Neuroendocrine tumour of the pancreas - Revision history

Brigitte: /* WHO classification of 2017 */

2019-03-03T20:21:02Z

WHO classification of 2017

← Older revision		Revision as of 20:21, 3 March 2019
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	===WHO classification of 2017===		===WHO classification of 2017===
	Five ~~categorizes~~:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->		Five categories:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->
	*NET G1.		*NET G1. Ki67 Index < 3%, Mitotic Index < 2/10HPF
	*NET G2.		*NET G2. Ki67 Index 3-20%, Mitotic Index 2-20/10HPF
	*NET G3.		*NET G3. Ki67 Index > 20%, Mitotic Index > 20/10 HPF AND well-differentiated, expressing neuroendocrine differentiation and hormones
	*Neuroendocrine carcinoma.		*Neuroendocrine carcinoma (NEC G3). Ki 67 Index > 20%, Mitotic Index > 20/10 HPF Poorly differentiated, expressing neuroendocrine differentiation but lacking exocrine markers.
	*[[MiNEN]].		*[[MiNEN]]. mixed endocrine-nonendocrine neoplasm: components of a non-endocrine carcinoma (mostly ductal adenocarcinoma or acinar cell carcinoma) combined with a neuroendocrine neoplasm

	===Classification by product===		===Classification by product===

Michael: /* IHC */

2018-05-08T19:02:51Z

IHC

← Older revision		Revision as of 19:02, 8 May 2018
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	*Synaptophysin +ve.		*Synaptophysin +ve.
	*CD56 +ve.		*CD56 +ve.
	*[[PAX8]] +ve.<ref name=pmid20890270>{{Cite journal \| last1 = Sangoi \| first1 = AR. \| last2 = Ohgami \| first2 = RS. \| last3 = Pai \| first3 = RK. \| last4 = Beck \| first4 = AH. \| last5 = McKenney \| first5 = JK. \| last6 = Pai \| first6 = RK. \| title = PAX8 expression reliably distinguishes pancreatic well-differentiated neuroendocrine tumors from ileal and pulmonary well-differentiated neuroendocrine tumors and pancreatic acinar cell carcinoma. \| journal = Mod Pathol \| volume = 24 \| issue = 3 \| pages = 412-24 \| month = Mar \| year = 2011 \| doi = 10.1038/modpathol.2010.176 \| PMID = 20890270 }}</ref>		*[[PAX8]] +ve (74% of cases<ref name=pmid20890270>{{Cite journal \| last1 = Sangoi \| first1 = AR. \| last2 = Ohgami \| first2 = RS. \| last3 = Pai \| first3 = RK. \| last4 = Beck \| first4 = AH. \| last5 = McKenney \| first5 = JK. \| last6 = Pai \| first6 = RK. \| title = PAX8 expression reliably distinguishes pancreatic well-differentiated neuroendocrine tumors from ileal and pulmonary well-differentiated neuroendocrine tumors and pancreatic acinar cell carcinoma. \| journal = Mod Pathol \| volume = 24 \| issue = 3 \| pages = 412-24 \| month = Mar \| year = 2011 \| doi = 10.1038/modpathol.2010.176 \| PMID = 20890270 }}</ref>).

	Functional tumours:		Functional tumours:

Michael: /* IHC */

2018-05-08T19:01:34Z

IHC

← Older revision		Revision as of 19:01, 8 May 2018
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	*Synaptophysin +ve.		*Synaptophysin +ve.
	*CD56 +ve.		*CD56 +ve.
			*[[PAX8]] +ve.<ref name=pmid20890270>{{Cite journal \| last1 = Sangoi \| first1 = AR. \| last2 = Ohgami \| first2 = RS. \| last3 = Pai \| first3 = RK. \| last4 = Beck \| first4 = AH. \| last5 = McKenney \| first5 = JK. \| last6 = Pai \| first6 = RK. \| title = PAX8 expression reliably distinguishes pancreatic well-differentiated neuroendocrine tumors from ileal and pulmonary well-differentiated neuroendocrine tumors and pancreatic acinar cell carcinoma. \| journal = Mod Pathol \| volume = 24 \| issue = 3 \| pages = 412-24 \| month = Mar \| year = 2011 \| doi = 10.1038/modpathol.2010.176 \| PMID = 20890270 }}</ref>

	Functional tumours:		Functional tumours:

Michael: /* WHO classification of 2017 */

2017-09-03T16:32:49Z

WHO classification of 2017

← Older revision		Revision as of 16:32, 3 September 2017
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	===WHO classification of 2017===		===WHO classification of 2017===
	Five categorizes:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->		Five categorizes:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->
	*~~NET1~~.		*NET G1.
	*~~NET2~~.		*NET G2.
	*~~NET3~~.		*NET G3.
	*Neuroendocrine carcinoma.		*Neuroendocrine carcinoma.
	*[[MiNEN]].		*[[MiNEN]].

Michael: /* General */

2017-09-03T16:31:50Z

General

← Older revision		Revision as of 16:31, 3 September 2017
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	**[[Neurofibromatosis type 1]].<ref name=pmid15249710>{{Cite journal \| last1 = Alexakis \| first1 = N. \| last2 = Connor \| first2 = S. \| last3 = Ghaneh \| first3 = P. \| last4 = Lombard \| first4 = M. \| last5 = Smart \| first5 = HL. \| last6 = Evans \| first6 = J. \| last7 = Hughes \| first7 = M. \| last8 = Garvey \| first8 = CJ. \| last9 = Vora \| first9 = J. \| title = Hereditary pancreatic endocrine tumours. \| journal = Pancreatology \| volume = 4 \| issue = 5 \| pages = 417-33; discussion 434-5 \| month = \| year = 2004 \| doi = 10.1159/000079616 \| PMID = 15249710 }}</ref>		**[[Neurofibromatosis type 1]].<ref name=pmid15249710>{{Cite journal \| last1 = Alexakis \| first1 = N. \| last2 = Connor \| first2 = S. \| last3 = Ghaneh \| first3 = P. \| last4 = Lombard \| first4 = M. \| last5 = Smart \| first5 = HL. \| last6 = Evans \| first6 = J. \| last7 = Hughes \| first7 = M. \| last8 = Garvey \| first8 = CJ. \| last9 = Vora \| first9 = J. \| title = Hereditary pancreatic endocrine tumours. \| journal = Pancreatology \| volume = 4 \| issue = 5 \| pages = 417-33; discussion 434-5 \| month = \| year = 2004 \| doi = 10.1159/000079616 \| PMID = 15249710 }}</ref>

	===Classification===		===WHO classification of 2017===
			Five categorizes:<!-- https://www.esp-congress.org/fileadmin/user_upload/Congress_2016/IAP_ESP_Presentations/Mon/0830-1200/SY-02/SY-02-004-Kl%C3%B6ppel-Update%20of%20WHO%20classification%20of%20endocrine%20pancreatic%20tumours.pdf -->
			*NET1.
			*NET2.
			*NET3.
			*Neuroendocrine carcinoma.
			*[[MiNEN]].

			===Classification by product===
	Based on peptide produced in the pancreatic islets:		Based on peptide produced in the pancreatic islets:
	#Glucagon from alpha cells ([[glucagonoma]]).		#Glucagon from alpha cells ([[glucagonoma]]).

Mitchell: /* Images */ Added low grade pancreatic neuroendocrine tumor

2016-11-23T22:31:36Z

Images: Added low grade pancreatic neuroendocrine tumor

← Older revision		Revision as of 22:31, 23 November 2016
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	Image: Pancreatic neuroendocrine tumour - 2 -- high mag.jpg \| Pancreatic NET - high mag. (WC/Nephron)		Image: Pancreatic neuroendocrine tumour - 2 -- high mag.jpg \| Pancreatic NET - high mag. (WC/Nephron)
	</gallery>		</gallery>

			[[File: PANC NET LG 1 sl 1.png\| Low grade pancreatic neuroendocrine tumor]]
			[[File: PANC NET LG 1 sl 2.png\| Low grade pancreatic neuroendocrine tumor]]
			[[File: PANC NET LG 1 sl 3.png\| Low grade pancreatic neuroendocrine tumor]]
			[[File: PANC NET LG 1 sl 4.png\| Low grade pancreatic neuroendocrine tumor]]
			[[File: PANC NET LG 1 sl 5.png\| Low grade pancreatic neuroendocrine tumor]]

			Low grade pancreatic neuroendocrine tumor. A. Stromal trabeculums (black arrows) support the uniform, non-necrotic tumor that has sharp edges (green arrows). B. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. C. Immunostain. Cytoplasm is diffusely synaptophysin positive. D. Immunostain. Cytoplasm shows stippled chromogranin positivity. E. Immunostain. Only scattered nuclei are Ki67 positive.


	www:		www:
	*[http://path.upmc.edu/cases/case172/micro.html Islet cell tumour (upmc.edu)].		*[http://path.upmc.edu/cases/case172/micro.html Islet cell tumour (upmc.edu)].

Michael: fix ref

2016-05-21T04:39:12Z

fix ref

← Older revision		Revision as of 04:39, 21 May 2016
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	==Gross==		==Gross==
	*Usually in the head of the pancreas - 68% in one series,<ref name=pmid22869477>{{Cite journal \| last1 = Oh \| first1 = TG. \| last2 = Chung \| first2 = MJ. \| last3 = Park \| first3 = JY. \| last4 = Bang \| first4 = SM. \| last5 = Park \| first5 = SW. \| last6 = Chung \| first6 = JB. \| last7 = Song \| first7 = SY. \| title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. \| journal = Yonsei Med J \| volume = 53 \| issue = 5 \| pages = 944-51 \| month = Sep \| year = 2012 \| doi = 10.3349/ymj.2012.53.5.944 \| PMID = 22869477 \| PMC = 3423842}}</ref> and 50% in another series.<ref name=pmid22869477>{{Cite journal \| last1 = Oh \| first1 = TG. \| last2 = Chung \| first2 = MJ. \| last3 = Park \| first3 = JY. \| last4 = Bang \| first4 = SM. \| last5 = Park \| first5 = SW. \| last6 = Chung \| first6 = JB. \| last7 = Song \| first7 = SY. \| title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. \| journal = Yonsei Med J \| volume = 53 \| issue = 5 \| pages = 944-51 \| month = Sep \| year = 2012 \| doi = 10.3349/ymj.2012.53.5.944 \| PMID = 22869477 }}</~~ref~~>		*Usually in the head of the pancreas - 68% in one series,<ref name=pmid22869477>{{Cite journal \| last1 = Oh \| first1 = TG. \| last2 = Chung \| first2 = MJ. \| last3 = Park \| first3 = JY. \| last4 = Bang \| first4 = SM. \| last5 = Park \| first5 = SW. \| last6 = Chung \| first6 = JB. \| last7 = Song \| first7 = SY. \| title = Prognostic factors and characteristics of pancreatic neuroendocrine tumors: single center experience. \| journal = Yonsei Med J \| volume = 53 \| issue = 5 \| pages = 944-51 \| month = Sep \| year = 2012 \| doi = 10.3349/ymj.2012.53.5.944 \| PMID = 22869477 \| PMC = 3423842}}</ref> and 50% in another series.<ref name=pmid22869477/>

	==Microscopic==		==Microscopic==
	Features:		Features:

Michael: +images

2014-11-15T07:20:30Z

+images

← Older revision		Revision as of 07:20, 15 November 2014
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	{{ Infobox diagnosis		{{ Infobox diagnosis
	\| Name = {{PAGENAME}}		\| Name = {{PAGENAME}}
	\| Image = Pancreatic ~~insulinoma (~~2).~~JPG~~		\| Image = Pancreatic neuroendocrine tumour - 2 -- high mag.jpg
	\| Width =		\| Width =
	\| Caption = Pancreatic neuroendocrine tumour ~~(insulinoma)~~. [[H&E stain]].		\| Caption = Pancreatic neuroendocrine tumour. [[H&E stain]].
	\| Synonyms = pancreatic islet cell tumour (obsolete term)		\| Synonyms = pancreatic islet cell tumour (obsolete term)
	\| Micro = nests of cells or cords, stippled chromatin, moderate quantity of cytoplasm, +/-hyaline globules		\| Micro = nests of cells or cords, stippled chromatin, moderate quantity of cytoplasm, +/-hyaline globules
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	Image: Pancreatic insulinoma (3) Chromogranin A.JPG \| Insulinoma - chromogranin A. (WC)		Image: Pancreatic insulinoma (3) Chromogranin A.JPG \| Insulinoma - chromogranin A. (WC)
	Image: Pancreatic insulinoma (4) Insulin immuostain.JPG \| Insulinoma - insulin IHC. (WC)		Image: Pancreatic insulinoma (4) Insulin immuostain.JPG \| Insulinoma - insulin IHC. (WC)
			</gallery>
			<gallery>
			Image: Pancreatic neuroendocrine tumour -- very low mag.jpg \| Pancreatic NET - very low mag. (WC/Nephron)
			Image: Pancreatic neuroendocrine tumour -- low mag.jpg \| Pancreatic NET - low mag. (WC/Nephron)
			Image: Pancreatic neuroendocrine tumour -- intermed mag.jpg \| Pancreatic NET - intermed. mag. (WC/Nephron)
			Image: Pancreatic neuroendocrine tumour - alt -- intermed mag.jpg \| Pancreatic NET - intermed. (WC/Nephron) mag.
			Image: Pancreatic neuroendocrine tumour -- high mag.jpg \| Pancreatic NET - high mag. (WC/Nephron)
			Image: Pancreatic neuroendocrine tumour -- very high mag.jpg \| Pancreatic NET - very high mag. (WC/Nephron)

			Image: Pancreatic neuroendocrine tumour - 2 -- intermed mag.jpg \| Pancreatic NET - intermed. mag. (WC/Nephron)
			Image: Pancreatic neuroendocrine tumour - 2 -- high mag.jpg \| Pancreatic NET - high mag. (WC/Nephron)
	</gallery>		</gallery>
	www:		www:

Michael: /* IHC */

2014-03-14T12:04:11Z

IHC

← Older revision		Revision as of 12:04, 14 March 2014
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	==IHC==		==IHC==
	*CK19 +ve ~~-- should be done as~~ a ~~routine in pancreatic NETs;~~ poor prognostic factor.<ref name=pmid19956064>{{Cite journal \| last1 = Jain \| first1 = R. \| last2 = Fischer \| first2 = S. \| last3 = Serra \| first3 = S. \| last4 = Chetty \| first4 = R. \| title = The use of Cytokeratin 19 (CK19) immunohistochemistry in lesions of the pancreas, gastrointestinal tract, and liver. \| journal = Appl Immunohistochem Mol Morphol \| volume = 18 \| issue = 1 \| pages = 9-15 \| month = Jan \| year = 2010 \| doi = 10.1097/PAI.0b013e3181ad36ea \| PMID = 19956064 }}</ref>		*CK19 +ve.
			**Considered a poor prognostic factor<ref name=pmid19956064>{{Cite journal \| last1 = Jain \| first1 = R. \| last2 = Fischer \| first2 = S. \| last3 = Serra \| first3 = S. \| last4 = Chetty \| first4 = R. \| title = The use of Cytokeratin 19 (CK19) immunohistochemistry in lesions of the pancreas, gastrointestinal tract, and liver. \| journal = Appl Immunohistochem Mol Morphol \| volume = 18 \| issue = 1 \| pages = 9-15 \| month = Jan \| year = 2010 \| doi = 10.1097/PAI.0b013e3181ad36ea \| PMID = 19956064 }}</ref> - disputed by an older paper.<ref>{{Cite journal \| last1 = La Rosa \| first1 = S. \| last2 = Rigoli \| first2 = E. \| last3 = Uccella \| first3 = S. \| last4 = Novario \| first4 = R. \| last5 = Capella \| first5 = C. \| title = Prognostic and biological significance of cytokeratin 19 in pancreatic endocrine tumours. \| journal = Histopathology \| volume = 50 \| issue = 5 \| pages = 597-606 \| month = Apr \| year = 2007 \| doi = 10.1111/j.1365-2559.2007.02662.x \| PMID = 17394496 }}</ref>
	*Chromogranin +ve.		*Chromogranin +ve.
	*Synaptophysin +ve.		*Synaptophysin +ve.

Michael: /* IHC */

2014-03-13T18:06:12Z

IHC

← Older revision		Revision as of 18:06, 13 March 2014
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	*Synaptophysin +ve.		*Synaptophysin +ve.
	*CD56 +ve.		*CD56 +ve.

			Functional tumours:
			*Insulin.
			*Glucagon.
			*Somatostatin.
			*Gastrin.

	A panel:		A panel:
	*Chromogranin, synaptophysin, CD10, PR, beta-catenin, CK7, pankeratin, Ki-67, CK19.		*Chromogranin, synaptophysin, CD10, PR, beta-catenin, CK7, pankeratin, Ki-67, CK19.

	~~Note~~:		Notes:
	*''CK19'' should '''not''' be confused with ''CA19-9''.		*''CK19'' should '''not''' be confused with ''CA19-9''.
			*If the tumour is '''not''' functional (clinically) one can forgo the stains for functional tumours.

	==Sign out==		==Sign out==