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

	TTF1	CDX2	PDX1	ISL1	PAX8
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

Clinical

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)

Classification/Lists

Gastrointestinal Endocrine Cell Proliferations and Neoplasms

Well differentiated processes including carcinoids
- Esophagus
  - Very rare
- Stomach
  - Gastric neuroendocrine cell hyperplasia and dysplasia
  - Carcinoid
- Duodenum and proximal jejunum
  - Predominantly ampullary
    - Somatostatinoma
    - Gangliocytic paraganglioma
  - Duodenum NOS and proximal jejunum
    - Gastrin cell neoplasm see also Zollinger Ellison syndrome
- Ileum and distal jejunum and cecum
  - Carcinoid, predominantly enterochromaffin cell, serotonin producing
- Appendix
  - Carcinoid, predominantly enterochromaffin cell, serotonin producing
  - Goblet cell carcinoid
- Large intestine
  - Cecum (see Ileum)
    - Carcinoid, predominantly enterochromaffin cell, serotonin producing
  - Rectum and distal colon
    - Carcinoid, predominantly L cell, glucagon-like peptide and pancreatic peptide (PP) producing
- Anus
  - Very rare
Poorly differentiated neuroendocrine carcinoma, all sites
- Small cell
- Large cell

Bibliography

Hamilton SR, Aaltonen LA eds. Pathology and genetics of tumours of the digestive system. World Health Organization classification of tumours, Vol. 2. Lyon: IARC Press 2000.
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.

Printed from Surgical Pathology Criteria: http://surgpathcriteria.stanford.edu/