Poorly differentiated neuroendocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases.

Détails

ID Serval
serval:BIB_F96A8A56A702
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Poorly differentiated neuroendocrine carcinomas of the pancreas: a clinicopathologic analysis of 44 cases.
Périodique
American Journal of Surgical Pathology
Auteur(s)
Basturk O., Tang L., Hruban R.H., Adsay V., Yang Z., Krasinskas A.M., Vakiani E., La Rosa S., Jang K.T., Frankel W.L., Liu X., Zhang L., Giordano T.J., Bellizzi A.M., Chen J.H., Shi C., Allen P., Reidy D.L., Wolfgang C.L., Saka B., Rezaee N., Deshpande V., Klimstra D.S.
ISSN
1532-0979 (Electronic)
ISSN-L
0147-5185
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
38
Numéro
4
Pages
437-447
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, N.I.H., ExtramuralPublication Status: ppublish
Résumé
BACKGROUND: In the pancreas, poorly differentiated neuroendocrine carcinomas include small cell carcinoma and large cell neuroendocrine carcinoma and are rare; data regarding their pathologic and clinical features are very limited.
DESIGN: A total of 107 pancreatic resections originally diagnosed as poorly differentiated neuroendocrine carcinomas were reassessed using the classification and grading (mitotic rate/Ki67 index) criteria put forth by the World Health Organization in 2010 for the gastroenteropancreatic system. Immunohistochemical labeling for neuroendocrine and acinar differentiation markers was performed. Sixty-three cases were reclassified, mostly as well-differentiated neuroendocrine tumor (NET) or acinar cell carcinoma, and eliminated. The clinicopathologic features and survival of the remaining 44 poorly differentiated neuroendocrine carcinomas were further assessed.
RESULTS: The mean patient age was 59 years (range, 21 to 82 y), and the male/female ratio was 1.4. Twenty-seven tumors were located in the head of the pancreas, 3 in the body, and 11 in the tail. The median tumor size was 4 cm (range, 2 to 18 cm). Twenty-seven tumors were large cell neuroendocrine carcinomas, and 17 were small cell carcinomas (mean mitotic rate, 37/10 and 51/10 HPF; mean Ki67 index, 66% and 75%, respectively). Eight tumors had combined components, mostly adenocarcinomas. In addition, 2 tumors had components of well-differentiated NET. Eighty-eight percent of the patients had nodal or distant metastatic disease at presentation, and an additional 7% developed metastases subsequently. Follow-up information was available for 43 patients; 33 died of disease, with a median survival of 11 months (range, 0 to 104 mo); 8 were alive with disease, with a median follow-up of 19.5 months (range, 0 to 71 mo). The 2- and 5-year survival rates were 22.5% and 16.1%, respectively.
CONCLUSIONS: Poorly differentiated neuroendocrine carcinoma of the pancreas is a highly aggressive neoplasm, with frequent metastases and poor survival. Most patients die within less than a year. Most (61%) are large cell neuroendocrine carcinomas. Well-differentiated NET and acinar cell carcinoma are often misdiagnosed as poorly differentiated neuroendocrine carcinoma, emphasizing that diagnostic criteria need to be clearly followed to ensure accurate diagnosis.
Mots-clé
Adult, Aged, Aged, 80 and over, Carcinoma, Neuroendocrine/mortality, Carcinoma, Neuroendocrine/pathology, Cell Differentiation, Disease Progression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pancreatic Neoplasms/mortality, Pancreatic Neoplasms/pathology, Proportional Hazards Models, Young Adult
Pubmed
Web of science
Création de la notice
06/09/2016 13:50
Dernière modification de la notice
03/03/2018 22:54
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