 24 patients with PDAC, and 24 patients with NET, who underwent both contrast-enhanced CT and MRI, were included. Clinical data and the key imaging features were retrospectively evaluated by two independent readers and compared between MiNEN and PDAC or NET. Univariate and multivariable logistic regression analyses were performed to obtain predictors for pancreatic MiNEN. RESULTS Patients with pancreatic MiNEN more frequently presented with large size and heterogeneous and cystic components compared with PDAC (p < 0.031) and ill-defined irregular margins, progressive enhancement, and adjacent organ involvement compared with NET (p < 0.036). However, vascular invasion was less commonly seen in MiNEN than PDAC (p = 0.010). Moderate enhancement was observed more frequently in MiNEN than in PDAC or NET (p < 0.001). Multivariate logistic analyses demonstrated that moderate enhancement and ill-defined irregular margin were the most valuable features for the prediction of pancreatic MiNEN (p ≤ 0.044). The combination of the two features resulted in a specificity of 93.8%, sensitivity of 83.3%, and accuracy of 91.7%. CONCLUSIONS We have mainly described the radiological findings of pancreatic MiNEN with ill-defined irregular margin and moderate enhancement compared with PDAC and NET. The combination of imaging features could improve diagnostic efficiency and help in the selection of the correct treatment method.
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Affiliation(s)
- Yanqi Zhong
- grid.258151.a0000 0001 0708 1323Department of Radiology, Affiliated Hospital, Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214122 Jiangsu China
| | - Heng Zhang
- grid.258151.a0000 0001 0708 1323Department of Radiology, Affiliated Hospital, Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214122 Jiangsu China
| | - Xian Wang
- grid.440785.a0000 0001 0743 511XDepartment of Radiology, Affiliated Renmin Hospital, Jiangsu University, No. 8, Dianli Road, Zhenjiang, 212002 Jiangsu China
| | - Zongqiong Sun
- grid.258151.a0000 0001 0708 1323Department of Radiology, Affiliated Hospital, Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214122 Jiangsu China
| | - Yuxi Ge
- grid.258151.a0000 0001 0708 1323Department of Radiology, Affiliated Hospital, Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214122 Jiangsu China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, 100176 China
| | - Shudong Hu
- grid.258151.a0000 0001 0708 1323Department of Radiology, Affiliated Hospital, Jiangnan University, No. 1000, Hefeng Road, Wuxi, 214122 Jiangsu China ,grid.440785.a0000 0001 0743 511XDepartment of Radiology, Affiliated Renmin Hospital, Jiangsu University, No. 8, Dianli Road, Zhenjiang, 212002 Jiangsu China
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Angelico R, Siragusa L, Pathirannehalage Don CB, Sensi B, Billeci F, Vattermoli L, Padial B, Palmieri G, Anselmo A, Coppola A, Tisone G, Manzia TM. Pancreatic Adeno-MiNEN, a Rare Newly Defined Entity with Challenging Diagnosis and Treatment: A Case Report with Systematic Literature Review and Pooled Analysis. J Clin Med 2022; 11:jcm11175021. [PMID: 36078951 PMCID: PMC9457227 DOI: 10.3390/jcm11175021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur throughout the whole gastrointestinal trait, and pancreatic localization is rare. Their main characteristic is the presence of at least a neuroendocrine and an epithelial component, each accounting for at least 30% of the tumour mass. The presence of epithelial ductal component defines adeno-MiNEN. We report a case of a 59-year-old woman affected by pancreatic adeno-MiNEN with challenging diagnosis and successfully treated. A systematic literature review and pooled analysis was also performed, aiming to define the management and outcomes of pancreatic adeno-MiNEN. Out of 190 identified records, 15 studies including 28 patients affected by pancreatic-adeno-MiNEN were included in the analysis. Pancreatic adeno-MiNEN occurred mainly in males (82.8%) and at a mean age of 61.7 (range: 24–82) years. Pre-operative diagnosis was possible only in 14.2% of cases. At presentation, the majority had already advanced disease (TNM stage III (53.8%) and stage IV 19.3%). Adjuvant therapy was performed in 55% of patients, and the tumour recurrence rate was in 30% of cases. Median disease-free survival (DFS) was 12 months (range: 0–216 months) with a 5-year DFS of 16.6%, while the median overall survival (OS) was 12 months (range: 0–288 months) with a 5-year OS of 23.5%. Pancreatic adeno-MiNENs are rare; as they have very heterogenous behaviour, they are rarely diagnosed preoperatively and have poor prognosis. Treatment of localised MiNEN still relies on radical surgical resection, which seems essential to achieve a good oncological prognosis. International registry on MiNEN is necessary to improve the knowledge on this rare tumour and to improve its outcomes.
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Affiliation(s)
- Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Leandro Siragusa
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | | | - Bruno Sensi
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Federica Billeci
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Leonardo Vattermoli
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Belen Padial
- Histopathologic Unit, Tor Vergata University of Rome, 00133 Rome, Italy
| | | | - Alessandro Anselmo
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alessandro Coppola
- Department of Surgery, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- Correspondence:
| | - Tommaso Maria Manzia
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
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Vial I, Kausar A. A rare case of concomittant pancreatic adenosquamous and neuroendocrine tumours. J Surg Case Rep 2022; 2022:rjac377. [PMID: 35991843 PMCID: PMC9386458 DOI: 10.1093/jscr/rjac377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Only two cases of concomitantly occurring adenosquamous and neuroendocrine tumours (NET) have been reported in the literature. We report a case where both NET and adenosquamous are simultaneously occurring. A 42-year-old lady was hospitalized following painless jaundice and loss of weight. Computer tomography scan showed 3.0 x 2.9 cm hypo enhancing and hypovascular mass in the uncinate/head process. Another hypervascular mass was seen in the body of the pancreas. Pathological examination showed that the lesion in the uncinate process/neck of pancreas was an adenosquamous in the main pancreatic duct intraductal papillary mucinous neoplasm. The second tumour was a NET measuring 36 mm with no metastatic involvement. These findings suggested concurrently occurring but separated adenocarcinoma and NET tumours. This is the third case in the literature where both NET and adenosquamous are happening concomitantly, and the previous two other cases are also reviewed in the article.
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Affiliation(s)
- Izziddine Vial
- Correspondence address. Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, UK. Tel: +44 7709770702; E-mail:
| | - Ambareen Kausar
- Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Blackburn, UK
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4
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Wang F, Lou X, Qin Y, Xu X, Yu X, Huang D, Ji S. Mixed neuroendocrine nonneuroendocrine neoplasms of the pancreas: a case report and literature review of pancreatic mixed neuroendocrine nonneuroendocrine neoplasm. Gland Surg 2021; 10:3443-3452. [PMID: 35070904 PMCID: PMC8749105 DOI: 10.21037/gs-21-564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/08/2021] [Indexed: 08/30/2023]
Abstract
A 36-year-old woman underwent left lateral hepatic lobectomy and tumor enucleation of the pancreatic head due to the diagnosis of mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs). Her past medical history revealed an ill-defined mass in the pancreatic uncinate (approximately 1 cm in size) and liver nodules in segment II, suggesting a pancreatic neuroendocrine tumor (pNET) and liver metastases. After the operation, pathological examination showed that the lesion in the pancreas was MiNEN. The neuroendocrine component consisted of grade 1 (G1) NETs, and the nonneuroendocrine part was well-differentiated adenocarcinoma. Additionally, in hepatic lesions, the type of pancreaticobiliary duct in moderately differentiated adenocarcinoma indicated the source of tumor cells. We present the following case in accordance with the CARE reporting checklist. MiNENs of the pancreas are extremely rare and heterogeneous malignancies. Owing to the rarity of pancreatic MiNEN, no structured guidelines on preoperative diagnostics, therapy and follow-up exist thus far. Thus, problems in differential diagnosis and appropriate therapy may arise when treating suspected MiNEN patients. We performed a rigorous search on pancreatic MiNEN via PubMed and Web of Science. In total, 167 studies were identified, and 28 cases in 15 studies about pancreatic MiNEN were assessed. All the available information was listed and fully discussed.
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Affiliation(s)
- Fei Wang
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xin Lou
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Yi Qin
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xiaowu Xu
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xianjun Yu
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Dan Huang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shunrong Ji
- Center for Neuroendocrine Tumors, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
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5
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Presentation and outcome of mixed neuroendocrine non-neuroendocrine neoplasms of the pancreas. Pancreatology 2021; 21:224-235. [PMID: 33309225 DOI: 10.1016/j.pan.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) of the pancreas and periampullary region are extremely rare and heterogeneous malignancies. Literature is sparse, clinical management is not standardized and little is known about survival outcomes. The aim of this study was to identify pathological and radiological features of MiNEN and assess the outcome of surgical management. METHODS Patients undergoing surgery for pancreatic and periampullary MiNEN between 2001 and 2019 were retrospectively analysed based on a prospective database. Histological, radiological and clinical features were assessed. Survival was analysed in a nested case-control study and matched-pair analyses with pure neuroendocrine neoplasms (pNEN) and ductal adeno- or acinar cell carcinomas of the pancreas. A literature review with focus on survival after surgical resection was additionally performed. RESULTS Of 13 patients with MiNEN, 5 had acinar-MiNEN and 8 adeno-MiNEN. Two of 5 (40%) acinar-MiNEN and one adeno-MiNEN patients had liver metastases. All but one adeno-MiNEN (88%) showed preoperative radiological features of pancreatic adenocarcinoma, 3 of 5 (60%) acinar-MiNEN exhibited mainly neuroendocrine features. No surgical mortality was observed. The 5-year overall survival rate in all MiNEN was 40%. Five-year survival rate was 58% in adeno-MiNEN and comparable to that of matched ductal adenocarcinomas (36%) and pNEN (48%). Five-year overall survival rate was 20% in acinar-MiNEN, compared to 39% in acinar carcinoma patients and 59% in matched pNEN patients. CONCLUSIONS MiNEN are rare and difficult to distinguish from pure adenocarcinoma or neuroendocrine neoplasm preoperatively. Surgical resection would therefore be the treatment of choice in localized tumors.
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Kanthan R, Tharmaradinam S, Asif T, Ahmed S, Kanthan SC. Mixed epithelial endocrine neoplasms of the colon and rectum – An evolution over time: A systematic review. World J Gastroenterol 2020; 26:5181-5206. [PMID: 32982118 PMCID: PMC7495040 DOI: 10.3748/wjg.v26.i34.5181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/18/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mixed tumors of the colon and rectum, composed of a combination of epithelial and endocrine elements of benign and malignant potential are rare neoplasms. These can occur anywhere in the gastrointestinal tract and are often diagnosed incidentally. Though they have been a well-documented entity in the pancreas, where the exocrine-endocrine mixed tumors have been known for a while, recognition and accurate diagnosis of these tumors in the colon and rectum, to date, remains a challenge. This is further compounded by the different terminologies that have been attributed to these lesions over the years adding to increased confusion and misclassification. Therefore, dedicated literature reviews of these lesions in the colon and rectum are inconsistent and are predominantly limited to case reports and case series of limited case numbers. Though, most of these tumors are high grade and of advanced stage, intermediate and low grade lesions of these mixed tumors are also increasingly been reported. There are no established independent consensus based guidelines for the therapeutic patient management of these unique lesions.
AIM To provide a comprehensive targeted literature review of these complex mixed tumors in the colon and rectum that chronicles the evolution over time with summarization of historical perspectives of terminology and to further our understanding regarding their pathogenesis including genomic landscape, clinicoradiological features, pathology, treatment, prognosis, the current status of the management of the primary lesions, their recurrences and metastases.
METHODS A comprehensive review of the published English literature was conducted using the search engines PubMed, MEDLINE and GOOGLE scholar. The following search terms [“mixed tumors colon” OR mixed endocrine/neuroendocrine tumor/neoplasm/lesion colon OR adenocarcinoma and endocrine/neuroendocrine tumor colon OR mixed adenocarcinoma and endocrine/neuroendocrine carcinoma colon OR Amphicrine tumors OR Collision tumors] were used. Eligibility criteria were defined and all potential relevant items, including full articles and/or abstracts were independently reviewed, assessed and agreed upon items were selected for in-depth analysis.
RESULTS In total 237 full articles/abstracts documents were considered for eligibility of which 45 articles were illegible resulting in a total of 192 articles that were assessed for eligibility of which 139 have been selected for reference in this current review. This seminal manuscript is a one stop article that provides a detailed outlook on the evolution over time with summarization of historical perspectives, nomenclature, clinicoradiological features, pathology, treatment, prognosis and the current status of the management of both the primary lesions, their recurrences and metastases. Gaps in knowledge have also been identified and discussed. An important outcome of this manuscript is the justified proposal for a new, simple, clinically relevant, non-ambiguous terminology for these lesions to be referred to as mixed epithelial endocrine neoplasms (MEENs).
CONCLUSION MEEN of the colon and rectum are poorly understood rare entities that encompass an extensive range of heterogeneous tumors with a wide variety of combinations leading to tumors of high, intermediate or low grade malignant potential. This proposed new revised terminology of MEEN will solve the biggest hurdle of confusion and misclassification that plagues these rare unique colorectal neoplasms thus facilitating the future design of multi institutional prospective randomized controlled clinical trials to develop and evaluate newer therapeutic strategies that are recommended for continued improved understanding and personal optimization of clinical management of these unique colorectal neoplasms.
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Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
| | - Suresh Tharmaradinam
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
| | - Tehmina Asif
- Division of Oncology, Saskatoon Cancer Centre, Saskatoon S7N 0W8, SK, Canada
| | - Shahid Ahmed
- Division of Oncology, Saskatoon Cancer Centre, Saskatoon S7N 0W8, SK, Canada
| | - Selliah C Kanthan
- Division of General Surgery, University of Saskatchewan, Saskatoon S7N 0W8, SK, Canada
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Li X, Li D, Sun X, Lv G. Mixed adenoneuroendocrine carcinoma (MANEC) of the ampulla of Vater in a Chinese patient: A case report. J Int Med Res 2020; 48:300060520947918. [PMID: 32833541 PMCID: PMC7448144 DOI: 10.1177/0300060520947918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumour of the gastrointestinal tract with both epithelial and neuroendocrine components. We describe a case of a 57-year-old man who presented with yellow sclera and dark urine. Contrast-enhanced computed tomography (CT) showed enlargement of the intra and extrahepatic bile ducts and a neoplastic lesion at the end of the common bile duct which was indistinguishable from the adjacent head of the pancreas and duodenum. A pancreaticoduodenectomy was performed and histopathological examination of resected samples showed that tumour was a complex lesion with adenocarcinoma and neuroendocrine components positive for neuroendocrine markers (chromogranin A and synaptophysin) with a Ki-67 labelling index of 40%. The patient was diagnosed with MANEC in the ampulla of Vater with a neuroendocrine carcinoma component of approximately 70%. Ampullary MANECs are highly aggressive tumours with a high risk for distant metastases and a poor prognosis. Therefore, establishing a standard therapeutic strategy is crucial.
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Affiliation(s)
- Xu Li
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Dezhao Li
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Xiaodong Sun
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
| | - Guoyue Lv
- Department of Hepatology, The first hospital of Jilin University, Changchun, China
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Varshney B, Bharti JN, Varshney VK, Yadav T. Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of pancreas: a rare entity-worth to note. BMJ Case Rep 2020; 13:13/4/e234855. [PMID: 32345587 DOI: 10.1136/bcr-2020-234855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mixed adenocarcinoma with neuroendocrine tumour of pancreas has been reported infrequently and consists of both epithelial and neuroendocrine component. We encountered an 81-year-old male patient who presented with clinical features of painful progressive jaundice for 1 month. Contrast-enhanced CT abdomen reported a mass in the pancreatic head with dilated common bile duct and pancreatic duct. He underwent pancreatoduodenectomy and histopathological examination revealed two different tumours: ductal adenocarcinoma admixed with neuroendocrine tumour of pancreas. He received adjuvant chemotherapy, and at the end of 1-year follow-up, he has no recurrence. Here, we reported this rare malignancy of pancreas for which pancreatoduodenectomy was done and diagnosed on histopathology with immunohistochemistry.
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Affiliation(s)
- Bharti Varshney
- Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Vaibhav Kumar Varshney
- Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tian F, Dai MH, Jia CW, Liu ZW, Li BL. Retrospective analysis of seven cases of pancreatic mixed adenoneuroendocrine carcinoma from a high-volume center and review of the literature. BMC Surg 2019; 19:89. [PMID: 31296197 PMCID: PMC6624901 DOI: 10.1186/s12893-019-0546-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Abstract
Backgrounds The clinicopathologic features and biological behaviors of pancreatic mixed adenoneuroendocrine carcinoma (pMANEC) and its impacts on survival are poorly known. Methods We retrospectively reviewed seven pMANEC cases from a single institution from September 2010 to January 2017 along with twenty-one previously reported cases from the literature. Survival and prognostic analyses were conducted using Kaplan-Meier estimates and Cox regression, respectively. Results Seven pMANEC cases were identified during the study interval. Among the six patients who underwent operations, five reached R0 resections, one experienced postoperative pancreatic fistula, and two suffered other complications. The median progression-free survival (PFS) and disease-specific survival (DSS) were 7.5 months (2 to 36 months) and 15 months (6 to 36 months), respectively. A total analysis of twenty-eight pMANEC cases showed that patients were mostly older (median age, 59.5 years) and male (64.3%). The two most common symptoms were abdominal pain (53.6%) and obstructive jaundice (35.7%). The majority of pMANECs were non-functional (89.3%) and located in the pancreatic head (64.3%). The median diameter of pMANEC was 3.0 cm, with a wide range (0.5 to 19.0 cm). Lymph node metastasis (P = 0.015) was associated with decreased DSS, while age (P = 0.414), sex (P = 0.125), tumor size (P = 0.392), location (P = 0.913), functional status (P = 0.313), CA19–9 level (P = 0.608), and liver metastasis (P = 0.935) did not show significant prognoses on DSS. Conclusions We reported seven pMANEC cases and outlined their clinical behaviors and prognoses with a review of twenty-one cases from the literature. Lymph node metastasis was found to be a negative prognostic factor of DSS based on the present study.
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Affiliation(s)
- Feng Tian
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - Meng-Hua Dai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China.
| | - Cong-Wei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zi-Wen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
| | - Bing-Lu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1, Shuaifuyuan, Wangfujing Avenue, Dongcheng District, Beijing, 100730, China
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10
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Düzköylü Y, Aras O, Bostancı EB, Keklik Temuçin T, Ulaş M. Mixed Adeno-Neuroendocrine Carcinoma; Case Series of Ten Patients with Review of the Literature. Balkan Med J 2018; 35:263-267. [PMID: 29551754 PMCID: PMC5981124 DOI: 10.4274/balkanmedj.2017.1471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims: Mixed adeno-neuroendocrine carcinoma is a rare entity, diagnosed with immunohistochemical studies. Literature mainly includes case reports and series which are very few. In our study, we aimed to report a case series from a tertiary hospital with demographics of the patients, detailed tumor and clinical findings and follow-up plus survival conditions. Methods: Pathology database was explored for patients with the pathological diagnosis of ‘mixed adeno-neuroendocrine carcinoma’ and patients were identified retrospectively and evaluated in means of demographics, histopathological examination, tumor properties. Results: Ten patients had been diagnosed with mixed adeno-neuroendocrine carcinoma in our center, diagnosed at a mean age of 64.7. Stomach was found to be the most common localization. Five patients (50%) were diagnosed as grade 3. Following surgery, median follow-up was 15 months with a median survival time of 20.6 months. Conclusion: This case series may contribute to the literature on the pathological and clinical aspects of the mixed adenoneuroendocrine carcinoma of the gastrointestinal system.
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Affiliation(s)
- Yiğit Düzköylü
- Clinic of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Orhan Aras
- Clinic of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Erdal Birol Bostancı
- Clinic of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Tülay Keklik Temuçin
- Clinic of Pathology, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Murat Ulaş
- Clinic of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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11
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Wu C, Bao W, Rao Q, Wang X, Shen Q, Wei J, Dai Y, Zhou X. Clinicopathological features and prognosis of gastric mixed adenoneuroendocrine carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:1499-1509. [PMID: 31938247 PMCID: PMC6958106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 01/18/2018] [Indexed: 06/10/2023]
Abstract
Gastric mixed adenoneuroendocrine carcinomas (MANECs) are rare malignant tumors. This study aimed to investigate the clinicopathological features, diagnosis, prognosis, and treatment outcome in gastric MANECs patients. Clinicopathological data and the archived slides of 40 cases of MANEC patients were retrospectively reviewed. Immunohistochemistry (IHC) staining was performed to detect expression of synaptophysin (Syn), chromogranin A (CgA), CD56, CKpan, CK7, CK8/18, carcinoembryonic antigen (CEA), CK5/6, P40 and Ki-67. Hematoxylin and eosin staining demonstrated exocrine and neuroendocrine components, each accounting for at least 30% of the whole lesion. Exocrine components diffusely expressed epithelial markers CKpan, CK7, CK8/18, and CEA and endocrine components widely expressed at least one of the markers Syn, CgA, and CD56. Ki-67 index and mitosis determined the endocrine component grade as G3. Thirty-three of 40 patients were successfully followed up for 3 to 105 months with median survival of 12 months. Survival analysis showed a significant difference in prognosis with regard to patient's age, disease stage, tumor relapse status, and distant metastasis status. In conclusion, patient's age, disease stage, tumor relapse status, and distant metastasis status are important contributors to poor prognosis. Old patients with advanced stage, recurrence, or metastasis to the liver, pancreas or other distant organs show a poor prognosis.
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Affiliation(s)
- Chun Wu
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
| | - Wei Bao
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
| | - Qiu Rao
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
| | - Xuan Wang
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
| | - Qin Shen
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
| | - Jun Wei
- Shanghai ERA Medicine ltd.Shanghai, PR China
| | - Yunhua Dai
- Shanghai ERA Medicine ltd.Shanghai, PR China
| | - Xiaojun Zhou
- Department of Pathology, Jinling Hospital, Clinical Medical School of Southern Medical UniversityNanjing, Jiangsu, PR China
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A case of mixed adenoneuroendocrine carcinoma of the pancreas mimicking intraductal papillary mucinous carcinoma. Clin J Gastroenterol 2018; 11:320-326. [DOI: 10.1007/s12328-018-0833-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 02/05/2018] [Indexed: 01/07/2023]
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13
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Tanigawa M, Nakayama M, Taira T, Hattori S, Mihara Y, Kondo R, Kusano H, Nakamura K, Abe Y, Ishida Y, Okabe Y, Hisaka T, Okuda K, Fujino K, Ito T, Kawahara A, Naito Y, Yamaguchi R, Akiba J, Akagi Y, Yano H. Insulinoma-associated protein 1 (INSM1) is a useful marker for pancreatic neuroendocrine tumor. Med Mol Morphol 2017; 51:32-40. [PMID: 28849340 DOI: 10.1007/s00795-017-0167-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/10/2017] [Indexed: 01/15/2023]
Abstract
Insulinoma-associated protein 1 (INSM1) is an important biomarker of Achaete-scute homolog-like 1-driven pathways. For diagnosis of pancreatic neuroendocrine tumors (PanNET), chromogranin A (CGA), synaptophysin (SYP), and neural cell adhesion molecule (NCAM) were also considered as potential biomarkers. However, it is often difficult to diagnose it immunohistochemically. Hence, we examined the expression pattern of INSM1 in pancreatic solid tumors. We detected INSM1, CGA, SYP, and NCAM immunohistochemically, in 27 cases of NET [pure type: 25 cases, mixed adenoneuroendocrine carcinoma (MANEC): 2 cases]. We included 5 cases of solid-pseudopapillary neoplasm (SPN), 7 cases of acinar cell carcinoma (ACC), and 15 cases of pancreatic ductal adenocarcinoma (PDAC) as the control group. Nuclear expression of INSM1 was found in all PanNET pure type cases. However, expression of INSM1 was negative in PDAC, ACC, and SPN in all cases, whereas faint expression was seen in the cytoplasm from SPN. MANEC comprises of two components: neuroendocrine carcinoma and adenocarcinoma components. The NET component was positive for INSM1 expression, whereas the PDAC component does not express INSM1, which aids in distinguishing these components. Our results suggest that INSM1 is a useful immunohistochemical marker for diagnosing pancreatic neuroendocrine tumor.
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Affiliation(s)
- Masahiko Tanigawa
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Masamichi Nakayama
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Tomoki Taira
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Satoshi Hattori
- Biostatistics Center, Kurume University School of Medicine, Kurume, Japan
| | - Yutaro Mihara
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Reiichiro Kondo
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Ken Nakamura
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yushi Abe
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kosuke Fujino
- Department of Pathology and Experimental Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Takaaki Ito
- Department of Pathology and Experimental Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan. .,Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
| | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
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