Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End?
MiNEN (mixed neuroendocrine-non-neuroendocrine neoplasm) is described in the 5th edition WHO classification of tumors of the digestive system as a mixed neoplasm, composed of neuroendocrine and non-neuroendocrine parts, each accounting for at least 30% of the tumor. Recently this formal criterion h...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Vilnius University Press
2022-04-01
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| Series: | Lietuvos Chirurgija |
| Subjects: | |
| Online Access: | https://www.journals.vu.lt/lietuvos-chirurgija/article/view/27421 |
| _version_ | 1811303203343433728 |
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| author | Gabrielė Cibulskaitė Rokas Stulpinas Eligijus Poškus Skaistė Tulytė Ugnius Mickys |
| author_facet | Gabrielė Cibulskaitė Rokas Stulpinas Eligijus Poškus Skaistė Tulytė Ugnius Mickys |
| author_sort | Gabrielė Cibulskaitė |
| collection | DOAJ |
| description |
MiNEN (mixed neuroendocrine-non-neuroendocrine neoplasm) is described in the 5th edition WHO classification of tumors of the digestive system as a mixed neoplasm, composed of neuroendocrine and non-neuroendocrine parts, each accounting for at least 30% of the tumor. Recently this formal criterion has been criticized based on the theory that both of these components could have a monoclonal origin and non-neuroendocrine cells develop neuroendocrinicity in the later evolutionary steps of adenocarcinoma. For this reason, the identification of pure adenocarcinoma component, that was overgrown by a more aggressive clone with neuroendocrine features, in a pathological specimen can be difficult and, in some cases, even impossible. So, it is likely that at least some of large cell neuroendocrine carcinomas follow the same pathway, a theory that is further supported by adenocarcinoma-like molecular alterations in these tumors. Precise diagnosis (which means identifying and naming each tumor component regardless of its size) is essential for a personalized treatment strategy. We present an illustrative case of a rectal neoplasm that could be classified as a poorly differentiated neuroendocrine carcinoma, but exhibits morphological heterogeneity, mucin production and has a typical KRAS mutation pointing to adenocarcinomatous origin, which makes MiNEN a more accurate diagnosis. The article discusses the key points in classification, pathogenesis, and diagnostic approach to help effectively manage such neoplasms.
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| first_indexed | 2024-04-13T07:42:35Z |
| format | Article |
| id | doaj.art-86f8ae3f923d42d7b9f37733592c32cc |
| institution | Directory Open Access Journal |
| issn | 1392-0995 1648-9942 |
| language | English |
| last_indexed | 2024-04-13T07:42:35Z |
| publishDate | 2022-04-01 |
| publisher | Vilnius University Press |
| record_format | Article |
| series | Lietuvos Chirurgija |
| spelling | doaj.art-86f8ae3f923d42d7b9f37733592c32cc2022-12-22T02:55:50ZengVilnius University PressLietuvos Chirurgija1392-09951648-99422022-04-0121110.15388/LietChirur.2022.21.58Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End?Gabrielė Cibulskaitė0Rokas Stulpinas1Eligijus Poškus2Skaistė Tulytė3Ugnius Mickys4Vilnius University, LithuaniaVilnius University, LithuaniaVilnius University, LithuaniaVilnius University, LithuaniaVilnius University, Lithuania MiNEN (mixed neuroendocrine-non-neuroendocrine neoplasm) is described in the 5th edition WHO classification of tumors of the digestive system as a mixed neoplasm, composed of neuroendocrine and non-neuroendocrine parts, each accounting for at least 30% of the tumor. Recently this formal criterion has been criticized based on the theory that both of these components could have a monoclonal origin and non-neuroendocrine cells develop neuroendocrinicity in the later evolutionary steps of adenocarcinoma. For this reason, the identification of pure adenocarcinoma component, that was overgrown by a more aggressive clone with neuroendocrine features, in a pathological specimen can be difficult and, in some cases, even impossible. So, it is likely that at least some of large cell neuroendocrine carcinomas follow the same pathway, a theory that is further supported by adenocarcinoma-like molecular alterations in these tumors. Precise diagnosis (which means identifying and naming each tumor component regardless of its size) is essential for a personalized treatment strategy. We present an illustrative case of a rectal neoplasm that could be classified as a poorly differentiated neuroendocrine carcinoma, but exhibits morphological heterogeneity, mucin production and has a typical KRAS mutation pointing to adenocarcinomatous origin, which makes MiNEN a more accurate diagnosis. The article discusses the key points in classification, pathogenesis, and diagnostic approach to help effectively manage such neoplasms. https://www.journals.vu.lt/lietuvos-chirurgija/article/view/27421mixed neuroendocrine non-neuroendocrine neoplasmMiNENmixed adeno-neuroendocrine carcinoma MANEClarge cell neuroendocrine carcinomacolorectal neoplasm |
| spellingShingle | Gabrielė Cibulskaitė Rokas Stulpinas Eligijus Poškus Skaistė Tulytė Ugnius Mickys Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? Lietuvos Chirurgija mixed neuroendocrine non-neuroendocrine neoplasm MiNEN mixed adeno-neuroendocrine carcinoma MANEC large cell neuroendocrine carcinoma colorectal neoplasm |
| title | Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? |
| title_full | Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? |
| title_fullStr | Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? |
| title_full_unstemmed | Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? |
| title_short | Colorectal Neoplasm with Predominant Neuroendocrine Immunophenotype: Where does Adenocarcinoma End? |
| title_sort | colorectal neoplasm with predominant neuroendocrine immunophenotype where does adenocarcinoma end |
| topic | mixed neuroendocrine non-neuroendocrine neoplasm MiNEN mixed adeno-neuroendocrine carcinoma MANEC large cell neuroendocrine carcinoma colorectal neoplasm |
| url | https://www.journals.vu.lt/lietuvos-chirurgija/article/view/27421 |
| work_keys_str_mv | AT gabrielecibulskaite colorectalneoplasmwithpredominantneuroendocrineimmunophenotypewheredoesadenocarcinomaend AT rokasstulpinas colorectalneoplasmwithpredominantneuroendocrineimmunophenotypewheredoesadenocarcinomaend AT eligijusposkus colorectalneoplasmwithpredominantneuroendocrineimmunophenotypewheredoesadenocarcinomaend AT skaistetulyte colorectalneoplasmwithpredominantneuroendocrineimmunophenotypewheredoesadenocarcinomaend AT ugniusmickys colorectalneoplasmwithpredominantneuroendocrineimmunophenotypewheredoesadenocarcinomaend |