Neuroendocrine tumors of the midgut: Difference between revisions

From patholines.org
Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,148 edits
→Stage: Expanded
Mikael Häggström (talk | contribs)
Administrators, Editors, Image-reviewer, csmoderator, Interface administrators, Administrators, Upload Wizard campaign editors
7,148 edits
→Grading: +Mitotic
Line 35: Line 35:
{| class="wikitable"
{| class="wikitable"
|-
|-
! G !! Mitotic count (per 10 HPF) !! Ki-67 index (%)
! G !! Mitotic count (per 2.0mm<sup>2</sup>) !! Ki-67 index (%)
|-
|-
| GX || colspan=2 | Grade cannot be assessed
| GX || colspan=2 | Grade cannot be assessed
Line 48: Line 48:
===Mitotic count===
===Mitotic count===
[[File:Mitoses in neuroendocrine tumor.jpg|thumb|Mitoses in a neuroendocrine tumor.]]
[[File:Mitoses in neuroendocrine tumor.jpg|thumb|Mitoses in a neuroendocrine tumor.]]
At least 40 HPFs should be counted.<ref name="RindiKlöppel2006">{{cite journal|last1=Rindi|first1=G.|last2=Klöppel|first2=G.|last3=Alhman|first3=H.|last4=Caplin|first4=M.|last5=Couvelard|first5=A.|last6=de Herder|first6=W. W.|last7=Erikssson|first7=B.|last8=Falchetti|first8=A.|last9=Falconi|first9=M.|last10=Komminoth|first10=P.|last11=Körner|first11=M.|last12=Lopes|first12=J. M.|last13=McNicol|first13=A-M.|last14=Nilsson|first14=O.|last15=Perren|first15=A.|last16=Scarpa|first16=A.|last17=Scoazec|first17=J-Y.|last18=Wiedenmann|first18=B.|title=TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system|journal=Virchows Archiv|volume=449|issue=4|year=2006|pages=395–401|issn=0945-6317|doi=10.1007/s00428-006-0250-1}}</ref>
The mitotic count should be estimated by counting mitoses over 8 mm<sup>2</sup> (or more), and then dividing that count by 4 (or proportionally more for a larger area).<ref name="mitotic">'''First reference states 40 high power fields (HPFs) and second reference states that one HPF can be assumed to be 0.2 mm<sup>2</sup>''':<br>-{{cite journal|last1=Rindi|first1=G.|last2=Klöppel|first2=G.|last3=Alhman|first3=H.|last4=Caplin|first4=M.|last5=Couvelard|first5=A.|last6=de Herder|first6=W. W.|last7=Erikssson|first7=B.|last8=Falchetti|first8=A.|last9=Falconi|first9=M.|last10=Komminoth|first10=P.|last11=Körner|first11=M.|last12=Lopes|first12=J. M.|last13=McNicol|first13=A-M.|last14=Nilsson|first14=O.|last15=Perren|first15=A.|last16=Scarpa|first16=A.|last17=Scoazec|first17=J-Y.|last18=Wiedenmann|first18=B.|title=TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system|journal=Virchows Archiv|volume=449|issue=4|year=2006|pages=395–401|issn=0945-6317|doi=10.1007/s00428-006-0250-1}}<br>- {{cite journal|last1=Klimstra|first1=David S.|last2=Modlin|first2=Irvin R.|last3=Coppola|first3=Domenico|last4=Lloyd|first4=Ricardo V.|last5=Suster|first5=Saul|title=The Pathologic Classification of Neuroendocrine Tumors|journal=Pancreas|volume=39|issue=6|year=2010|pages=707–712|issn=0885-3177|doi=10.1097/MPA.0b013e3181ec124e}}</ref> {{Further|Evaluation#Counts per mm2}}
 
The mitotic count applies to a HPF area 0.2 mm<sup>2</sup>.<ref name="KlimstraModlin2010">{{cite journal|last1=Klimstra|first1=David S.|last2=Modlin|first2=Irvin R.|last3=Coppola|first3=Domenico|last4=Lloyd|first4=Ricardo V.|last5=Suster|first5=Saul|title=The Pathologic Classification of Neuroendocrine Tumors|journal=Pancreas|volume=39|issue=6|year=2010|pages=707–712|issn=0885-3177|doi=10.1097/MPA.0b013e3181ec124e}}</ref> Thus, calculation of the mitotic count varies for different microscope types:
{|class="wikitable"
! Microscope type !! Area per HPF !! Mitotic count calculation<br>(Mitoses/10HPF)
|-
|
*Olympus BX50, BX40 or BH2 or AO or Nikon with 15x eyepiece
*Olympus BX43 with 10x eyepiece
| 0.096 mm<sup>2</sup> <ref name=stanford>{{cite web|url=http://surgpathcriteria.stanford.edu/breast/infductcabr/grading.html|title=Infiltrating Ductal Carcinoma of the Breast (Carcinoma of No Special Type)|website=Stanford University School of Medicine|accessdate=2019-10-02}}</ref> || Mitoses in 40 HPFs x 0.52
|-
| AO with 10x eyepiece || 0.12 mm<sup>2</sup> <ref name=stanford/> || Mitoses in 40 HPFs x 0.41
|-
| Nikon Eclipse E400 with 10x eyepiece and 40x objective || 0.25 mm<sup>2</sup> || Mitoses in 40 HPFs x 0.20
|-
| Leitz Ortholux || 0.27 mm<sup>2</sup> <ref name=stanford/> || Mitoses in 40 HPFs x 0.19
|-
| Leitz Diaplan || 0.31 mm<sup>2</sup> <ref name=stanford/> || Mitoses in 40 HPFs x 0.16
|}


===Ki-67 index===
===Ki-67 index===

Revision as of 20:07, 22 November 2021

Author: Mikael Häggström [note 1]

File:Histopathology of small intestinal well-differentiated grade 1 (G1) carcinoid.jpg
Well-differentiated grade 1 (G1) neuroendocrine tumor (carcinoid)

The processing of neuroendocrine tumors (NET) of the midgut includes:

  • Gross processing
  • Microscopic evaluation
  • Immunohistochemistry
  • For diagnosis if not clear from initial microscopy
  • Grading

Gross processing

See Intestine with tumor

Microscopic evaluation

Characteristics:[1]

  • Round regular nuclei
  • Stippled (salt and pepper) chromatin
  • Moderate to abundant cytoplasm

Diagnostic immunohistochemistry

If the diagnosis is not clear from light microscopy:

  • Argyrophil: positive in almost all cases[1]
  • Argentaffin mostly positive[1]
  • Neuron specific enolase, PGP9.5 and CD56 are sensitive but unspecific.[1]

Grading

Neuroendocrine lesions are graded histologically according to markers of cellular proliferation, rather than cellular polymorphism. For this purpose, it is recommended that mitotic count and Ki-67 index is determined for all gastroenteropancreatic neuroendocrine neoplasms:[2]

G Mitotic count (per 2.0mm2) Ki-67 index (%)
GX Grade cannot be assessed
G1 < 2 < 3%
G2 2 to 20 3% - 20%
G3 > 20 > 20%

Mitotic count

File:Mitoses in neuroendocrine tumor.jpg
Mitoses in a neuroendocrine tumor.

The mitotic count should be estimated by counting mitoses over 8 mm2 (or more), and then dividing that count by 4 (or proportionally more for a larger area).[3] Further information: Evaluation#Counts per mm2

Ki-67 index

File:Counting Ki-67 index in immunohistochemistry.jpg
Counting Ki-67 index. To count as positive, a nucleus should be:
- Homogenously darkly stained (not just stippled).
- Not be located in stroma.
- Be at least half within the field of view.
- Be large enough.

The counting is made in areas with the highest concentration of Ki-67 positive cells, called "hot spots".[4]

The main methods are:

  • 'Eye-balling' , which is apparently the most common method for determining the Ki-67 index. In 'eye-balling', an impression is made without actually counting individual cells. It can be done on one single view intermediate power (× 10 objective), or by scrolling at higher magnification.[4]
  • Manual counting, which is indicated if eye-balling is within a factor of 2 from any grading limit (such as between 1.5% and 6%). It should be done by photographing (and perhaps printing) the slide so that cells can be marked as they are counted.[4] Officially, at least 500 cells should be counted.[5]

If the mitotic count and Ki-67 index are discordant, the figure which gives the highest grade is used.

G1 and G2 neuroendocrine neoplasms are called neuroendocrine tumors (NETs).[notes 1] G3 neoplasms are called neuroendocrine carcinomas (NECs).

Stage

Use the AJCC standard, and take both gross and microscopic evaluation into account:[6]

Primary Tumor (T)
T Category Tumor Criteria
TX Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Invades the lamina propria or submucosa, and less than or equal to 1 cm in size
T2 Invades the muscularis propria, or greater than 1 cm in size
T3 Invades through the muscularis propria into subserosal tissue without penetration of overlying serosa
T4 Invades visceral peritoneum (serosal) or other organs or adjacent structures
Regional Lymph Node (N)
N Category N Criteria
NX Regional lymph nodes cannot be assessed (including no lymph nodes submitted or found)
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis less than 12 nodes
N2 Large mesenteric masses (> 2 cm) and / or extensive nodal deposits (12 or greater), especially those that encase the superior mesenteric vessels

Mesenteric lymph node metastasis from neuroendocrine tumors of the midgut:

Report

It should include:

  • Diagnosis of neuroendocrine tumor
  • Grade
  • T and N stage by AJCC standard
  • Whether the resection is radical

Notes

  1. ↑ Neuroendocrine tumors of the intestines were formerly called carcinoid tumours
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Cite error: Invalid <ref> tag; no text was provided for refs named stanford
  2. ↑ >WHO Classification of Tumours of the Digestive System (4 ed.). Lyon: International Agency for Research on Cancer. 2010. pp. 13–14. ISBN 978-92-832-2432-7. 
  3. ↑ First reference states 40 high power fields (HPFs) and second reference states that one HPF can be assumed to be 0.2 mm2:
    -Rindi, G.; Klöppel, G.; Alhman, H.; Caplin, M.; Couvelard, A.; de Herder, W. W.; Erikssson, B.; Falchetti, A.; et al. (2006). "TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system ". Virchows Archiv 449 (4): 395–401. doi:10.1007/s00428-006-0250-1. ISSN 0945-6317. 
    - Klimstra, David S.; Modlin, Irvin R.; Coppola, Domenico; Lloyd, Ricardo V.; Suster, Saul (2010). "The Pathologic Classification of Neuroendocrine Tumors ". Pancreas 39 (6): 707–712. doi:10.1097/MPA.0b013e3181ec124e. ISSN 0885-3177. 
  4. ↑ 4.0 4.1 4.2 Reid, Michelle D; Bagci, Pelin; Ohike, Nobuyuki; Saka, Burcu; Erbarut Seven, Ipek; Dursun, Nevra; Balci, Serdar; Gucer, Hasan; et al. (2014). "Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies ". Modern Pathology 28 (5): 686–694. doi:10.1038/modpathol.2014.156. ISSN 0893-3952. 
  5. ↑ Basile, Maíra Leite; Kuga, Fábio Seiji; Del Carlo Bernardi, Fabíola (2019). "Comparation of the quantification of the proliferative index KI67 between eyeball and semi-automated digital analysis in gastro-intestinal neuroendrocrine tumors ". Surgical and Experimental Pathology 2 (1). doi:10.1186/s42047-019-0045-8. ISSN 2520-8454. 
  6. ↑ AJCC, 8th edition: "29 - Neuroendocrine Tumors of the Stomach". AJCC Cancer Staging Manual (8 ed.). Springer. 2017. pp. 355. ISBN 978-3-319-40617-6. 

Image sources


Retrieved from "https://patholines.org/index.php?title=Neuroendocrine_tumors_of_the_midgut&oldid=4261"