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Immunohistochemical consistency between primary tumors and lymph node metastases of gastric neuroendocrine carcinoma.

Uchiyama C, Tamura S, Nakatsuka S, Takeno A, Miki H, Kanemura T, Nakahira S, Suzuki R, Nakata K, Takeda Y, Kato T - World J Surg Oncol (2012)

Bottom Line: The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two.A total of 31 metastatic lymph nodes were found in these patients.G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Kansai Rousai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan.

ABSTRACT

Background: Gastric neuroendocrine carcinoma (G-NEC) is a rare, highly malignant tumor that exhibits aggressive growth leading to vascular invasion, distant metastasis and extremely poor prognosis. We studied the clinicopathological findings of seven patients at our institute to better under this disease.

Methods: Seven cases of G-NEC were identified among 1,027 cases of gastric carcinoma that underwent gastrectomy at Kansai Rousai Hospital between 2002 and 2010. We studied the pathological and immunohistochemical features of gastric neuroendocrine carcinomas at both the primary site and metastatic lymph nodes.

Results: The mean patient age was 73 years (range 63 to 86 years). There were no females in this series. The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two. A total of 31 metastatic lymph nodes were found in these patients. This study revealed that the ratio of neuroendocrine cells was similar between the primary and metastatic sites, which tended to show the same expression patterns of neuroendocrine markers.

Conclusions: Metastatic lymph nodes showed heterogeneous immunohistochemical expression patterns similar to the primary sites. G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer. MINI ABSTRACT: G-NEC grows rapidly and metastasizes to the lymph nodes, retaining its pathological and immunohistochemical heterogeneity even at the metastatic sites.

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Immunohistochemical expression for neuroendocrine markers in primary tumor (Case 1). a) Synaptophysin, b) chromogranin A, c) CD56, d) neuron-specific enolase. Tumor cells variably expressed neuroendocrine markers.
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Figure 1: Immunohistochemical expression for neuroendocrine markers in primary tumor (Case 1). a) Synaptophysin, b) chromogranin A, c) CD56, d) neuron-specific enolase. Tumor cells variably expressed neuroendocrine markers.

Mentions: Only three cases were correctly diagnosed as G-NEC preoperatively. We summarized the varied histological patterns of the primary tumors and lymph nodes in Table 3. According to the WHO classification, five of the seven tumors were large-cell subtypes and the others were small-cell subtypes. They were classified into five pure neuroendocrine carcinomas and two tumors combined with adenocarcinoma. We examined a total of 236 lymph nodes obtained from seven patients. Among them, 31 positive nodes included 12 nodes showing pure adenocarcinoma, 3 showing both adenocarcinoma and neuroendocrine carcinoma, and 16 showing pure neuroendocrine carcinoma. While the cases with pure NEC had lymph node metastasis of pure NEC (for example, Case 1 shown in Figures 1 and 2), the two remaining cases with both adenocarcinoma cells and neuroendocrine carcinoma cells had varied lymph node metastasis. Case 4 had pure NEC, and Case 6 had both pure adenocarcinoma nodes and concomitant nodes. In addition, we verified the primary and lymph node subtypes by staining for neuroendocrine markers, and all primary tumors were strongly stained by SYN and CD56. Most cases showed varied expression patterns that were similar in both the primary and metastatic sites. The accordance of positivity between the primary sites and lymph nodes was extremely high: 80% in SYN, 100% in CGA, 60% in CD56 and 80% in NSE. Furthermore, the Ki67 labeling index was high, over 20% in all cases.


Immunohistochemical consistency between primary tumors and lymph node metastases of gastric neuroendocrine carcinoma.

Uchiyama C, Tamura S, Nakatsuka S, Takeno A, Miki H, Kanemura T, Nakahira S, Suzuki R, Nakata K, Takeda Y, Kato T - World J Surg Oncol (2012)

Immunohistochemical expression for neuroendocrine markers in primary tumor (Case 1). a) Synaptophysin, b) chromogranin A, c) CD56, d) neuron-specific enolase. Tumor cells variably expressed neuroendocrine markers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475116&req=5

Figure 1: Immunohistochemical expression for neuroendocrine markers in primary tumor (Case 1). a) Synaptophysin, b) chromogranin A, c) CD56, d) neuron-specific enolase. Tumor cells variably expressed neuroendocrine markers.
Mentions: Only three cases were correctly diagnosed as G-NEC preoperatively. We summarized the varied histological patterns of the primary tumors and lymph nodes in Table 3. According to the WHO classification, five of the seven tumors were large-cell subtypes and the others were small-cell subtypes. They were classified into five pure neuroendocrine carcinomas and two tumors combined with adenocarcinoma. We examined a total of 236 lymph nodes obtained from seven patients. Among them, 31 positive nodes included 12 nodes showing pure adenocarcinoma, 3 showing both adenocarcinoma and neuroendocrine carcinoma, and 16 showing pure neuroendocrine carcinoma. While the cases with pure NEC had lymph node metastasis of pure NEC (for example, Case 1 shown in Figures 1 and 2), the two remaining cases with both adenocarcinoma cells and neuroendocrine carcinoma cells had varied lymph node metastasis. Case 4 had pure NEC, and Case 6 had both pure adenocarcinoma nodes and concomitant nodes. In addition, we verified the primary and lymph node subtypes by staining for neuroendocrine markers, and all primary tumors were strongly stained by SYN and CD56. Most cases showed varied expression patterns that were similar in both the primary and metastatic sites. The accordance of positivity between the primary sites and lymph nodes was extremely high: 80% in SYN, 100% in CGA, 60% in CD56 and 80% in NSE. Furthermore, the Ki67 labeling index was high, over 20% in all cases.

Bottom Line: The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two.A total of 31 metastatic lymph nodes were found in these patients.G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Kansai Rousai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo 660-8511, Japan.

ABSTRACT

Background: Gastric neuroendocrine carcinoma (G-NEC) is a rare, highly malignant tumor that exhibits aggressive growth leading to vascular invasion, distant metastasis and extremely poor prognosis. We studied the clinicopathological findings of seven patients at our institute to better under this disease.

Methods: Seven cases of G-NEC were identified among 1,027 cases of gastric carcinoma that underwent gastrectomy at Kansai Rousai Hospital between 2002 and 2010. We studied the pathological and immunohistochemical features of gastric neuroendocrine carcinomas at both the primary site and metastatic lymph nodes.

Results: The mean patient age was 73 years (range 63 to 86 years). There were no females in this series. The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two. A total of 31 metastatic lymph nodes were found in these patients. This study revealed that the ratio of neuroendocrine cells was similar between the primary and metastatic sites, which tended to show the same expression patterns of neuroendocrine markers.

Conclusions: Metastatic lymph nodes showed heterogeneous immunohistochemical expression patterns similar to the primary sites. G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer. MINI ABSTRACT: G-NEC grows rapidly and metastasizes to the lymph nodes, retaining its pathological and immunohistochemical heterogeneity even at the metastatic sites.

Show MeSH
Related in: MedlinePlus