GENERAL ENDOCRINE TUMORS CATEGORIES WHO classification 1.Well differentiated endocrine tumor 2.Well...
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Transcript of GENERAL ENDOCRINE TUMORS CATEGORIES WHO classification 1.Well differentiated endocrine tumor 2.Well...
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GENERAL ENDOCRINE TUMORS CATEGORIES
WHO classification
1. Well differentiated endocrine tumor
2. Well differentiated endocrine carcinoma
3. Poorly differentiated endocrine (small cell) carcinoma
4. Mixed exocrine - endocrine tumor
5. Tumor - like lesion
WHO Histological Typing of Endocrine Tumours, 2000/2004
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PURE ENDOCRINE TUMORS The Differentiation Concept
Well differentiated endocrine neoplasm
1 - tumor (carcinoid)
2 - carcinoma (malignant / atypical carcinoid)
Poorly differentiated endocrine carcinoma
3 - small / intermediate cell carcinoma
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GUT ENDOCRINE TUMORS TUMOR GRADING AND CLASSIFICATION
ENETS GRADING PROPOSAL
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ENETS TNM WORKING PROPOSALPANCREAS
Size increase
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ENETS STAGING PROPOSALPANCREAS
Size increase
Mets presence
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GENERAL NEUROENDOCRINE TUMORS CATEGORIES
lung
Well differentiated neuroendocrine neoplasm
1 - tumor (carcinoid)
2 - carcinoma (malignant / atypical carcinoid)
Poorly differentiated endocrine carcinoma
3 - large cell neuroendocrine carcinoma
4 - small / intermediate cell carcinoma
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THE SPECTRUM OF NEUROENDOCRINE PROLIFERATIONS
lung
1. NEUROENDOCRINE CELL HYPERPLASIA AND TUMORLETS
2. TUMORS WITH NEUROENDOCRINE MORPHOLOGY
3. NON-SCLC WITH NEUROENDOCRINE DIFFERENTIATION
4. OTHER TUMORS WITH NEUROENDOCRINE PROPERTIES
Travis et al. WHO Classification of Tumours, 2004
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REQUIRED
THE SPECTRUM OF LUNG NEUROENDOCRINE PROLIFERATIONS
IMMUNOHISTOCHEMISTRY
TC/ACCD56 N-CAM +CgA +Syn +Ki67 low
LCNECCD56 N-CAM +CgA +/-Syn +Ki67 high
SCLCCD56 N-CAM +CgA +/-Syn +Ki67 very high
HMWCK -LMWCK CAM5.2 +P63/Desmocollin -TTF1 usually -
HMWCK -LMWCK CAM5.2 +P63/Desmocollin -TTF1 usually +/-
HMWCK -LMWCK CAM5.2 +P63/Desmocollin -TTF1 usually +
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marker expected positivity
• LDCV antigens WDET/WDEC/PDEC• SSV antigens WDET/WDEC/PDEC• cytosol antigens WDET/WDEC/PDEC• Ki67 index WDET/WDEC/PDEC• P53 WDET/WDEC/PDEC
• hormones WDET/WDEC/PDEC• membrane antigens WDET/WDEC/PDEC
• FAL/AI/CIN WDET/WDEC/PDEC
MARKER EXPRESSION IN ENDOCRINE TUMORS
CD56 n-CAMSST2
(e.g. chromogranin A)
(e.g. synaptophysin)
(e.g. NSE, PGP9.5)
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Well differentiated
Poorly differentiated
(NEURO)ENDOCRINE TUMORSTUMOR GRADING AND CLASSIFICATION
SUMMARY
Differentiation Tumor definition
Carcinoid / TC / WDET
Atypical carcinoid / AC / WDEC
SCNEC / PDEC / LCNEC / SCLC
WHO1/G1
WHO2/G2
WHO3/G3
Grading