Neuroendocrine neoplasm


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  • WHO 2010 Grading and classification

    • neuroendocrine tumor G1
      • mitosis < 2 per 10 hpf
      • Ki67 <= 2%
      • bland cytology, strong chromogranin and synaptophysin
      • aka: well differentiated endocrine tumor, carcinoid tumor
    • neuroendocrine tumor G2
      • mitosis 2-20 per 10 hpf
      • Ki67 2-20%
      • bland cytology, strong chromogranin and synaptophysin
      • aka: well differentiated endocrine carcinoma, atypical carcinoid tumor
    • neuroendocrine carcinoma
      • mitosis > 20 per 10 hpf
      • Ki67 > 20%
      • loss of chromogranin, retains synaptophysin
      • atypia, necrosis
      • types: small cell and large cell
      • aka: NET G3, poorly differentiated NEC, small cell ca, large cell NEC
    • mixed adenoneuroendocrine carcinoma
      • both ductal adenoca and NEC, at least 30% of either
      • squamous component is rare
      • aka: mixed exocrine-endocrine carcinoma
    • hyperplastic and preneoplastic lesions = tumor like lesions
    • use higher grade re: mitosis vs Ki67
    • requirements: 50 hpf for mitosis count, 500 cells for Ki67
    • evidence support for stomach, duodenum and pancreas.

  • Stains

    • pos: synaptophysin, chromogranin
    • rectal carcinoids: PAP+, PSA- (vs prostate PAP+, PSA+)
    • lung (TTF1+, PAX8-) vs GI (TTF1-, PAX8+)

  • Hormones

    • nonfunctional
    • serotonin
    • gastrin
    • glucagon
    • insulin
    • somatostatin
    • VIPoma

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    • grade / classification
    • mitosis count per 10 hpf
    • Ki67
    • margins
    • TNM
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