Spectrum of gastro-entero-pancreatic and hepatic neuroendocrine neoplasms from a cancer centre-audit with review of literature

Abstract

Author(s): Sangeetha K Nayanar, Anju Mohan, Nimmy James, Noushad Aryadan

Neuroendocrine Neoplasms (NENs) can arise in most epithelial organs of the body. NENs are a heterogeneous group of neoplasms with widely differing etiologies, clinical features, morphology and prognosis. In 2019 World Health Organization (WHO) published a uniform classification framework for all NENs. The key feature of this classification is the distinction between well differentiated Neuroendocrine Tumours (NETs) and poorly differentiated Neuroendocrine Carcinoma (NEC). NETs graded as G1, G2, and G3 based on proliferation index while NECs are classified as small cell type and large cell type. The incidence of NENs is steadily increasing but there are only limited data available from South India on the histomorphologic profiling of these tumours. Hence this study aims at the same with special emphasis on WHO grading of tumor. This is a hospital based descriptive study of 30 cases of NENs of gastroenteropancreatic and hepatic origin diagnosed on small biopsies and resection specimens, in Division of Onco-Pathology, Malabar cancer centre, Kerala, India, from January 2014 to June 2018. The hematoxylin and eosin (H and E) stained sections were reviewed along with the expression of neuroendocrine markers and proliferation index using immunohistochemistry. Among the total 30 patients included, a female predominant distribution was identified. The age group varied from 23 to 78 years and majority were aged above 50 years. Abdominal pain was the most common clinical presentation. Based on the location of the tumor 17 cases were included in the Gastrointestinal Tract (GIT), nine cases of hepatic and four of pancreatic origin. Among the gastrointestinal tumours, most were of colorectal origin. Among the immunohistochemical markers for neuroendocrine origin, Neuron Specific Enolase (NSE) was found to be the most sensitive Of the total 26 cases in GIT and Liver, nine cases each were Grade 1 and Grade 2 NETs and eight were diagnosed as NEC. Among the four pancreatic tumors, three were Grade 2 NETs and one was NEC, large cell type. Attempts were made to reclassify the cases based on the recent WHO Blue book of tumors for gastrointestinal tract which compiles both the gastroenterohepatic and pancreatic tumours into the same classification. We could reclassify three cases which were previously categorized as small cell neuroendocrine carcinomas as Grade 3 neuroendocrine tumours, based on proliferative index alone. To conclude, a change in trend was observed in the site of occurrence of neuroendocrine tumours. Reclassification of the tumours according to the latest WHO Blue book of tumours of Gastrointestinal tract (5th edition, 2019) facilitated down staging of few neuroendocrine carcinomas into Grade 3 neuroendocrine tumours resulting in most apt treatment options.

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Editors List

  • S.SREEDHAR

    Submitted PhD thesis in Biotechnology at GITAM University, Vizag.

  • Yousef Alomi

    Yousef Alomi
    The Past Head, General Administration of Pharmaceutical Care at Ministry of Health,
    Saudi Arabia Critical Care/TPN
    Clinical Pharmacist Ministry of Health,
    Riyadh, Saudi Arabia.

  • Osamu Tanaka

    Osamu Tanaka
    Assistant Professor,
    Department of Radiation Oncology
    Asahi University Hospital
    Gifu city, Gifu, Japan

  • Maher Abdel Fattah Al-Shayeb

    Department of Surgical Sciences, Ajman University, UAE

  • Andrzej Zdziennicki

    Institute of Gynecology and Obstetrics, Medical University of Lodz, I Clinic of Gynecology and Gynecological Oncology (Lodz, Poland)

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