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Priya Asokan L, A S, Kani V, Srinivasan C. Unlocking Precise Lung Cancer Detection Through Minimal Panel Immunostaining in Small Biopsy Samples. Cureus 2024; 16:e63159. [PMID: 39070322 PMCID: PMC11272665 DOI: 10.7759/cureus.63159] [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: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction Lung cancer diagnosis faces challenges due to morphological heterogeneity and limited biopsy tissue. This study evaluates the efficacy of a minimal panel immunostaining technique using immunohistochemical markers like napsin A, thyroid transcription factor 1 (TTF-1), p63, and synaptophysin to improve the precision of lung carcinoma subclassification. Methods A retrospective analytical study was conducted at the Histopathology Laboratory of Saveetha Medical College and Hospital, Chennai, from January 2018 to February 2024. A total of 64 lung carcinoma cases were analyzed. Inclusion criteria included biopsy samples from lung lesions with a confirmed diagnosis of lung carcinoma based on histomorphological examination, covering all age groups and both genders. Non-carcinomatous lung lesions were excluded. Clinical data were obtained from the Medical Information Archiving Software (MIAS) database and histopathological examination request forms. Under a light microscope, tissue samples were examined after being fixed in formalin, processed, and stained with hematoxylin and eosin (H&E). Additionally, a minimal panel of immunohistochemical markers, including napsin A, TTF-1, p63, and synaptophysin, was used to subclassify lung carcinomas. Results The age group older than 50 years was the most affected, with a higher incidence in males. Histologically, 49% of cases were adenocarcinoma, 42% were squamous cell carcinoma, and 9% were small cell carcinoma. Immunohistochemistry (IHC) results adjusted these proportions to 54.6% adenocarcinoma, 31.2% squamous cell carcinoma, and 14% small cell carcinoma, showing a 5.6% increase in adenocarcinoma cases. The most common adenocarcinoma pattern was mixed, followed by acinar. TTF-1 and napsin A were crucial for identifying adenocarcinoma, while p63 was key for squamous cell carcinoma. Synaptophysin confirmed neuroendocrine differentiation in small cell carcinoma. Conclusion Incorporating a minimal panel of IHC markers significantly enhances the accuracy of lung carcinoma subclassification, addressing diagnostic challenges posed by morphological heterogeneity and limited sample size. This approach supports more precise and efficient clinical care for patients with lung cancer. Further validation in diverse clinical settings is recommended.
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Affiliation(s)
- Lakshmi Priya Asokan
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sumithra A
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vallal Kani
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Chitra Srinivasan
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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2
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Derks JL, Rijnsburger N, Hermans BCM, Moonen L, Hillen LM, von der Thüsen JH, den Bakker MA, van Suylen RJ, Speel EJM, Dingemans AMC. Clinical-Pathologic Challenges in the Classification of Pulmonary Neuroendocrine Neoplasms and Targets on the Horizon for Future Clinical Practice. J Thorac Oncol 2021; 16:1632-1646. [PMID: 34139363 DOI: 10.1016/j.jtho.2021.05.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
Diagnosing a pulmonary neuroendocrine neoplasm (NEN) may be difficult, challenging clinical decision making. In this review, the following key clinical and pathologic issues and informative molecular markers are being discussed: (1) What is the preferred outcome parameter for curatively resected low-grade NENs (carcinoid), for example, overall survival or recurrence-free interval? (2) Does the WHO classification combined with a Ki-67 proliferation index and molecular markers, such as OTP and CD44, offer improved prognostication in low-grade NENs? (3) What is the value of a typical versus atypical carcinoid diagnosis on a biopsy specimen in local and metastatic disease? Diagnosis is difficult in biopsy specimens and recent observations of an increased mitotic rate in metastatic carcinoid from typical to atypical and high-grade NEN can further complicate diagnosis. (4) What is the (ir)relevance of morphologically separating large cell neuroendocrine carcinoma (LCNEC) SCLC and the value of molecular markers (RB1 gene and pRb protein or transcription factors NEUROD1, ASCL1, POU2F3, or YAP1 [NAPY]) to predict systemic treatment outcome? (5) Are additional diagnostic criteria required to accurately separate LCNEC from NSCLC in biopsy specimens? Neuroendocrine morphology can be absent owing to limited sample size leading to missed LCNEC diagnoses. Evaluation of genomic studies on LCNEC and marker studies have identified that a combination of napsin A and neuroendocrine markers could be helpful. Hence, to improve clinical practice, we should consider to adjust our NEN classification incorporating prognostic and predictive markers applicable on biopsy specimens to inform a treatment outcome-driven classification.
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Affiliation(s)
- Jules L Derks
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Nicole Rijnsburger
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bregtje C M Hermans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laura Moonen
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lisa M Hillen
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Robert J van Suylen
- Pathology-DNA, Location Jeroen Bosch Hospital, s' Hertogenbosch, The Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Respiratory Medicine, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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Raso MG, Bota-Rabassedas N, Wistuba II. Pathology and Classification of SCLC. Cancers (Basel) 2021; 13:cancers13040820. [PMID: 33669241 PMCID: PMC7919820 DOI: 10.3390/cancers13040820] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Small cell lung carcinoma (SCLC), is a high-grade neuroendocrine carcinoma defined by its aggressiveness, poor differentiation, and somber prognosis. This review highlights current pathological concepts including classification, immunohistochemistry features, and differential diagnosis. Additionally, we summarize the current knowledge of the immune tumor microenvironment, tumor heterogeneity, and genetic variations of SCLC. Recent comprehensive genomic research has improved our understanding of the diverse biological processes that occur in this tumor type, suggesting that a new era of molecular-driven treatment decisions is finally foreseeable for SCLC patients. Abstract Lung cancer is consistently the leading cause of cancer-related death worldwide, and it ranks as the second most frequent type of new cancer cases diagnosed in the United States, both in males and females. One subtype of lung cancer, small cell lung carcinoma (SCLC), is an aggressive, poorly differentiated, and high-grade neuroendocrine carcinoma that accounts for 13% of all lung carcinomas. SCLC is the most frequent neuroendocrine lung tumor, and it is commonly presented as an advanced stage disease in heavy smokers. Due to its clinical presentation, it is typically diagnosed in small biopsies or cytology specimens, with routine immunostaining only. However, immunohistochemistry markers are extremely valuable in demonstrating neuroendocrine features of SCLC and supporting its differential diagnosis. The 2015 WHO classification grouped all pulmonary neuroendocrine carcinomas in one category and maintained the SCLC combined variant that was previously recognized. In this review, we explore multiple aspects of the pathologic features of this entity, as well as clinically relevant immunohistochemistry markers expression and its molecular characteristics. In addition, we will focus on characteristics of the tumor microenvironment, and the latest pathogenesis findings to better understand the new therapeutic options in the current era of personalized therapy.
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Affiliation(s)
- Maria Gabriela Raso
- Correspondence: (M.G.R.); (I.I.W.); Tel.: +1-713-834-6026 (M.G.R.); +1-713-563-9184 (I.I.W.)
| | | | - Ignacio I. Wistuba
- Correspondence: (M.G.R.); (I.I.W.); Tel.: +1-713-834-6026 (M.G.R.); +1-713-563-9184 (I.I.W.)
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4
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Moran CA, Lindholm KE, Brunnström H, Langman G, Jang SJ, Spagnolo D, Chai SM, Laycock A, Falconieri G, Pizzolitto S, de Pellegrin A, Medeiros F, Edmunds L, Catarino A, Cunha F, Ro J, Pina-Oviedo S, Torrealba J, Coppola D, Petersson F, Oon ML, Elmberger G, Y Cajal SR, Valero IS, Dalurzo L, Soares F, Campos AH, Vranic S, Skenderi F, Correa AM, Sepesi B, Rice D, Mehran R, Walsh G. Typical and atypical carcinoid tumors of the lung: a clinicopathological correlation of 783 cases with emphasis on histological features. Hum Pathol 2020; 98:98-109. [PMID: 32145220 DOI: 10.1016/j.humpath.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/17/2020] [Accepted: 02/23/2020] [Indexed: 11/17/2022]
Abstract
We present 783 surgical resections of typical and atypical carcinoid tumors of the lung identified in the pathology files of 20 different pathology departments. All cases were critically reviewed for clinical and pathological features and further correlated with clinical outcomes. Long-term follow-up was obtained in all the patients and statistically analyzed to determine significance of the different parameters evaluated. Of the histopathological features analyzed, the presence of mitotic activity of 4 mitoses or more per 2 mm2, necrosis, lymphatic invasion, and lymph node metastasis were identified as statistically significant. Tumors measuring 3 cm or more were also identified as statistically significant and correlated with clinical outcomes. Based on our analysis, we consider that the separation of low- and intermediate-grade neuroendocrine neoplasms of the lung needs to be readjusted in terms of mitotic count as the risk of overgrading these neoplasms exceeds 10% under the current criteria. We also consider that tumor size is an important feature to be considered in the assessment of these neoplasms and together with the histological grade of the tumor offers important features that can be correlated with clinical outcomes.
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Affiliation(s)
- Cesar A Moran
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Kaleigh E Lindholm
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hans Brunnström
- Lund University, Laboratory Medicine, Department of Clinical Sciences Lund, Pathology, Lund, 22210, Sweden
| | - Gerald Langman
- Heart of England NHS Foundation Trust, Birmingham, B1 1BB, United Kingdom
| | - Se Jin Jang
- Asan Medical Center, Ulsan University School of Medicine, Seoul, 100-011, Republic of Korea
| | - Dominic Spagnolo
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia; University of Notre Dame, Fremantle, Western Australia, 6006, Australia
| | - Siaw Ming Chai
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia
| | - Andrew Laycock
- PathWest Laboratory Medicine Western Australia, University of Western Australia, School of Pathology and Laboratory Medicine, Nedlands, Western Australia, 6006, Australia; University of Notre Dame, Fremantle, Western Australia, 6006, Australia
| | | | | | | | - Filomena Medeiros
- Essex Cardiothoracic Center, Basildon, CB1 6NU, United Kingdom; Thurrock University Hospitals NHS Foundation Trust, RM16 4XS, United Kingdom
| | - Lilian Edmunds
- Essex Cardiothoracic Center, Basildon, CB1 6NU, United Kingdom; Thurrock University Hospitals NHS Foundation Trust, RM16 4XS, United Kingdom
| | | | | | - Jae Ro
- Methodist Hospital, Houston, TX, 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Arlene M Correa
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Boris Sepesi
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - David Rice
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Reza Mehran
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
| | - Garrett Walsh
- Department of Thoracic Surgery, M D Anderson Cancer Center, Houston, TX, 77030, USA
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5
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Abstract
Advancement in the understanding of lung tumor biology enables continued refinement of lung cancer classification, reflected in the recently introduced 2015 World Health Organization classification of lung cancer. In small biopsy or cytology specimens, special emphasis is placed on separating adenocarcinomas from the other lung cancers to effectively select tumors for targeted molecular testing. In resection specimens, adenocarcinomas are further classified based on architectural pattern to delineate tissue types of prognostic significance. Neuroendocrine tumors are divided into typical carcinoid, atypical carcinoid, small cell carcinoma, and large cell neuroendocrine carcinoma based on a combination of features, especially tumor cell proliferation rate.
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Affiliation(s)
- Min Zheng
- Department of Pathology, Jersey Shore University Medical Center, 1945 Route 33, Neptune, NJ 07753, USA.
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6
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Feng J, Sheng H, Zhu C, Qian X, Wan D, Su D, Chen X, Zhu L. Correlation of neuroendocrine features with prognosis of non-small cell lung cancer. Oncotarget 2018; 7:71727-71736. [PMID: 27687592 PMCID: PMC5342116 DOI: 10.18632/oncotarget.12327] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/21/2016] [Indexed: 01/22/2023] Open
Abstract
The improvement in histological diagnostic tools, including neuroendocrine markers by immunohistochemistry (IHC), has led to increased recognition of non-small cell lung cancer (NSCLC) with neuroendocrine (NE) feature. However, little is known regarding the prevalence and clinical implications of NE feature in patients with NSCLC. In this study, we performed IHC in a tissue microarray containing 451 Chinese NSCLC cases, and analyzed correlation of the expression of neuroendocrine marker with pathological and clinical features of NSCLC. The result showed that NE feature in NSCLC was detectable in almost 30% of studied patients, and tumors with NE feature were significantly correlated with pathological classification, clinical stages and cell differentiation of NSCLC. Our data also revealed that NE feature indicated worse overall survival and disease free survival. Compared with mutant p53, NE markers showed more significance as for prognostic evaluation. Multi-factor COX analysis further suggested a potential clinical impact for NE feature as an independent indicator of poor prognosis for NSCLC patients.
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Affiliation(s)
- Jianguo Feng
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang 310022, China.,Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Huaying Sheng
- Department of Thoracic Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Chihong Zhu
- Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Xiaoqian Qian
- Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Danying Wan
- Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Dan Su
- Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology, Hangzhou, Zhejiang 310022, China.,Cancer Research Institute, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Xufeng Chen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Liming Zhu
- Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
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Weissferdt A. Pulmonary neuroendocrine carcinomas-evidence for a spectrum of differentiation. Virchows Arch 2018; 472:579-580. [PMID: 29388011 DOI: 10.1007/s00428-018-2308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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8
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Patel P, Galoian K. Molecular challenges of neuroendocrine tumors. Oncol Lett 2017; 15:2715-2725. [PMID: 29456718 DOI: 10.3892/ol.2017.7680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023] Open
Abstract
Neuroendocrine tumors (NETs) are a very heterogeneous group that are thought to originate from the cells of the endocrine and nervous systems. These tumors develop in a number of organs, predominantly in the gastrointestinal and pulmonary systems. Clinical detection and diagnosis are reliable at the late stages when metastatic spread has occurred. However, traditional conventional therapies such as radiation and chemotherapy are not effective. In the majority of cases even surgical resection at that stage is unlikely to produce promising reusults. NETs present a serious clinical challenge, as the survival rates remain low, and as these rare tumors are very difficult to study, novel approaches and therapies are required. This review will highlight the important points of accumulated knowledge covering the molecular aspects of the role of neuroendocrine cells, hormonal peptides, the reasons for ectopic hormone production in NET, neuropeptides and epigenetic regulation as well as the other challenging questions that require further understanding.
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Affiliation(s)
- Parthik Patel
- Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Karina Galoian
- Department of Orthopedic Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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9
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Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature. Int J Surg Oncol 2017; 2017:6424812. [PMID: 28593056 PMCID: PMC5448049 DOI: 10.1155/2017/6424812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 02/06/2023] Open
Abstract
Our understanding of the biology, genetics, and natural history of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas has improved considerably in the last several decades and the spectrum of available therapeutic options is rapidly expanding. The management of patients with metastatic low or intermediate grade NETs has been revolutionized by the development of new treatment strategies such as molecular targeting therapies with everolimus and sunitinib, somatostatin analogs, tryptophan hydroxylase inhibitors, and peptide receptor radionuclide therapy that can be used alone or as a multimodal approach with or without surgery. To further define and clarify the utility, appropriateness, and the sequence of the growing list of available therapies for this patient population will require more high level evidence; however, data from well-designed randomized phase III clinical trials is rapidly accumulating that will further stimulate development of new management strategies. It is therefore important to thoroughly review emerging evidence and report major findings in frequent updates, which will expand our knowledge and contribute to a better understanding, characterization, and management of advanced NETs.
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10
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Role of minimal panel immunostaining in accurate diagnosis of lung cancer using small biopsies. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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11
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Supraclavicular Metastasis from Infraclavicular Organs: Retrospective Analysis of 18 Patients. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.4720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Pericleous M, Karpathakis A, Toumpanakis C, Lumgair H, Reiner J, Marelli L, Thirlwell C, Caplin ME. Well-differentiated bronchial neuroendocrine tumors: Clinical management and outcomes in 105 patients. CLINICAL RESPIRATORY JOURNAL 2017; 12:904-914. [PMID: 28026127 DOI: 10.1111/crj.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/23/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bronchial neuroendocrine tumors (NETs) are rare tumors representing approximately 20%-30% of all neuroendocrine tumors and 2%-3% of all adult lung cancers. Here, they present a large case series of well-differentiated bronchial NETs with the aim of investigating the behavior of these tumors and long-term outcomes. METHODS A retrospective review was performed of 105 patients with bronchial NETs managed in a tertiary referral center in the period between January 1998 and January 2012. RESULTS Bronchial NETs are commoner in females and the commonest presenting symptoms were cough (13.9%) and dyspnoea (11.6%). OctreoscanTM and Gallium-68 DOTATATE PET were found to have similar diagnostic sensitivity and FDG PET was more sensitive for higher-grade tumors. Over a median follow-up period of 35.5 months mortality rate was 5.7%. The 5-year survival was 76% and the 10-year survival was 62%. Female patients survived longer but this difference was not statistically significant (P = .59). Older age greater than 50 years (P = .027), higher levels of Chromogranin A (CgA) (P = .034), first-line treatment with surgery (P = .005), ki67 over 10% (P = .037), and tumor stage (P = .036) but not tumor grade (P = .22), were significantly associated with survival. DISCUSSION Several factors have been identified which are independently associated with survival including CgA levels greater than 100 pmol/L, tumor stage, age greater than 50, ki67 over 10% and having surgery as first-line treatment. There was no difference in survival between typical and atypical carcinoids.
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Affiliation(s)
- Marinos Pericleous
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Anna Karpathakis
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom.,University College London Cancer Institute, London, United Kingdom
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Heather Lumgair
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Jonathan Reiner
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
| | - Laura Marelli
- Centre of Gastroenterology, Royal Free Hospital, London, United Kingdom
| | - Christina Thirlwell
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom.,University College London Cancer Institute, London, United Kingdom
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, European (ENETS) Centre of Excellence, Royal Free Hospital, London, United Kingdom
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Fabbri A, Cossa M, Sonzogni A, Papotti M, Righi L, Gatti G, Maisonneuve P, Valeri B, Pastorino U, Pelosi G. Ki-67 labeling index of neuroendocrine tumors of the lung has a high level of correspondence between biopsy samples and surgical specimens when strict counting guidelines are applied. Virchows Arch 2017; 470:153-164. [PMID: 28054150 DOI: 10.1007/s00428-016-2062-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/10/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023]
Abstract
Optimal histopathological analysis of biopsies from metastases of neuroendocrine tumor (NET) of the lung requires more than morphology only. Additional parameters such as Ki-67 labeling index are required for adequate diagnosis, but few studies have compared reproducibility of different counting protocols and modalities of reporting on biopsies of lung NET. We compared the results of four different manual counting techniques to establish Ki-67 LI. On 47 paired biopsies and surgical specimens from 22 typical carcinoids (TCs), 14 atypical carcinoids (ACs), six large cell neuroendocrine carcinomas (LCNECs), and five small cell carcinomas (SCCs) immunohistochemical staining of Ki-67 antigen was performed. We counted, in regions of highest nuclear staining (HSR), a full ×40-high-power field (diameter = 0.55 mm), 500 or 2000 cells, or 2 mm2 surface area, including the HSR or the entire biopsy fragment(s). Mitoses and necrosis were evaluated in an area of 2 mm2 or the entire biopsy fragment(s). Between the four counting methods, no differences in Ki-67 LI were observed. However, a Ki-67 LI higher than 5% was found in only four cases when in an HSR, 500 cells were counted (18%), five (23%) when in an HSR 2000 cells were counted, four (18%) when 2 mm2 were counted, and one (5%) TC case when the entire biopsy was counted. A 20% cutoff distinguished TC and AC from LCNEC and SCC with 100% specificity and sensitivity, while mitoses and necrosis failed to a large extent. Ki-67 LI in biopsy samples was concordant with that in resection specimens when 2000 cells, 2 mm2, or the entire biopsy fragment(s) were counted. Our results are important for clinical management of patients with metastases of a lung NET.
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Affiliation(s)
- Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mara Cossa
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angelica Sonzogni
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mauro Papotti
- Department of Oncology, University of Turin, Turin, Italy
| | - Luisella Righi
- Department of Oncology, University of Turin, Turin, Italy
| | - Gaia Gatti
- Department of Oncology, University of Turin, Turin, Italy
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Barbara Valeri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ugo Pastorino
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
- Department of Oncology and Hemato-oncology, Università degli Studi, Milan, Italy.
- Dipartimento di Oncologia ed Emato-oncologia, Via Festa del Perdono, 7, I-20122, Milan, Italy.
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14
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Hilal T. Current understanding and approach to well differentiated lung neuroendocrine tumors: an update on classification and management. Ther Adv Med Oncol 2016; 9:189-199. [PMID: 28344664 DOI: 10.1177/1758834016678149] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neuroendocrine tumors (NETs) are rare neoplasms that can arise from any tissue. They are classified based on embryonic gut derivative (i.e. foregut, midgut and hindgut) with midgut tumors being the most common (e.g. gastrointestinal NET). The second most common category of NETs is that which arises from the lung. In fact, 25% of primary lung cancers are NETs, including small cell lung cancer (SCLC), which comprises 20% of all lung cancers. The remaining 5% are large cell neuroendocrine cancer (LCNEC, 3%), typical carcinoids (TCs, 1.8%), and atypical carcinoids (ACs, 0.2%). The less common TCs/ACs are well differentiated lung NETs. Their incidence has been increasing in more recent years and although these tumors are slow growing, advanced disease is associated with poor survival. There have been advances in classification of lung NETs that have allowed for more appropriate management upfront. They are cured by surgical resection when disease is limited. However, advanced and metastatic disease requires medical therapy that is ever changing and expanding. In this review, the aim is to summarize the current understanding and classification of well differentiated lung NETs (i.e. TCs and ACs), and focus on recent updates in medical management of advanced disease, along with a brief discussion on potential future discoveries.
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Affiliation(s)
- Talal Hilal
- Division of Hematology and Medical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Pulmonary Neuroendocrine Tumors: Part I. Spectrum and Characteristics of Tumors. J Bronchology Interv Pulmonol 2016; 22:267-73. [PMID: 26165900 DOI: 10.1097/lbr.0000000000000157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pulmonary neuroendocrine tumors arise from Kulchitzky cells of the bronchial mucosa and include typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma, and small cell lung cancer. These tumors have a variable growth rate that determines their presentation and prognosis. Typical carcinoid has the lowest growth rate and better prognosis; in contrast, small cell lung cancer is an aggressive tumor with a very poor prognosis. Although there are some overlapping histologic features between these tumors, clinical, imaging, and immunohistochemical markers are useful in the differentiation of pulmonary neuroendocrine tumors. The treatment options differ on the basis of histologic characteristics. In this article, we aim to describe the spectrum of neuroendocrine tumors of the lung, except for small cell lung cancer, and their clinical, pathologic, and imaging findings, with a focus on treatment options.
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Rouquette Lassalle I. Tumeurs neuroendocrines pulmonaires et lésions prénéoplasiques. Ann Pathol 2016; 36:34-43. [DOI: 10.1016/j.annpat.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/25/2022]
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18
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Marchevsky AM, Wick MR. Diagnostic difficulties with the diagnosis of small cell carcinoma of the lung. Semin Diagn Pathol 2015; 32:480-8. [DOI: 10.1053/j.semdp.2015.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pelosi G, Fabbri A, Cossa M, Sonzogni A, Valeri B, Righi L, Papotti M. What clinicians are asking pathologists when dealing with lung neuroendocrine neoplasms? Semin Diagn Pathol 2015; 32:469-79. [PMID: 26561395 DOI: 10.1053/j.semdp.2015.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lung neuroendocrine tumors (NET) are currently classified in resection specimens according to four histological categories, namely typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCC). Diagnostic criteria have remained unchanged in the 2015 WHO classification, which has ratified the wide acceptance and popularity of such terminology in the pathologists׳ and clinicians׳ community. A unifying umbrella of NE morphology and differentiation has been recognized in lung NET, which has pushed to enter an unique box of invasive tumors along with diffuse idiopathic pulmonary NE cell hyperplasia (DIPNECH) as a pre-invasive lesion with a potential toward the development of carcinoids. However, uncertainties remain in the terminology of lung NET upon small samples, where Ki-67 antigen could play some role to avoid misdiagnosing carcinoids as high-grade NE tumors. Epidemiologic, clinical and genetic traits support a biological three-tier over a pathology four-tier model, according to which TC are low malignancy tumors, AC intermediate malignancy tumors and LCNEC/SCC high malignancy tumors with no significant differences in survival among them. Inconsistencies in diagnostic reproducibility, troubles in the therapy of AC and LCNEC, and limitations to histology within the same tumor category argue in favor of a global re-thinking of lung NET where a grading system could play a role. This review outlines three main key questions in the field of lung NET: (A) unbiased diagnoses, (B) the role of Ki-67 and tumor grading, and (C) management of predictive markers. Answers are still inconclusive, thus additional research is required to improve our understanding on lung NET.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, I-20133, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi, Milan, Italy.
| | - Alessandra Fabbri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, I-20133, Milan, Italy
| | - Mara Cossa
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, I-20133, Milan, Italy
| | - Angelica Sonzogni
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, I-20133, Milan, Italy
| | - Barbara Valeri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, I-20133, Milan, Italy
| | - Luisella Righi
- Department of Pathology, University of Torino, Torino, Italy
| | - Mauro Papotti
- Department of Pathology, University of Torino, Torino, Italy
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Tabaksblat EM, Langer SW, Knigge U, Grønbæk H, Mortensen J, Petersen RH, Federspiel BH, Ladekarl M. Diagnosis and treatment of bronchopulmonary neuroendocrine tumours: State of the art. Acta Oncol 2015. [PMID: 26223571 DOI: 10.3109/0284186x.2015.1067715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bronchopulmonary neuroendocrine tumours (BP-NET) are a heterogeneous population of neoplasms with different pathology, clinical behaviour and prognosis compared to the more common lung cancers. The management of BP-NET patients is largely based on studies with a low level of evidence and extrapolation of data obtained from more common types of neuroendocrine tumours. This review reflects our view of the current state of the art of diagnosis and treatment of patients with BP-NET.
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Affiliation(s)
| | - Seppo W. Langer
- Department of Oncology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Knigge
- Departments of Surgery C and Endocrinology PE, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Hartnack Federspiel
- Department of Pathology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Ladekarl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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21
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Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A, Rossi RE, Travis WD, Capdevila J, Costa F, Cwikla J, de Herder W, Delle Fave G, Eriksson B, Falconi M, Ferone D, Gross D, Grossman A, Ito T, Jensen R, Kaltsas G, Kelestimur F, Kianmanesh R, Knigge U, Kos-Kudla B, Krenning E, Mitry E, Nicolson M, O'Connor J, O'Toole D, Pape UF, Pavel M, Ramage J, Raymond E, Rindi G, Rockall A, Ruszniewski P, Salazar R, Scarpa A, Sedlackova E, Sundin A, Toumpanakis C, Vullierme MP, Weber W, Wiedenmann B, Zheng-Pei Z. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol 2015; 26:1604-20. [PMID: 25646366 DOI: 10.1093/annonc/mdv041] [Citation(s) in RCA: 397] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 01/22/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary carcinoids (PCs) are rare tumors. As there is a paucity of randomized studies, this expert consensus document represents an initiative by the European Neuroendocrine Tumor Society to provide guidance on their management. PATIENTS AND METHODS Bibliographical searches were carried out in PubMed for the terms 'pulmonary neuroendocrine tumors', 'bronchial neuroendocrine tumors', 'bronchial carcinoid tumors', 'pulmonary carcinoid', 'pulmonary typical/atypical carcinoid', and 'pulmonary carcinoid and diagnosis/treatment/epidemiology/prognosis'. A systematic review of the relevant literature was carried out, followed by expert review. RESULTS PCs are well-differentiated neuroendocrine tumors and include low- and intermediate-grade malignant tumors, i.e. typical (TC) and atypical carcinoid (AC), respectively. Contrast CT scan is the diagnostic gold standard for PCs, but pathology examination is mandatory for their correct classification. Somatostatin receptor imaging may visualize nearly 80% of the primary tumors and is most sensitive for metastatic disease. Plasma chromogranin A can be increased in PCs. Surgery is the treatment of choice for PCs with the aim of removing the tumor and preserving as much lung tissue as possible. Resection of metastases should be considered whenever possible with curative intent. Somatostatin analogs are the first-line treatment of carcinoid syndrome and may be considered as first-line systemic antiproliferative treatment in unresectable PCs, particularly of low-grade TC and AC. Locoregional or radiotargeted therapies should be considered for metastatic disease. Systemic chemotherapy is used for progressive PCs, although cytotoxic regimens have demonstrated limited effects with etoposide and platinum combination the most commonly used, however, temozolomide has shown most clinical benefit. CONCLUSIONS PCs are complex tumors which require a multidisciplinary approach and long-term follow-up.
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Affiliation(s)
- M E Caplin
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - E Baudin
- Department of Nuclear Medicine, Endocrine Cancer and Interventional Radiology, Institut Gustave Roussy, Université Paris Sud, Villejuif Cedex, France
| | - P Ferolla
- NET Center, Umbria Regional Cancer Network, Università degli Studi di Perugia, Perugia
| | - P Filosso
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - M Garcia-Yuste
- Department of Thoracic Surgery, University Clinic Hospital, Valladolid, Spain
| | - E Lim
- Imperial College and The Academic Division of Thoracic Surgery, The Royal Brompton Hospital, London, UK
| | - K Oberg
- Endocrine Oncology Unit, Department of Medicine, University Hospital, Uppsala, Sweden
| | - G Pelosi
- Fondazione IRCCS Istituto Nazionale dei Tumori and Dipartimento di Scienze Biologiche e Cliniche Luigi Sacco, Università degli studi di Milano, Milan, Italy
| | - A Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - R E Rossi
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - W D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
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Abstract
PURPOSE OF REVIEW This review presents an update on classification, diagnosis and potentially 'drugable' molecular alterations of small cell carcinoma (SCC) and large cell neuroendocrine carcinoma (LCNEC) of the lung. RECENT FINDINGS The main controversies in the classification of lung neuroendocrine tumors are: whether SCC and LCNEC should remain separated or should be unified into a high-grade category; and what the role is of Ki67 as an adjunct to the classical parameters (mitotic rate and necrosis). Regarding the diagnosis of SCC and LCNEC, in difficult cases it requires the combined evaluation of clinical-radiological data, histological and cytological material and selected immunostains. The prognosis of both tumors remains very poor. Despite the promising identification of potential molecular targets on preclinical studies, including antiangiogenetic drugs and tricyclic antidepressants, at the moment no specific molecular-driven therapy is available. SUMMARY The field of high-grade neuroendocrine carcinomas remains complex in several respects, and studies on molecular targets are urgently needed.
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Righi L, Volante M, Rapa I, Vatrano S, Pelosi G, Papotti M. Therapeutic biomarkers in lung neuroendocrine neoplasia. Endocr Pathol 2014; 25:371-7. [PMID: 25252622 DOI: 10.1007/s12022-014-9335-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The well-known classification of neuroendocrine neoplasms of the lung into four major subtypes (including typical and atypical carcinoids and small- and large-cell neuroendocrine carcinomas) has a proven prognostic validity but only partially helps to predict the response to specific therapies. Therapeutic biomarkers are incompletely known and include morphological, immunophenotypic, and molecular markers. Morphology alone has no specific predictive role, nor has any immunophenotypic marker been proven to bear predictive implications. Ki67 is a relevant prognostic marker and can indirectly predict response to chemotherapy, when levels are extremely high in high-grade neuroendocrine (NE) carcinomas. The expression of somatostatin receptors, especially of the type 2A, has been shown to predict response to somatostatin analog treatments, paralleling the information derived from octreotide scintigraphy. mTOR pathway is targeted by specific inhibitors, but the exact cellular molecules predicting response are still to be defined. It seems that high levels of phosphorylated forms of mTOR and of its downstream factor S6K are associated to a better response to rapalogs in experimental models. Data from gene expression profiling and mutational analyses are currently emerging, providing a more detailed map of different molecular activation pathways, potentially leading to a more accurate molecular classification of lung NE tumors as well as to the discovery of new therapeutic targets. The combination of mutational profiles with those of upregulated or downregulated genes also by gene gains or losses may ultimately provide a better characterization of NE tumor histological types in terms of response to specific chemotherapy or biotherapy.
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Affiliation(s)
- Luisella Righi
- Department of Oncology, University of Turin at San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
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Pelosi G, Hiroshima K, Mino-Kenudson M. Controversial issues and new discoveries in lung neuroendocrine tumors. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mpdhp.2014.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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Modlin IM, Bodei L, Kidd M. A Historical Appreciation of Bronchopulmonary Neuroendocrine Neoplasia. Thorac Surg Clin 2014; 24:235-55. [DOI: 10.1016/j.thorsurg.2014.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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26
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Pelosi G, Papotti M, Rindi G, Scarpa A. Unraveling tumor grading and genomic landscape in lung neuroendocrine tumors. Endocr Pathol 2014; 25:151-64. [PMID: 24771462 DOI: 10.1007/s12022-014-9320-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Currently, grading in lung neuroendocrine tumors (NETs) is inherently defined by the histological classification based on cell features, mitosis count, and necrosis, for which typical carcinoids (TC) are low-grade malignant tumors with long life expectation, atypical carcinoids (AC) intermediate-grade malignant tumors with more aggressive clinical behavior, and large cell NE carcinomas (LCNEC) and small cell lung carcinomas (SCLC) high-grade malignant tumors with dismal prognosis. While Ki-67 antigen labeling index, highlighting the proportion of proliferating tumor cells, has largely been used in digestive NETs for assessing prognosis and assisting therapy decisions, the same marker does not play an established role in the diagnosis, grading, and prognosis of lung NETs. Next generation sequencing techniques (NGS), thanks to their astonishing ability to process in a shorter timeframe up to billions of DNA strands, are radically revolutionizing our approach to diagnosis and therapy of tumors, including lung cancer. When applied to single genes, panels of genes, exome, or the whole genome by using either frozen or paraffin tissues, NGS techniques increase our understanding of cancer, thus realizing the bases of precision medicine. Data are emerging that TC and AC are mainly altered in chromatin remodeling genes, whereas LCNEC and SCLC are also mutated in cell cycle checkpoint and cell differentiation regulators. A common denominator to all lung NETs is a deregulation of cell proliferation, which represents a biological rationale for morphologic (mitoses and necrosis) and molecular (Ki-67 antigen) parameters to successfully serve as predictors of tumor behavior (i.e., identification of pathological entities with clinical correlation). It is envisaged that a novel grading system in lung NETs based on the combined assessment of mitoses, necrosis, and Ki-67 LI may offer a better stratification of prognostic classes, realizing a bridge between molecular alterations, morphological features, and clinical behavior.
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Affiliation(s)
- Giuseppe Pelosi
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,
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27
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Patel C, Mathur M, Escarcega RO, Bove AA. Carcinoid heart disease: current understanding and future directions. Am Heart J 2014; 167:789-95. [PMID: 24890526 DOI: 10.1016/j.ahj.2014.03.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/17/2014] [Indexed: 12/11/2022]
Abstract
Carcinoid tumors are rare and aggressive malignancies. A multitude of vasoactive agents are central to the systemic effects of these tumors. The additional burden of cardiac dysfunction heralds a steep decline in quality of life and survival. Unfortunately, by the time carcinoid syndrome surfaces clinically, the likelihood of cardiac involvement is 50%. Although medical therapies such as somatostatin analogues may provide some symptom relief, they offer no mortality benefit. On the other hand, referral to surgery following early detection has shown increased survival. The prompt recognition of this disease is therefore of the utmost importance.
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Comparative immunohistochemical analysis of pulmonary and thymic neuroendocrine carcinomas using PAX8 and TTF-1. Mod Pathol 2013; 26:1554-60. [PMID: 23787439 DOI: 10.1038/modpathol.2013.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/23/2013] [Accepted: 04/26/2013] [Indexed: 02/03/2023]
Abstract
PAX8 is expressed in thymic epithelial neoplasms and a subset of neuroendocrine carcinomas of gastrointestinal origin but not pulmonary neuroendocrine carcinomas. Thyroid transcription factor 1 (TTF-1) is known to be positive in pulmonary neuroendocrine carcinomas, but studies investigating its expression in thymic neuroendocrine carcinomas are lacking. To date, there are no comprehensive studies focusing on the comparative expression of PAX8 or TTF-1 in pulmonary and thymic neuroendocrine carcinoma. Twenty-five cases of low and intermediate grade neuroendocrine carcinomas of pulmonary and thymic origin, respectively, were selected for immunohistochemical studies using antibodies directed against PAX8 and TTF-1. The percentage of positive tumor cells as well as the intensity of staining were evaluated and scored. Twenty-one of the pulmonary neuroendocrine carcinomas were classified as low grade (typical carcinoid) and 4 as intermediate grade (atypical carcinoid) tumors; the thymic tumors consisted of 8 low grade and 17 intermediate grade neuroendocrine carcinomas. Only 2 (8%) of the pulmonary tumors showed nuclear expression of PAX8 while 19 (76%) expressed TTF-1. Of the thymic tumors, 8 (32%) were positive for PAX8 and 2 (8%) showed TTF-1 positivity. Primary neuroendocrine carcinomas of the thymus are rare neoplasms that display a more aggressive clinical course than pulmonary neuroendocrine carcinomas, highlighting the importance of the separation of these tumors. To date, there are no specific immunomarkers to distinguish between neuroendocrine carcinomas of pulmonary and thymic origin. The differential expression of PAX8 and TTF-1 may prove useful in this context as a PAX8+/TTF-1- immunophenotype appears to be more common in thymic neuroendocrine carcinomas, whereas the reverse (PAX8-/TTF-1+) is true for most pulmonary neuroendocrine carcinomas.
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Primary high-grade neuroendocrine carcinoma of the esophagus: a clinicopathologic and immunohistochemical study of 42 resection cases. Am J Surg Pathol 2013; 37:467-83. [PMID: 23426118 DOI: 10.1097/pas.0b013e31826d2639] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary high-grade neuroendocrine carcinoma of the esophagus (HNCE) is rare and poorly understood. In this study, we aimed at delineating the clinicopathologic and immunohistochemical characteristics of HNCE diagnosed on the basis of the World Health Organization criteria for pulmonary neuroendocrine carcinomas. We identified 42 (3.8%) consecutive resection cases of HNCE among 1105 esophageal cancers over a 7-year period. Patients' mean age was 62 years (range, 47 to 79 y) with a male to female ratio of 3.7. Dysphagia was present in 79% of patients and tobacco abuse in 50%. Most tumors were centered in the middle (52%) or lower (36%) esophagus; 48% were ulcerated and 31% exophytic. All tumors were sharply demarcated with a pushing border in either solid sheet (83%) or nodular (17%) growth patterns. Pure HNCE was found in 57%, and the remainder also exhibited small components of squamous cell carcinoma (SqCC) or glandular, signet ring cell differentiations. SqCC in situ was present in 50%. Most tumors (88%) were the small cell type with pure oat-like cells in 52%, and the larger spindled, anaplastic, and giant cells were common. Tumor crush artifact (98%) and the Azzopardi effect (88%) were widespread. Extensive lymphovascular (50%) and perineural (33%) invasion and metastasis to regional (48%) and abdominal celiac lymph nodes (29%) were observed. Neoplastic cells were immunoreactive to synaptophysin (100%), CD56 (93%), chromogranin A (67%), p63 (55%), TTF-1 (71%), CK8/18 (90%), CD117 (86%), HER2 (16%), and p16 (84%) antibodies. The 5-year survival rate was 25%, similar to that of SqCC. Lymphovascular and perineural invasion was associated with a worse prognosis.
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30
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Beck T, Mantooth R. Long-term management of a patient with well-differentiated pulmonary neuroendocrine carcinoma: a case report. Case Rep Oncol 2013; 6:209-15. [PMID: 23626563 PMCID: PMC3636965 DOI: 10.1159/000350745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pulmonary neuroendocrine tumors (NET) are rare, and very few published reports have described the long-term treatment of patients with this disease. Current treatment options for patients with metastatic well-differentiated pulmonary NET are limited. This case report details the long-term treatment of a 62-year-old female patient with well-differentiated pulmonary NET and multiple liver metastases. The heavily pretreated patient achieved radiographic stability in measurable disease, improvement in nonmeasurable disease, and symptomatic improvement over 3 years while receiving the combination of everolimus and octreotide long-acting repeatable (LAR). Treatment was well tolerated without mucositis, rash, or pneumonitis. This case report suggests that the combination of everolimus and octreotide LAR may be a novel treatment option for heavily pretreated patients with metastatic well-differentiated pulmonary NET, but these findings require further analysis in clinical trials.
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31
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Mankal P, O'Reilly E. Sunitinib malate for the treatment of pancreas malignancies--where does it fit? Expert Opin Pharmacother 2013; 14:783-92. [PMID: 23458511 DOI: 10.1517/14656566.2013.776540] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Sunitinib , a broad-spectrum multikinase inhibitor, was recently approved for use in progressive, well-differentiated pancreatic neuroendocrine tumors (pNETs). Its mechanism of action affects various signaling cascades involving antiangiogenesis and tumor proliferation, including vascular endothelial growth factors and platelet-derived growth factors. AREAS COVERED In this article, we review sunitinib's mechanism of action at a molecular level and review key preclinical and clinical studies for pNETs and more limited data regarding sunitinib's evaluation in pancreas adenocarcinoma. The data for sunitinib in pNETs are placed in the context of the changing landscape of therapeutic options for this cancer, and relevant ongoing clinical trials and future directions are highlighted. EXPERT OPINION Sunitinib malate has become integrated into routine clinical management for pNETs; however, its role in pancreas adenocarcinoma is not established.
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Affiliation(s)
- Pavan Mankal
- Columbia University College of Physicians and Surgeons, St. Luke's-Roosevelt Hospital Center, Department of Medicine, New York, USA
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32
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Min KW. Two Different Types of Carcinoid Tumors of the Lung: Immunohistochemical and Ultrastructural Investigation and Their Histogenetic Consideration. Ultrastruct Pathol 2013; 37:23-35. [DOI: 10.3109/01913123.2012.707962] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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33
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Costa FP, Gumz B, Pasche B. Selecting patients for cytotoxic therapies in gastroenteropancreatic neuroendocrine tumours. Best Pract Res Clin Gastroenterol 2012; 26:843-54. [PMID: 23582923 DOI: 10.1016/j.bpg.2012.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 12/27/2012] [Indexed: 02/07/2023]
Abstract
Gastroenteropancreatic neuroendocrine tumours (GEP-NET) have heterogenic clinical presentations. The majority of GEP-NET tumours have an indolent behaviour, but patients will eventually develop symptoms of tumour progression or hormone secretion that may require systemic medical interventions. Cytotoxic chemotherapy has been tested in GEP-NETs since the 80s, but treatment recommendations are controversial in many instances. Patient selection is mandatory for optimal use of chemotherapy. Important prognostic factors such as primary tumour site, tumour differentiation, tumour staging and proliferation index have been identified and validated in retrospective and prospective series. The combination of those factors and the natural history of GEP-NET provide valuable information with respect to treatment planning. In this report we provide treatment recommendations to improve systemic therapy in patients with advanced GEP-NETs based on a comprehensive review of the literature.
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Affiliation(s)
- F P Costa
- Centro de Oncologia, Hospital Sírio Libanês, Rua Dona Adma Jafet 90, São Paulo, SP, CEP 01308-050, Brazil.
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Neuroendocrine tumors of the lung. Cancers (Basel) 2012; 4:777-98. [PMID: 24213466 PMCID: PMC3712715 DOI: 10.3390/cancers4030777] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/04/2012] [Accepted: 07/13/2012] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine tumors may develop throughout the human body with the majority being found in the gastrointestinal tract and bronchopulmonary system. Neuroendocrine tumors are classified according to the grade of biological aggressiveness (G1-G3) and the extent of differentiation (well-differentiated/poorly-differentiated). The well-differentiated neoplasms comprise typical (G1) and atypical (G2) carcinoids. Large cell neuroendocrine carcinomas as well as small cell carcinomas (G3) are poorly-differentiated. The identification and differentiation of atypical from typical carcinoids or large cell neuroendocrine carcinomas and small cell carcinomas is essential for treatment options and prognosis. Pulmonary neuroendocrine tumors are characterized according to the proportion of necrosis, the mitotic activity, palisading, rosette-like structure, trabecular pattern and organoid nesting. The given information about the histopathological assessment, classification, prognosis, genetic aberration as well as treatment options of pulmonary neuroendocrine tumors are based on own experiences and reviewing the current literature available. Most disagreements among the classification of neuroendocrine tumor entities exist in the identification of typical versus atypical carcinoids, atypical versus large cell neuroendocrine carcinomas and large cell neuroendocrine carcinomas versus small cell carcinomas. Additionally, the classification is restricted in terms of limited specificity of immunohistochemical markers and possible artifacts in small biopsies which can be compressed in cytological specimens. Until now, pulmonary neuroendocrine tumors have been increasing in incidence. As compared to NSCLCs, only little research has been done with respect to new molecular targets as well as improving the classification and differential diagnosis of neuroendocrine tumors of the lung.
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Bhatt JM, Young JN, Cooke DT. Comparison of Patient Survival after Resection for Pulmonary Carcinoid Tumors Compared to Other Neuroendocrine Tumors: A United States Population Study. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojts.2012.24020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Caldarella A, Crocetti E, Paci E. Distribution, incidence, and prognosis in neuroendocrine tumors: a population based study from a cancer registry. Pathol Oncol Res 2011; 17:759-63. [PMID: 21476126 DOI: 10.1007/s12253-011-9382-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/02/2011] [Indexed: 12/13/2022]
Abstract
Neuroendocrine tumors are considered rare tumors: recently an increased incidence and an improvement in survival were described. We explore distribution, incidence and survival of neuroendocrine tumors using population based registry data. We extracted from the Tuscan Cancer Registry neuroendocrine tumors from 1985-2005, and we evaluated distribution, incidence ad survival according to sex, site of tumor, age and stage at diagnosis. 455 cases of neuroendocrine tumors were identified. The overall incidence increased over the study period from 0.7 per 100,000 per year to 1.6 among men (APC +3.6) and from 0.3 to 2.1 among women (APC +4.8). The anatomic distribution of tumors was lung 25.7%, small intestine 23.5%, appendix 10.9%, colon 10.3%, pancreas 9.4%, stomach 7.4%, and rectum 5.2%. Neuroendocrine tumors were more frequent among males and incidence rate increased with age. We observed increased incidence of neuroendocrine tumors, while survival did not change over time. Prognosis varied with age, stage and localization; females had better survival than males. The increase number of neuroendocrine tumors may be due, at least in part, to better registration and to improvement of diagnosis.
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Affiliation(s)
- Adele Caldarella
- Clinical and Descriptive Epidemiology Unit, Institute for Study and Cancer Prevention, Florence, Italy.
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Kulke MH, Siu LL, Tepper JE, Fisher G, Jaffe D, Haller DG, Ellis LM, Benedetti JK, Bergsland EK, Hobday TJ, Van Cutsem E, Pingpank J, Oberg K, Cohen SJ, Posner MC, Yao JC. Future directions in the treatment of neuroendocrine tumors: consensus report of the National Cancer Institute Neuroendocrine Tumor clinical trials planning meeting. J Clin Oncol 2011; 29:934-43. [PMID: 21263089 PMCID: PMC3068065 DOI: 10.1200/jco.2010.33.2056] [Citation(s) in RCA: 235] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/17/2010] [Indexed: 12/18/2022] Open
Abstract
Neuroendocrine tumors (NETs) arise from a variety of anatomic sites and share the capacity for production of hormones and vasoactive peptides. Because of their perceived rarity, NETs have not historically been a focus of rigorous clinical research. However, the diagnosed incidence of NETs has been increasing, and the estimated prevalence in the United States exceeds 100,000 individuals. The recent completion of several phase III studies, including those evaluating octreotide, sunitinib, and everolimus, has demonstrated that rigorous evaluation of novel agents in this disease is both feasible and can lead to practice-changing outcomes. The NET Task Force of the National Cancer Institute GI Steering Committee convened a clinical trials planning meeting to identify key unmet needs, develop appropriate study end points, standardize clinical trial inclusion criteria, and formulate priorities for future NET studies for the US cooperative group program. Emphasis was placed on the development of well-designed clinical trials with clearly defined efficacy criteria. Key recommendations include the evaluation of pancreatic NET separately from NETs of other sites and the exclusion of patients with poorly differentiated histologies from trials focused on low-grade histologies. Studies evaluating novel agents for the control of hormonal syndromes should avoid somatostatin analog washout periods when possible and should include quality-of-life end points. Because of the observed long survival after progression of many patients, progression-free survival is recommended as a feasible and relevant primary end point for both phase III studies and phase II studies where a delay in progression is expected in the absence of radiologic responses.
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Affiliation(s)
- Matthew H. Kulke
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Lillian L. Siu
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Joel E. Tepper
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - George Fisher
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Deborah Jaffe
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Daniel G. Haller
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Lee M. Ellis
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Jacqueline K. Benedetti
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Emily K. Bergsland
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Timothy J. Hobday
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Eric Van Cutsem
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - James Pingpank
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Kjell Oberg
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Steven J. Cohen
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - Mitchell C. Posner
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
| | - James C. Yao
- From the Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC; Stanford University School of Medicine, Stanford; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA; Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute, Rockville, MD; Abramson Cancer Center, University of Pennsylvania; Fox Chase Cancer Center, Philadelphia; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Mayo Clinic College of Medicine, Rochester, MN; University of Chicago, Chicago, IL; Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada; University Hospital Gasthuisberg, Leuven, Belgium; and University Hospital, Uppsala, Sweden
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Cui T, Hurtig M, Elgue G, Li SC, Veronesi G, Essaghir A, Demoulin JB, Pelosi G, Alimohammadi M, Öberg K, Giandomenico V. Paraneoplastic antigen Ma2 autoantibodies as specific blood biomarkers for detection of early recurrence of small intestine neuroendocrine tumors. PLoS One 2010; 5:e16010. [PMID: 21209860 PMCID: PMC3012732 DOI: 10.1371/journal.pone.0016010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 12/03/2010] [Indexed: 01/01/2023] Open
Abstract
Background Small intestine neuroendocrine tumors (SI-NETs) belong to a rare group of cancers. Most patients have developed metastatic disease at the time of diagnosis, for which there is currently no cure. The delay in diagnosis is a major issue in the clinical management of the patients and new markers are urgently needed. We have previously identified paraneoplastic antigen Ma2 (PNMA2) as a novel SI-NET tissue biomarker. Therefore, we evaluated whether Ma2 autoantibodies detection in the blood stream is useful for the clinical diagnosis and recurrence of SI-NETs. Methodology/Principal Findings A novel indirect ELISA was set up to detect Ma2 autoantibodies in blood samples of patients with SI-NET at different stages of disease. The analysis was extended to include typical and atypical lung carcinoids (TLC and ALC), to evaluate whether Ma2 autoantibodies in the blood stream become a general biomarker for NETs. In total, 124 blood samples of SI-NET patients at different stages of disease were included in the study. The novel Ma2 autoantibody ELISA showed high sensitivity, specificity and accuracy with ROC curve analysis underlying an area between 0.734 and 0.816. Ma2 autoantibodies in the blood from SI-NET patients were verified by western blot and sequential immunoprecipitation. Serum antibodies of patients stain Ma2 in the tumor tissue and neurons. We observed that SI-NET patients expressing Ma2 autoantibody levels below the cutoff had a longer progression and recurrence-free survival compared to those with higher titer. We also detected higher levels of Ma2 autoantibodies in blood samples from TLC and ALC patients than from healthy controls, as previously shown in small cell lung carcinoma samples. Conclusion Here we show that high Ma2 autoantibody titer in the blood of SI-NET patients is a sensitive and specific biomarker, superior to chromogranin A (CgA) for the risk of recurrence after radical operation of these tumors.
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Affiliation(s)
- Tao Cui
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - Monica Hurtig
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Graciela Elgue
- Division of Clinical Immunology, Uppsala University, Uppsala, Sweden
| | - Su-Chen Li
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - Giulia Veronesi
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Ahmed Essaghir
- de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | | | - Giuseppe Pelosi
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan School of Medicine, Milan, Italy
| | | | - Kjell Öberg
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | - Valeria Giandomenico
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University Hospital, Uppsala, Sweden
- * E-mail:
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The NANETS consensus guidelines for the diagnosis and management of gastrointestinal neuroendocrine tumors (nets): well-differentiated nets of the distal colon and rectum. Pancreas 2010; 39:767-74. [PMID: 20664474 DOI: 10.1097/mpa.0b013e3181ec1261] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuroendocrine tumors (NETs) of the distal colon and rectum are also known as hindgut carcinoids based on their common embryologic derivation. Their annual incidence in the United States is rising, primarily as a result of increased incidental detection. Symptoms of rectal NETs include hematochezia, pain, and change in bowel habits. Most rectal NETs are small, submucosal in location, and associated with a very low malignant potential. Tumors larger than 2 cm or those invading the muscularis propria are associated with a significantly higher risk of metastatic spread. Colonic NETs proximal to the rectum are rarer and tend to behave more aggressively. The incidence of rectal NETs in African Americans and Asians is substantially higher than in Caucasians. Colorectal NETs are generally not associated with a hormonal syndrome such as flushing or diarrhea. A multidisciplinary approach is recommended in diagnosing and managing hindgut NETs.
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Abstract
Neuroendocrine tumors (NETs) arise in most organs of the body and share many common pathologic features. However, a variety of different organ-specific systems have been developed for nomenclature, grading, and staging of NETs, causing much confusion. This review examines issues in the pathologic assessment of NETs that are common among primaries of different sites. The various systems of nomenclature are compared along with new proposal for grading and staging NETs. Although differences persist, there are many common themes, such as the distinction of well-differentiated (low and intermediate-grade) from poorly differentiated (high-grade) NETs and the significance of proliferative rate in prognostic assessment. A recently published minimum pathology data set is presented to help standardize the information in pathology reports. Although an ultimate goal of standardizing the pathologic classification of all NETs, irrespective of primary site, remains elusive, an understanding of the common themes among the different current systems will permit easier translation of information relevant to prognosis and treatment.
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Histopathologic and genetic alterations as predictors of response to treatment and survival in lung cancer: A review of published data. Crit Rev Oncol Hematol 2010; 75:94-109. [PMID: 19914087 DOI: 10.1016/j.critrevonc.2009.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/13/2009] [Accepted: 10/07/2009] [Indexed: 12/21/2022] Open
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Large cell/neuroendocrine carcinoma. Lung Cancer 2010; 69:13-8. [DOI: 10.1016/j.lungcan.2009.12.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/04/2009] [Accepted: 12/20/2009] [Indexed: 11/21/2022]
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Neuroendocrine bronchial and thymic tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v220-2. [DOI: 10.1093/annonc/mdq191] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Reclassificação do carcinoma broncopulmonar: Diferenciação do tipo histológico em biópsias por imuno-histoquímica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2009. [DOI: 10.1016/s0873-2159(15)30195-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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