Gastrointestinal neuro-endocrine tumors: retrospective study of 36 cases

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Published Dec 20, 2017
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Vol. 95 No. 6 (2017): Issue Jun 2017

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Alia Zehani
Sarra Aloui
Ines Chelly
Slim Haouet
Nidhameddine Kchir

Abstract


Background: Neuroendocrine tumors (NETs) of the gastrointestinal tract are a heterogeneous group of tumors which have different malignant potential and evolution. The World Health Organization (WHO) has set up a new classification of gastrointestinal NETs in 2010. However, it does not evaluate the risk of malignancy for each tumor.
Aim: To evaluate the prognostic impact of the WHO classification in 2010 by reclassifying the tumor according to new recommendations and to identify histoprognostic factors to better predict changes.
Methods: This is a descriptive retrospective study of 36 cases of gastrointestinal NETs, collected at the pathological anatomy department in Rabta hospital, over a period of 11 years from 2003 to 2013.
Results: Our series included 11 NETs of Appendix, nine of the pancreas, seven of the small bowel, four of the stomach, three of the rectum, one of the colon and one of the esophagus. The mean age of patients across all sites, was 50.3 years old and the sex ratio was 0,44. The tumors were classified according to the 2010 WHO classification. They were divided into: G1 in 27 cases (75%); G2 in three cases (8.3%); G3 small cell carcinoma in two cases (5.6%); G3 large cell carcinoma in one case (2.8%) and mixed adeno-neuroendocrine carcinoma in three cases (8.3%).
Conclusion: Our study has shown limits of the latest 2010 WHO classification of NETs. The prognosis of these tumors could be better predicted by the evaluation of other histoprognostic factors and by the improvement of criteria defining histological degrees including tumor size.

Keywords:

neuroendocrine tumor; gastrointestinal tract; prognosis; immunohistochemistry

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References

  1. Modlin IM, Oberg K, Chung DC, Jensen RT, de Herder WW, Thak-ker RV, et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 2008;9:61-72.
  2. Yacoub M, Laban E, Taris M, Debiais C, Jamet C, Levillain P. Classification et aspects anatomopathologiques des tumeurs endocrines digestives. Med Nucl. 2009;33:680-8.
  3. Couvelard A, Scoazec JY. Une nouvelle classification OMS des tumeurs (neuro) endocrines digestives. Ann pathol. 2011;31:88-92.
  4. Maggard MA, O'Connell JB, Ko CY. Updated Population-Based Review of Carcinoid Tumors. Ann Surg. 2004;240:117-22.
  5. Modlin IM, Lye KD, Kidd M. A 5-Decade Analysis of 13715 Carcinoid Tumors. Cancer. 2003;97:934-59.
  6. Lepage C1, Bouvier AM, Phelip JM, Hatem C, Vernet C, Faivre J. Incidence and management of malignant digestive endocrine tumours in a well-defined French population. Gut. 2004;53:549-53.
  7. Estrozi B, Bacchi CE. Neuroendocrine tumors involving the gastroenteropancreatic tract: a clinic pathological evaluation of 773 cases. CLINICS 2011; 66(10): 1671-5.
  8. Eriksson B, Oberg K, Skogseid B. Neuroendocrine Pancreatic Tumors. Acta Oncol 1989; 28: 373-7.
  9. Bado A, Chayvialle AJ. Peptides digestifs. Encycl Med Chir. (Elsevier Masson, Paris), Gastro-entérologie, 9-000-B-40, 2011, 9p
  10. Chanson P, Murat A, Cadiot G, Calender A. Néoplasie endocrinienne multiple de type 1. Encycl Med Chir. Endocrinologie-Nutrition, 10-036-A-05, 2009, 12p.
  11. Öberg K. The Genetics of Neuroendocrine Tumors. Semin Oncol 2013; 40: 37-44.
  12. Scalzi ES, Ychou M. Marqueurs tumoraux et cancer du tractus gastro-intestinal. Encycl Med Chir. (Elsevier Masson, Paris), Gastro-entérologie, 9-000-E-22, 2009, 13p.
  13. Tasu JP, Ramirez M, Raban N. Imagerie des tumeurs endocrines digestives : le point de vue du radiologue. Med Nucl. 2009;33:695-705.
  14. Vullierme PM. Diagnostic bilan d'extension et suivi des tumeurs Neuroendocrine malignes: Intérêt de l'examen radiologique. Ann Pathol. 2011;31:81-2.
  15. Leung D, Schwartz L. Imaging of Neuroendocrine Tumors. Semin Oncol 2013; 40: 109-19.
  16. Sozac JY, Clouverd A. Tumeurs neuroendocrines du tube digestif et du pancréas : ce que le pathologiste doit savoir et doit faire en 2014. Ann Pathol. 2014;34(1):40-50.
  17. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th edition. New York: Wiley; 2009.
  18. Rindi G, Kloppel G, Couvelard A, Komminoth P, Korner M, Lopes JM, et al. TNM staging of midgut and hindgut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2007;451:757-62.
  19. Pape UF, Jann H, Muller-Nordhorn J, Bockelbrink A, Berndt U, Willich SN et al. Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors. Cancer 2008; 113: 256-65.
  20. Pape UF, Babouri A, Couvelard A. Validation de la nouvelle classification TNM des tumeurs endocrines originaires de l'intestin moyen et postérieur. Gastroenterol Clin Biol 2009; 33: 254.
  21. Terris B. Classification et facteurs pronostiques morphologiques et moléculaires des tumeurs endocrines du pancréas. Ann Pathol 2002; 22: 367-74.
  22. Mitry E, Rougier P. Tumeurs endocrines digestives. Encycl Med Chir. (Elsevier Masson, Paris), Gastro-entérologie, 9-089-C-9, 2007, 15p.
  23. Baudin E, Leboulleux S, Dromain C. Tumeurs endocrines gastro-entéro-pancréatiques : Diagnostic, caractérisation clinique, pronostic et traitement. Encycl Med Chir. (Elsevier Masson, Paris), Endocrinologie Nutrition, 10-036-B-10, 2008, 17p
  24. Rindi G, Couvelard A, Scoazec JY. Évaluation de la malignité dans les tumeurs endocrines digestives : recommandations pratiques. Ann Pathol 2005;25:487-98.
  25. Couvelard A. Ki 67 et tumeurs neuroendocrines. Ann Pathol. 2011;31:55-6.
  26. Yamaguchi T, Fujimori T, Tomita S, Ichikawa K. Clinical validation of the gastrointestinal NET grading system: Ki67 index criteria of the WHO 2010 classification is appropriate to predict metastasis or recurrence. Diagnostic Pathology. 2013;8:65-1.
  27. Klimstra DS. Pathology Reporting of Neuroendcrine Tumors: Essential Elements for Accurate Diagnosis, Classification and staging. Semin Oncol 2013; 40: 23-36.
  28. Couvelard A, Felce-Dachez M, Degott C. Classification histologique des Tumeurs endocrines du pancreas. Gastroenterol Clin Biol 2003; 27: 15-9.
  29. Pavel M, Baudin E, Couvelard A, Krenning E, Öberg K, Steinmüller T et al. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 2012; 95: 157-76.