Stanford School of Medicine

Surgical Pathology Criteria

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Gastric Endocrine Hyperplasia, Dysplasia and Neoplasia

WHO 2010 has changed back to usage of the term Neuroendocrine rather than Endocrine

See: Gastric Neuroendocrine Hyperplasia, Dysplasia, Neoplasia (Carcinoid)

Differential Diagnosis

Determination of common sites of origin for metastatic well differentiated endocrine neoplasms
Lung 40-50% Negative Negative Negative Negative
Pancreas Negative 0-18% 28% 68% 50-67%
Stomach Negative 0-17% 60% Negative 20%
Duodenum Negative 0-17% 60% Negative 100%
Ileum Negative >90% Negative Negative Negative
Appendix Negative >90% 55% Negative 21%
Rectum Negative 0-55% 17% Negative 85%
Detection of specific islet hormones may be useful; PAX8 data has been questioned (see Pancreas).


Determination of common sites of origin for metastatic well differentiated endocrine neoplasms-keratins
  CK7 CK20
Lung Variable Negative
Pancreas Variable Variable
Stomach Variable Negative
Duodenum Negative Variable
Ileum Negative Variable
Appendix Negative Variable
Rectum Variable Variable
CK7/20 staining is only helpful in instances of positivity where a negative result is expected


  • The significance of hyperplasia or dysplasia has not been demonstrated
  • It has been proposed that hyperplasia does not progress to neoplasm, but that dysplasia does
  • It would appear that both would merit followup
  • The behavior of a carcinoid is dependent both upon size and the setting in which it arises (see Diagnostic Criteria)


Gastrointestinal Endocrine Cell Proliferations and Neoplasms


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  • Bordi C, Annibale B, Azzoni C, Marignani M, Ferraro G, Antonelli G, D'Adda T, D'Ambra G, Delle Fave G. Endocrine cell growths in atrophic body gastritis. Critical evaluation of a histological classification. J Pathol. 1997 Jul;182(3):339-46.
  • Reinecke P, Borchard F. Pattern of gastric endocrine cells in microcarcinoidosis--an immunohistochemical study of 14 gastric biopsies. Virchows Arch. 1996 Jul;428(4-5):237-41.
  • Solcia E, Villani L, Luinetti O, Fiocca R. Proton pump inhibitors, enterochromaffin-like cell growth and Helicobacter pylori gastritis. Aliment Pharmacol Ther. 1993;7 Suppl 1:25-8, discussion 29-31.
  • Solcia E, Capella C, Fiocca R, Rindi G, Rosai J. Gastric argyrophil carcinoidosis in patients with Zollinger-Ellison syndrome due to type 1 multiple endocrine neoplasia. A newly recognized association. Am J Surg Pathol. 1990 Jun;14(6):503-13.
  • Itsuno M, Watanabe H, Iwafuchi M, Ito S, Yanaihara N, Sato K, Kikuchi M, Akiyama N. Multiple carcinoids and endocrine cell micronests in type A gastritis. Their morphology, histogenesis, and natural history. Cancer. 1989 Mar 1;63(5):881-90.
  • Alsaad KO, Serra S, Schmitt A, Perren A, Chetty R. Cytokeratins 7 and 20 immunoexpression profile in goblet cell and classical carcinoids of appendix. Endocr Pathol. 2007 Spring;18(1):16-22.
  • Cai YC, Banner B, Glickman J, Odze RD. Cytokeratin 7 and 20 and thyroid transcription factor 1 can help distinguish pulmonary from gastrointestinal carcinoid and pancreatic endocrine tumors. Hum Pathol. 2001 Oct;32(10):1087-93.
  • Srivastava A, Hornick JL. Immunohistochemical staining for CDX-2, PDX-1, NESP-55, and TTF-1 can help distinguish gastrointestinal carcinoid tumors from pancreatic endocrine and pulmonary carcinoid tumors. Am J Surg Pathol. 2009 Apr;33(4):626-32.
  • Rindi G, Solcia E. Endocrine hyperplasia and dysplasia in the pathogenesis of gastrointestinal and pancreatic endocrine tumors. Gastroenterol Clin North Am. 2007 Dec;36(4):851-65.
  • Klöppel G, Anlauf M, Perren A. Endocrine precursor lesions of gastroenteropancreatic neuroendocrine tumors. Endocr Pathol. 2007 Fall;18(3):150-5.
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