Difference between revisions of "Neuroendocrine tumour of the pancreas"

Jump to navigation Jump to search

Neuroendocrine tumour of the pancreas (view source)

Revision as of 20:21, 3 March 2019

3,242 bytes added ,  20:21, 3 March 2019
→‎WHO classification of 2017
 
(8 intermediate revisions by 2 users not shown)
Line 1: Line 1:
{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Pancreatic insulinoma (2).JPG
| Image      = Pancreatic neuroendocrine tumour - 2 -- high mag.jpg
| Width      =
| Width      =
| Caption    = Pancreatic neuroendocrine tumour (insulinoma). [[H&E stain]].
| Caption    = Pancreatic neuroendocrine tumour. [[H&E stain]].
| Synonyms  = pancreatic islet cell tumour (obsolete term)
| Synonyms  = pancreatic islet cell tumour (obsolete term)
| Micro      = nests of cells or cords, stippled chromatin, moderate quantity of cytoplasm, +/-hyaline globules
| Micro      = nests of cells or cords, stippled chromatin, moderate quantity of cytoplasm, +/-hyaline globules
Line 46: Line 46:
**[[Neurofibromatosis type 1]].<ref name=pmid15249710>{{Cite journal  | last1 = Alexakis | first1 = N. | last2 = Connor | first2 = S. | last3 = Ghaneh | first3 = P. | last4 = Lombard | first4 = M. | last5 = Smart | first5 = HL. | last6 = Evans | first6 = J. | last7 = Hughes | first7 = M. | last8 = Garvey | first8 = CJ. | last9 = Vora | first9 = J. | title = Hereditary pancreatic endocrine tumours. | journal = Pancreatology | volume = 4 | issue = 5 | pages = 417-33; discussion 434-5 | month =  | year = 2004 | doi = 10.1159/000079616 | PMID = 15249710 }}</ref>
**[[Neurofibromatosis type 1]].<ref name=pmid15249710>{{Cite journal  | last1 = Alexakis | first1 = N. | last2 = Connor | first2 = S. | last3 = Ghaneh | first3 = P. | last4 = Lombard | first4 = M. | last5 = Smart | first5 = HL. | last6 = Evans | first6 = J. | last7 = Hughes | first7 = M. | last8 = Garvey | first8 = CJ. | last9 = Vora | first9 = J. | title = Hereditary pancreatic endocrine tumours. | journal = Pancreatology | volume = 4 | issue = 5 | pages = 417-33; discussion 434-5 | month =  | year = 2004 | doi = 10.1159/000079616 | PMID = 15249710 }}</ref>


===Classification===  
===WHO classification of 2017===
Five categories:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->
*NET G1.  Ki67 Index < 3%, Mitotic Index < 2/10HPF
*NET G2.  Ki67 Index 3-20%,  Mitotic Index 2-20/10HPF
*NET G3.  Ki67 Index > 20%,  Mitotic Index > 20/10 HPF  AND well-differentiated, expressing neuroendocrine differentiation and hormones
*Neuroendocrine carcinoma (NEC G3).  Ki 67 Index > 20%,  Mitotic Index > 20/10 HPF  Poorly differentiated, expressing neuroendocrine differentiation but lacking exocrine markers.
*[[MiNEN]].  mixed endocrine-nonendocrine neoplasm:  components of a non-endocrine carcinoma (mostly ductal adenocarcinoma or acinar cell carcinoma) combined with a neuroendocrine neoplasm
 
===Classification by product===  
Based on peptide produced in the pancreatic islets:
Based on peptide produced in the pancreatic islets:
#Glucagon from alpha cells ([[glucagonoma]]).  
#Glucagon from alpha cells ([[glucagonoma]]).  
Line 60: Line 68:


==Gross==
==Gross==
*Usually in the head of the pancreas - 68% in one series,<ref name=pmid22869477>{{Cite journal  | last1 = Oh | first1 = TG. | last2 = Chung | first2 = MJ. | last3 = Park | first3 = JY. | last4 = Bang | first4 = SM. | last5 = Park | first5 = SW. | last6 = Chung | first6 = JB. | last7 = Song | first7 = SY. | title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. | journal = Yonsei Med J | volume = 53 | issue = 5 | pages = 944-51 | month = Sep | year = 2012 | doi = 10.3349/ymj.2012.53.5.944 | PMID = 22869477 | PMC = 3423842}}</ref> and 50% in another series.<ref name=pmid22869477>{{Cite journal  | last1 = Oh | first1 = TG. | last2 = Chung | first2 = MJ. | last3 = Park | first3 = JY. | last4 = Bang | first4 = SM. | last5 = Park | first5 = SW. | last6 = Chung | first6 = JB. | last7 = Song | first7 = SY. | title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. | journal = Yonsei Med J | volume = 53 | issue = 5 | pages = 944-51 | month = Sep | year = 2012 | doi = 10.3349/ymj.2012.53.5.944 | PMID = 22869477 }}</ref>
*Usually in the head of the pancreas - 68% in one series,<ref name=pmid22869477>{{Cite journal  | last1 = Oh | first1 = TG. | last2 = Chung | first2 = MJ. | last3 = Park | first3 = JY. | last4 = Bang | first4 = SM. | last5 = Park | first5 = SW. | last6 = Chung | first6 = JB. | last7 = Song | first7 = SY. | title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. | journal = Yonsei Med J | volume = 53 | issue = 5 | pages = 944-51 | month = Sep | year = 2012 | doi = 10.3349/ymj.2012.53.5.944 | PMID = 22869477 | PMC = 3423842}}</ref> and 50% in another series.<ref name=pmid22869477/>
 
==Microscopic==
==Microscopic==
Features:
Features:
Line 81: Line 88:
Image: Pancreatic insulinoma (4) Insulin immuostain.JPG | Insulinoma - insulin IHC. (WC)
Image: Pancreatic insulinoma (4) Insulin immuostain.JPG | Insulinoma - insulin IHC. (WC)
</gallery>
</gallery>
<gallery>
Image: Pancreatic neuroendocrine tumour -- very low mag.jpg | Pancreatic NET - very low mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour -- low mag.jpg | Pancreatic NET - low mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour -- intermed mag.jpg | Pancreatic NET - intermed. mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour - alt -- intermed mag.jpg | Pancreatic NET - intermed. (WC/Nephron) mag.
Image: Pancreatic neuroendocrine tumour -- high mag.jpg | Pancreatic NET - high mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour -- very high mag.jpg | Pancreatic NET - very high mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour - 2 -- intermed mag.jpg | Pancreatic NET - intermed. mag. (WC/Nephron)
Image: Pancreatic neuroendocrine tumour - 2 -- high mag.jpg | Pancreatic NET - high mag. (WC/Nephron)
</gallery>
[[File: PANC NET LG 1 sl 1.png| Low grade pancreatic neuroendocrine tumor]]
[[File: PANC NET LG 1 sl 2.png| Low grade pancreatic neuroendocrine tumor]]
[[File: PANC NET LG 1 sl 3.png| Low grade pancreatic neuroendocrine tumor]]
[[File: PANC NET LG 1 sl 4.png| Low grade pancreatic neuroendocrine tumor]]
[[File: PANC NET LG 1 sl 5.png| Low grade pancreatic neuroendocrine tumor]]
Low grade pancreatic neuroendocrine tumor.  A. Stromal trabeculums (black arrows) support the uniform, non-necrotic tumor that has sharp edges (green arrows). B. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. C. Immunostain. Cytoplasm is diffusely synaptophysin positive. D.  Immunostain. Cytoplasm shows stippled chromogranin positivity. E. Immunostain. Only scattered nuclei are Ki67 positive.
www:
www:
*[http://path.upmc.edu/cases/case172/micro.html Islet cell tumour (upmc.edu)].
*[http://path.upmc.edu/cases/case172/micro.html Islet cell tumour (upmc.edu)].
Line 87: Line 115:


==IHC==
==IHC==
*CK19 +ve -- should be done as a routine in pancreatic NETs; poor prognostic factor.<ref name=pmid19956064>{{Cite journal  | last1 = Jain | first1 = R. | last2 = Fischer | first2 = S. | last3 = Serra | first3 = S. | last4 = Chetty | first4 = R. | title = The use of Cytokeratin 19 (CK19) immunohistochemistry in lesions of the pancreas, gastrointestinal tract, and liver. | journal = Appl Immunohistochem Mol Morphol | volume = 18 | issue = 1 | pages = 9-15 | month = Jan | year = 2010 | doi = 10.1097/PAI.0b013e3181ad36ea | PMID = 19956064 }}</ref>
*CK19 +ve.
**Considered a poor prognostic factor<ref name=pmid19956064>{{Cite journal  | last1 = Jain | first1 = R. | last2 = Fischer | first2 = S. | last3 = Serra | first3 = S. | last4 = Chetty | first4 = R. | title = The use of Cytokeratin 19 (CK19) immunohistochemistry in lesions of the pancreas, gastrointestinal tract, and liver. | journal = Appl Immunohistochem Mol Morphol | volume = 18 | issue = 1 | pages = 9-15 | month = Jan | year = 2010 | doi = 10.1097/PAI.0b013e3181ad36ea | PMID = 19956064 }}</ref> - disputed by an older paper.<ref>{{Cite journal  | last1 = La Rosa | first1 = S. | last2 = Rigoli | first2 = E. | last3 = Uccella | first3 = S. | last4 = Novario | first4 = R. | last5 = Capella | first5 = C. | title = Prognostic and biological significance of cytokeratin 19 in pancreatic endocrine tumours. | journal = Histopathology | volume = 50 | issue = 5 | pages = 597-606 | month = Apr | year = 2007 | doi = 10.1111/j.1365-2559.2007.02662.x | PMID = 17394496 }}</ref>
*Chromogranin +ve.
*Chromogranin +ve.
*Synaptophysin +ve.
*Synaptophysin +ve.
*CD56 +ve.
*CD56 +ve.
*[[PAX8]] +ve (74% of cases<ref name=pmid20890270>{{Cite journal  | last1 = Sangoi | first1 = AR. | last2 = Ohgami | first2 = RS. | last3 = Pai | first3 = RK. | last4 = Beck | first4 = AH. | last5 = McKenney | first5 = JK. | last6 = Pai | first6 = RK. | title = PAX8 expression reliably distinguishes pancreatic well-differentiated neuroendocrine tumors from ileal and pulmonary well-differentiated neuroendocrine tumors and pancreatic acinar cell carcinoma. | journal = Mod Pathol | volume = 24 | issue = 3 | pages = 412-24 | month = Mar | year = 2011 | doi = 10.1038/modpathol.2010.176 | PMID = 20890270 }}</ref>).


Functional tumours:
Functional tumours:
Brigitte
30

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/30253...49808"

Navigation menu