Risk Factors Associated with the Development of Metastases in Patients with Gastroenteropancreatic Neuroendocrine Tumors

Neuroendocrine tumors develop from systemic endocrine and nerve cells, and their occurrence has increased recently. Since these tumors are heterogeneous, pathological classification has been based on the affected organ. In 2019, the World Health Organization introduced a change that is expected to influence neuroendocrine tumor research, as gastroenteropancreatic neuroendocrine tumors are now included within a unified classification. In this retrospective study, we aimed to investigate the characteristics (e.g., lymph node metastases, all other metastases) of gastroenteropancreatic neuroendocrine tumors using this new classification in 50 cases. Tumor size, depth, MIB-1 index, lymphatic invasion, venous invasion, and neuroendocrine tumor grade were significantly correlated with lymph node metastasis and all other metastases. Venous invasion was more strongly correlated with lymph node metastasis and all other types of metastasis than with lymphatic invasion. Identification rates for lymphatic invasion were considered lower because of structural problems such as lymphatic vessels being much thinner than veins. However, venous invasion was considered effective in compensating for the low rate of identification in cases of lymphatic invasion. In future research, a unified classification and standardized framework for assessment will be important when analyzing the characteristics of neuroendocrine tumors, and large-scale studies are required.

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Risk Factors Associated with the Development of Metastases in Patients with Gastroenteropancreatic Neuroendocrine Tumors: A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm11010060 ◽

2021 ◽

Vol 11 (1) ◽

pp. 60

Author(s):

Shuzo Kohno ◽

Masahiro Ikegami ◽

Toru Ikegami ◽

Hiroaki Aoki ◽

Masaichi Ogawa ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Neuroendocrine Tumor ◽

Neuroendocrine Tumors ◽

Venous Invasion ◽

Lymphatic Invasion ◽

World Health ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Node Metastasis ◽

Structural Problems

Neuroendocrine tumors develop from systemic endocrine and nerve cells, and their occurrence has increased recently. Since these tumors are heterogeneous, pathological classification has been based on the affected organ. In 2019, the World Health Organization introduced a change expected to influence neuroendocrine tumor research, as gastroenteropancreatic neuroendocrine tumors are now included within a unified classification. This retrospective study aimed to investigate the characteristics (e.g., lymph node metastases and all other metastases) of gastroenteropancreatic neuroendocrine tumors using this new classification in 50 cases. Tumor size, depth, MIB-1 index, lymphatic invasion, venous invasion, and neuroendocrine tumor grade were significantly correlated with lymph node metastasis and other metastases. The venous invasion was more strongly correlated with lymph node metastasis and all other types of metastases than with lymphatic invasion. Identification rates for lymphatic invasion were considered lower because of structural problems such as lymphatic vessels being much thinner than veins. However, venous invasion was considered effective in compensating for the low identification rate in cases of lymphatic invasion. In future research, a unified classification and standardized framework for assessment will be important when analyzing the characteristics of neuroendocrine tumors, and large-scale studies are required.

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Pure Well-Differentiated Adenocarcinoma Is a Safe Factor for Lymph Node Metastasis in T1 and T2 Colorectal Cancer: A Pilot Study

Gastroenterology Research and Practice ◽

10.1155/2018/8798405 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Naohisa Yoshida ◽

Masayoshi Nakanishi ◽

Ken Inoue ◽

Ritsu Yasuda ◽

Ryohei Hirose ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Venous Invasion ◽

Lymphatic Invasion ◽

Clinicopathological Factors ◽

Node Metastasis ◽

Kappa Value ◽

T1 And T2 ◽

Well Differentiated

Background and Aims. Various risk factors for lymph node metastasis (LNM) have been reported in colorectal T1 cancers. However, the factors available are insufficient for predicting LNM. We therefore investigated the utility of the new histological factor “pure well-differentiated adenocarcinoma” (PWDA) as a safe factor for predicting LNM in T1 and T2 cancers. Materials and Methods. We reviewed 115 T2 cancers and 202 T1 cancers in patients who underwent surgical resection in our center. We investigated the rates of LNM among various clinicopathological factors, including PWDA. PWDA was defined as a lesion comprising only well-differentiated adenocarcinoma. The consistency of the diagnosis of PWDA was evaluated among two pathologists. In addition, 72 T1 cancers with LNM from 8 related hospitals over 10 years (2008–2017) were also analyzed. Results. The rates of LNM and PWDA were 23.5% and 20.0%, respectively, in T2 cancers. Significant differences were noted between patients with and without LNM regarding lymphatic invasion (81.5% vs. 36.4%, p<0.001), poor histology (51.9% vs. 19.3%, p=0.008), and PWDA (3.7% vs. 25.0%, p=0.015). The rates of LNM and PWDA were 8.4% and 36.1%, respectively, in T1 cancers. Regarding the 73 PWDA cases and 129 non-PWDA cases, the rates of LNM were 0.0% and 13.2%, respectively (p<0.001). Among the 97 cases with lymphatic or venous invasion, the rates of LNM in 29 PWDA cases and 68 non-PWDA were 0% and 14.7%, respectively (p=0.029). The agreement of the two pathologists for the diagnosis of PWDA was acceptable (kappa value > 0.5). A multicenter review showed no cases of PWDA among 72 T1 cancers with LNM. Conclusions. PWDA is considered to be a safe factor for LNM in T1 cancer.

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Do morphologic characteristics play a role in nodal metastatic progression of well-differentiated pancreatic neuroendocrine tumors?

Tumori Journal ◽

10.1177/0300891620941921 ◽

2020 ◽

pp. 030089162094192

Author(s):

Nesrin Ugras ◽

Seçil Hasdemir ◽

Ömer Yerci ◽

Pınar Taşar ◽

Halit Ziya Dündar ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Neuroendocrine Tumors ◽

Lymphocytic Infiltration ◽

World Health ◽

Tumor Diameter ◽

Metastatic Progression ◽

Proliferative Index ◽

Node Metastasis ◽

Well Differentiated

Background: Pancreatic neuroendocrine neoplasms (NENs) are tumors with histopathologic and prognostic heterogeneity that pose difficulties in establishing standards for diagnosis, classification, and treatment. Among NENs, well-differentiated neuroendocrine tumors (NETs) have been classified as grade 1, 2, and 3 in the most recently released World Health Organization classification. Although well-differentiated NETs are associated with relatively better prognosis, they have a potential for malignant behavior such as extrapancreatic spread, metastasis, or recurrence. The present study aimed to evaluate clinical and histomorphologic findings of patients with well-differentiated pancreatic NETs and to identify histopathologic findings effective in predicting nodal metastatic progression. Methods: The study group consisted of 54 patients diagnosed with well-differentiated NET. All preparations and blocks of the patients were examined for the following histopathologic parameters: tumor diameter, microscopic tumor growth pattern (solid, trabecular, acinar, and mixed), cellular features (clear, eosinophilic, oncocytic, peliotic, and pseudopapillary), stromal changes (calcification, lymphocytic infiltration, and stromal hyalinization), presence of necrosis, perineural invasion, lymphovascular invasion, mitotic activity, and Ki67 proliferative index. Results: Lymph node metastasis was present in 7 patients. Lymph node metastasis was significantly associated with tumor diameter of >2 cm ( p = 0.012), Ki67 proliferative index of >20% ( p = 0.022), grade 3 tumors ( p = 0.002), presence of dense stromal hyalinization ( p = 0.034), and mild lymphocytic infiltration ( p = 0.041). Conclusion: The present study revealed that the new findings such as presence of dense stromal hyalinization and absence of remarkable lymphocytic infiltration could be predictive morphologic findings for the development of lymph node metastasis.

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