Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series

Background Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions. Methods In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009 to 2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed. Results The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1 and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage (HR 6.444 95%CI 1.477–28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409–79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719–19.940 P = 0.005), grade of the adenocarcinoma component (HR 3.876 95%CI 1.451–10.357 P = 0.007) and CD56 positivity (HR 0.265 95%CI 0.100–0.705 P = 0.008) were independent predictors of overall survival. Conclusions Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended.

Mixed adenoneuroendocrine carcinomas of stomach and ampulla of vater after curative-intent resection: a single center cases series

Background Mixed adenoneuroendocrine carcinoma is a rare clinical manifestation, especially in the gastric and ampullary. The purpose of this study was to investigate the clinicopathological features and prognosis of mixed adenoneuroendocrine carcinoma in the gastric and ampullary and summarize related treatment suggestions. Methods In all, 32 cases of mixed adenoneuroendocrine carcinoma in the gastric and ampullary that were diagnosed from resected specimens were analyzed from 2009–2015. The corresponding demographic, clinicopathological and survival data were retrospectively reviewed. Results The 1-year, 3-year and 5-year survival rates were 78.1%, 28.1% and 9.4%, respectively, and the median overall survival was 28.0 months. In all, 75.0% (24/32) had lymph node metastasis at the time of initial diagnosis. A multivariate analysis revealed that TNM stage(HR6.444 95%CI 1.477–28.121 P = 0.013), lymph nodes metastasis (HR10.617 95%CI 1.409–79.997 P = 0.022), vascular invasion (HR 5.855 95%CI 1.719–19.940 P = 0.005),grade of the adenocarcinoma component (HR 3.876 95% CI 1.451–10.357 P = 0.007) and CD56 positivity (HR 0.265 95% CI 0.100-0.705 P = 0.008)were independent predictors of overall survival. Conclusions Mixed adenoneuroendocrine carcinoma is an aggressive clinical entity with a poor prognosis. Taking both the neuroendocrine component and the adenocarcinoma component into consideration of optimal treatment is strongly recommended.

A Gastric Intramucosal Mixed Adenocarcinoma-Neuroendocrine Tumor

Gastric mixed adenocarcinoma-neuroendocrine tumor (NET) is a rare composite tumor, and a limited number of studies have reported on it. A 77-year-old man was admitted to our hospital because of acute cholecystitis. He underwent a cholecystectomy. Esophagogastroduodenoscopy during his admission revealed a slightly elevated tumor, and biopsy demonstrated a well-differentiated tubular adenocarcinoma. The tumor was resected completely by endoscopic submucosal dissection. Histological findings showed that it measured 9 mm in diameter, was located within the mucosa, and consisted of well-differentiated tubular adenocarcinoma and a NET G1. The NET was covered with adenocarcinoma and both components exhibited histological continuity. The NET and a part of the adenocarcinoma component showed a positive reaction for chromogranin A and synaptophysin. Neither enterochromaffin-like cell hyperplasia nor endocrine cell micronest surrounded the tumor. The diagnosis was gastric mixed adenocarcinoma-NET. The histological continuity between the two components can be likened to the same histogenesis.

A Rare Case of Mixed Ductal Neuroendocrine Tumor of the Pancreas

Collision tumors are tumors that have at least two types of tumors in the same anatomical site with no area of mixing within the transition zone. In 2010 WHO classification of neuroendocrine tumors consists of an adenocarcinoma component and a neuroendocrine carcinoma component in which each of the components accounts for 30% of the tumor. Such tumors are defined as mixed adenoneuroendocrine carcinomas. Occurrence of exocrine and endocrine tumors of the pancreas is extremely rare. The aim of our study was to describe a case in a 60 years old male who was diagnosed with this rare tumor. Gross, microscopic features and immunohistochemistry were used to diagnose this rare condition. Immunohistochemistry markers such as synaptophysin, chromogranin, EMA and Pan CK were used to come to a definitive diagnosis. Synaptophysin and chromogranin were found to be positive in the neuroendocrine component. EMA and Pan CK were found to be positive in the ductal component. Hence a diagnosis of mixed ductal neuroendocrine tumour (collision tumor) was made.

Multiple Lung Cancers: Independent Primary Tumors or Intrapulmonary Metastases, A Case Report

Background The prevalence of multiple primary lung cancers is rising, highlighting the need for tools to distinguish independent primary tumors from metastases. Molecular markers and hisopathologic comparison are useful to aid in this distinction, but they have significant limitations. Case Presentation A 76-year old woman presented with recurrent bronchorrhea, non-productive cough, and dyspnea upon exertion. She was a former smoker (15 pack-year history). Computerized tomography imaging revealed multiple lung masses: 1.9 × 2.3 cm nodule in the right upper lobe, and a 6.5 cm mass in the right lower lobe. Histologic examination of the tumors showed that the right lower lobe mass was an adenosquamous carcinoma with a mucinous adenocarcinoma component. This tumor showed visceral pleural invasion, and direct invasion of one intrapulmonary peribronchial lymph node. The upper lobe lesion was characterized by pure invasive mucinous adenocarcinoma with no squamous component. Abdominal and pelvic imaging was performed to rule out alternative primary sites, and no evidence of disease was identified outside of the chest. A cancer mutation and rearrangement panel on the adenosquamous carcinoma did not reveal any mutations. Conclusions In this interesting case, a patient presented with two lung tumors which had some morphologic similarities, but also some important differences, and no specific genetic mutations were present to establish the relationship between the tumors. Although current tools are useful, this case highlights an example of a case where it remains extremely difficult to determine whether two lung cancers are independent primary tumors or intrapulmonary metastases.

Mixed adenoneuroendocrine carcinoma of proximal stomach; a rare but sinister pathology

Mixed adeno-neuroendocrine carcinoma is a rare tumor of the gastrointestinal tract comprising of both epithelial and neuroendocrine components, each representing at least 30% of the tumor. Diagnosis is based on clinical evaluation, radiological findings, histopathological features in conjunction with immunostaining with specific neuroendocrine markers such as chromogranin, synaptophysin, CD56, and markers of epithelial differentiation such as cytokeratin, CDX2, and carcinoembryonic antigen. A 50-year-old female presented with a history of dysphagia, chest pain, anorexia, and significant weight loss with normal physical findings and baseline investigations. Upper Gastrointestinal endoscopy showed growth at the gastroesophageal junction involving cardia of the stomach. Histopathological examination of the resected mass showed both adenocarcinoma and neuroendocrine carcinomatous components each involving more than 30% of total mass examined. Identifying adenocarcinoma component admixed with a high-grade neuroendocrine component is significant as the prognosis and survival of patients differ from pure adenocarcinoma.