Objectives. Terminology 03/11/2013. Pitfalls in the diagnosis of Gastroenteropancreatic Neuroendocrine Tumors. Pathology Update 2013
|
|
- Karen Webb
- 5 years ago
- Views:
Transcription
1 Pitfalls in the diagnosis of Gastroenteropancreatic Neuroendocrine Tumors Pathology Update 2013 Ozgur Mete, MD Consultant in Endocrine Pathology, Department of Pathology, University Health Network Assistant Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto Objectives To review the terminology of neuroendocrine tumors To review the current classification systems To review pitfalls in the diagnosis of neuroendocrine tumors To review the role of ancillary tools To discuss the grading system To be aware of site-specific and grade-dependent staging systems of neuroendocrine tumors Terminology 1
2 Terminology Carcinoid tumor Siegfried Oberndorfer, 1907 No longer acceptable Islet cell tumor No longer acceptable APUDoma No longer acceptable Neuroendocrine tumor/neoplasm Endocrine tumor Neuroendocrine carcinoma Carcinoid, 1907 Carcinoma-like Siegfried Oberndorfer Original sections showing ileal carcinoids from the collection of Siegfried Oberndorfer, obviously provided in 1907 by Robert Rössle ( ). Kloppel et al. Virchows Arch. 2007;451 (Suppl 1): S3-7 Kloppel et al. Virchows Arch. 2007;451 (Suppl 1): S3-7 2
3 Arch Surg 2007;142: WHO 2010 (GEPNET) Neuroendocrine tumor (NET) -NET Grade 1 (ICD-O 8240/3) -NET Grade 2 (ICD-O 8249/3) Neuroendocrine carcinoma (NEC) (ICD-O 8246/3) -Large cell NEC, Grade 3 (ICD-O 8013/3) -Small cell NEC, Grade 3 (ICD-O 8041/3) Morphologic Diagnosis 3
4 How do we diagnose neuroendocrine tumors morphologically? -Growth Patterns -Nuclear Features salt&pepper -Sometimes cytoplasmic granularity and -NEUROENDOCRINE MARKERS Morphologic Features of NETs Histological Growth Patterns Solid/nesting pattern Trabecular/gyriform Glandular Tubular-acinar Cystic Papillary Angiomatoid Mixed patterns Histological patterns are NOT specific for Tumor type or Functional status Exception-Amyloid deposition Insulinoma Exception-Psammoma bodies with glandular structures Somatostatinoma (duodenal) 4
5 Cytological Features of NETs Cytology Usual Salt&Pepper Nuclei Oncocytic and clear cell Spindle cell Rhabdoid Large cell Small cell 1111 Confirm Neuroendocrine and Epithelial differentiation Neuroendocrine Differentiation Synaptophysin Chromogranins *poorly differentiated can be negative *rectal NETs can be negative for chr-a *circulating tumor marker PGP 9.5, CD56, CD57 NESP-55 Histidine decarboxylase, NSE Chromogranin-A Epithelial Differentiation AE1/AE3 CAM5.2 EMA, other keratins.. CAM5.2 Immunohistochemical Diagnosis of NETs Hormones Glucagon, insulin, somatostatin, PP Serotonin, Gastrin, VIP, somatostatin PYY, glucagon like peptide 1, PP Inhibin, bombesin, ACTH, GHRH, CRH, and other ectopic hormones Proliferation Rate Ki67 (MIB-1), phospho-histone3 Predictive Markers DAXX, ATRX, menin: pancreas CK19, CD117: pancreas E cadherin, beta catenin, CEACAM1 mtor pathway Factors that help to characterize Site of Origin TTF 1 in lung, thyroid and others poorly diferantiated neuroendocrine carcinomas PDX 1, islet 1 (Isl 1), and Pax 6/Pax 8 in pancreas Islet 1 (Isl 1) and Pax 8 in rectal NETs CDX 2 in small bowel and pancreas Xenin in duodenum Pit 1, T pit, SF 1 in pituitary Tyrosine hydroxylase in paraganglioma and pheochromocytoma 5
6 The role of Immunohistochemistry in the Diagnosis of GEP-NETs 1. Confirm neuroendocrine differentiation 2. Confirm epithelial differentiation 3. Hormones -Determine the peptide profile -Define precursor lesions -Help to determine certain cell types 4. Determine the cell origin (transcription factors) 5. Determine the proliferative rate 6. Prognosticators Hormone and Transcription Factor e.g. Diffuse CDX 2 and Serotonin in a metastatic small bowel NET SEROTONIN CDX 2* Positive for chromogranin A Positive for synaptophysin Negative for keratins (in this case) Negative for tyrosine hydroxylase Positive for CDX 2 Positive for Serotonin MIB 1 LI is 4% * Nuclear The possibility of a paraganglioma should be excluded in a keratin-negative neuroendocrine tumor Neuroendocrine Tumor, Grade 2 (WHO 2010) or Paraganglioma Clinical management is different for paragangliomas Unlike other NETs, paragangliomas are MIBG-avid Criteria of malignancy in paragangliomas 6
7 Tyrosine Hydroxylase Tyrosine hydroxylase The role of Immunohistochemistry in the Diagnosis of GEP-NETs 1. Confirm neuroendocrine differentiation 2. Confirm epithelial differentiation 3. Hormones -Determine the peptide profile -Define precursor lesions -Help to determine certain cell types 4. Determine the cell origin (transcription factors) 5. Determine the proliferative rate 6. Prognosticators Hormone Immunohistochemistry Assessment of cellular origin of neuroendocrine cell proliferations PPI-related G cell hyperplasia (illustrations) ECL cell hyperplasia, D cell hyperplasia, L cell NET Gastrin Mete & Asa. Pathology 2013; 45(3):
8 Hormone Immunohistochemistry Assessment of Precursor lesions e.g. islet dysplasia, pancreatic endocrine microadenomas Glucagon Insulin Somatostatin PP Glucagon Dysplasia Insulin Dysplasia Somatostatin Dysplasia PP Dysplasia Mete & Asa. Pathology 2013; 45(3): The role of Immunohistochemistry in the Diagnosis of GEP-NETs 1. Confirm neuroendocrine differentiation 2. Confirm epithelial differentiation 3. Hormones -Determine the peptide profile -Define precursor lesions -Help to determine certain cell types 4. Determine the cell origin (transcription factors) 5. Determine the proliferative rate 6. Prognosticators Is this neuroendocrine tumor functional? No clinical evidence of symptoms (surgeon says) Biochemically high PP levels Pancreatic Polypeptide 8
9 Clear cell change: VHL syndrome Rarely in MEN1 syndrome and sporadic NETs inhibin Gucer H et al. Virchows Arch 2013; 463(4): The assessment of the non-tumorous parenchyma can provide critical information! NESIDIOBLASTOSIS (DUCTULO-INSULAR COMPLEXES) Type 1 gastric NET PELIOSIS ECL cell hyperplasia ECL cell hyperplasia Mete & Asa. Pathology 2013; 45(3): Grading & Staging in Gastroenteropancreatic NETs 9
10 Grading of Neuroendocrine Tumors GEP-NETs Tumor grade refers to the degree of biologic aggressiveness and is also related to differentiation but different Tumor differentiation refers to the extent of resemblance to the normal cellular counterpart Grading-GEPNET G1 G2 G3 Mitotic activity <2/10HPF 2-20/10HPF >20/10 HPF Ki-67 index <3% 3-20% >20% Neuroendocrine tumors are malignant!! G1 G2 G3 To count or not to count is not the question, but rather how to count Counting vs eyeballing Manual counting Digital image analysis Ki67 LI assessment percent of 2000 cells in areas of hot spot nuclear labeling tumor heterogeneity Mitotic counting at least 50HPF in areas at highest mitotic density 10
11 Staging of Neuroendocrine Tumors Tumor Stage refers to the extent of the spread of the tumor. The size of the tumor The extent of invasion into the organ of origin The involvement of lymph nodes The involvement of distant sites are crital factors The AJCC/IUCC has recently provided in 2010 the new TNM staging for GEP NETs of different anatomical sites TNM Staging of PETs (G1, G2, G3) TNM T primary tumor (For any T, add (m) for multiple tumors) TX T0 T1 T2 T3 Primary tumor cannot be assessed No evidence of primary tumor Tumor limited to the pancreas and size <2 cm Tumor limited to the pancreas and size >2 cm Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery T4 Tumor involves the celiac axis or the superior mesenteric artery (unresectable) N regional lymph nodes NX Regional lymph node cannot be assessed N0 N1 No regional lymph node metastasis Regional lymph node metastasis M distant metastases MX M0 M1 Distant metastasis cannot be assessed No distant metastases Distant metastasis (indicates the presence of any single or multiple metastases at any distant anatomical site including nonregional nodes) Stage Ia Stage Ib Stage IIa Stage IIb Stage III Stage IV T1,N0 T2,N0 T3,N0 T1-3,N1 T4, Any N, M0 Any T, N M1 AJCC/IUCC 7 th edition 2010 TNM Staging of Gastric NETs (G1, G2) TNM T primary tumor (For any T, add (m) for multiple tumors) TX T0 Tis T1 T2 T3 Primary tumor cannot be assessed No evidence of primary tumor Carcinoma in situ/dysplasia (tumor size < 0.5 mm), confined to mucosa Tumor invades lamina propria or submucosa and 1 cm Tumor invades muscularis propria or tumor size >1 cm Tumor penetrates subserosa T4 Tumor invades visceral peritoneum (serosal) or other organs or adjacent structures N regional lymph nodes NX Regional lymph node cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis M distant metastases MX Distant metastasis cannot be assessed M0 No distant metastases M1 Distant metastasis Stage 0 Stage Ia Stage IIa Stage IIb Stage IIIa Stage IIb Stage IV Tis, NO T1,N0 T2,N0 T3,N0 T4,N0 AnyT, N1, M0 Any T, Any N, M1 AJCC/IUCC 7 th edition
12 TNM Staging of Small Bowel NETs (G1, G2) TNM T primary tumor (For any T, add (m) for multiple tumors) TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tumor invades lamina propria or submucosa and size 1 cm or less (small intestinal tumors); T1 tumor 1 cm or less (ampullary tumors) Tumor invades muscularis propria or tumor size >1 cm (small intestinal tumors); T2 tumor size >1 cm (ampullary tumors) Tumor invades through the muscularis propria into subserosal tissue without penetration of T3 overlying serosa (jejunal or ileal tumors) or invades pancreas or retroperitoneum (ampullary or duodenal tumors) or into non-peritonealized tissues T4 Tumor penetrates visceral peritoneum (serosa) or invades other organs N regional lymph nodes NX Regional lymph node cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis M distant metastases MX Distant metastasis cannot be assessed M0 No distant metastases M1 Distant metastasis Stage Ia Stage IIa Stage IIb Stage IIIa Stage IIb Stage IV T1,N0 T2,N0 T3,N0 T4,N0 AnyT, N1, M0 Any T, Any N, M1 AJCC/IUCC 7 th edition 2010 TNM Staging of Large Bowel NETs (G1, G2) TNM T primary tumor (For any T, add (m) for multiple tumors) TX T0 T1 T1a T1b T2 Primary tumor cannot be assessed No evidence of primary tumor Tumor invades lamina propria or submucosa and size 2 cm Tumor size <1 cm in greatest dimension Tumor size 1 to 2 cm in greatest dimension Tumor invades muscularis propria or size > 2 cm with invasion of lamina propria or submucosa Tumor invades through the muscularis propria into the subserosa, or into non-peritonealized T3 pericolic or perirectal tissues T4 Tumor invades peritoneum or other organs N regional lymph nodes NX Regional lymph node cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis M distant metastases MX Distant metastasis cannot be assessed M0 No distant metastases M1 Distant metastasis Stage Ia Stage IIa Stage IIb Stage IIIa Stage IIb Stage IV T1,N0 T2,N0 T3,N0 T4,N0 Any T, N1, M0 Any T, Any N, M1 AJCC/IUCC 7 th edition 2010 TNM Staging of Appendiceal NETs (G1, G2) TNM T primary tumor (For any T, add (m) for multiple tumors) TX T0 T1 T1a T1b T2 T3 T4 Primary tumor cannot be assessed No evidence of primary tumor Tumor invades lamina propria or submucosa and size 2 cm Tumor size <1 cm in greatest dimension Tumor size 1 to 2 cm in greatest dimension Tumor > 2 cm but 4 cm or with extension to the cecum Tumor > 4 cm or with extension to the ileum Tumor directly invades other adjacent organs or structures, eg, abdominal wall, skeletal muscle N regional lymph nodes NX Regional lymph node cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis M distant metastases MX Distant metastasis cannot be assessed M0 No distant metastases M1 Distant metastasis Stage Ia Stage II Stage III Stage IV T1,N0 T2 or T3,N0 T4,N0 or Any T, N1, M0 Any T, Any N, M1 AJCC/IUCC 7 th edition
13 Conclusions NETs are clinically & pathologically heterogeneous. Functionality depends on the presence of clinical symptoms. However, hormone immunohistochemistry can provide important information. Long term follow-up data indicates that all neuroendocrine tumors are malignant. Grading and Staging are important factors, and they are still evolving in neuroendocrine tumors Grading: Ki67: at least 2000 cells, hot spots Mitotic count: at least 50 HPF, hot spots Staging (TNM): extent of spread of the tumor The status of differentiation should be present in the report. Rule out paraganglioma when dealing with a keratin- and transcription factor-negative NET! Beware of wolves in sheep s clothing in NETs 13
Oberndofer 1907 Illeal Serotonin Secreting Tumor Carcinoid (Karzinoide)
GEP-NET Adel K. El-Naggar, M.D., Ph.D. The University of Texas MD Anderson Cancer Center, Houston, Texas Oberndofer 1907 Illeal Serotonin Secreting Tumor Carcinoid (Karzinoide) 1 Histogenesis 16 different
More informationCRITICAL ANALYSIS OF NEN GUIDELINES. G Pentheroudakis Associate Professsor of Oncology Medical School, University of Ioannina Chair, ESMO Guidelines
CRITICAL ANALYSIS OF NEN GUIDELINES G Pentheroudakis Associate Professsor of Oncology Medical School, University of Ioannina Chair, ESMO Guidelines DISCLOSURES NO CONFLICTS OF INTEREST TO DECLARE UPDATED
More informationGreater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14
Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 14 Contents 14. Neuroendocrine Tumours 161 14.1. Diagnostic algorithm
More informationGastric Cancer Histopathology Reporting Proforma
Gastric Cancer Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given name(s) Date of birth Sex Male Female Intersex/indeterminate
More informationMy personal experience at University of Toronto and recent updates of
My personal experience at University of Toronto and recent updates of Endocrine Pathology Toshitetsu Hayashi M.D. Ph.D. ¹Department of Diagnostic Pathology, Takamatsu Red Cross Hospital, Japan ²Laboratory
More informationNeuroendocrine tumors of GI and Pancreatobiliary tracts. N. Volkan Adsay, MD
Neuroendocrine tumors of GI and Pancreatobiliary tracts N. Volkan Adsay, MD New (2017) WHO WHO 2017 (endocrine book; for pancreas) WHO 2017 (endocrine book; for pancreas) PD-NE ca WD-NE Tumor Intended
More informationGastric Cancer Staging AJCC eighth edition. Duncan McLeod Westmead Hospital, NSW
Gastric Cancer Staging AJCC eighth edition Duncan McLeod Westmead Hospital, NSW Summary of changes New clinical stage prognostic groups, ctnm Postneoadjuvant therapy pathologic stage groupings, yptnm -
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL NEUROENDOCRINE GASTRO-ENTERO-PANCREATIC TUMOURS GI Site Group Neuroendocrine gastro-entero-pancreatic tumours Authors: Dr.
More informationA916: rectum: adenocarcinoma
General facts of colorectal cancer The colon has cecum, ascending, transverse, descending and sigmoid colon sections. Cancer can start in any of the r sections or in the rectum. The wall of each of these
More informationNeuroendocrine Tumors: Just the Basics. George Fisher, MD PhD
Neuroendocrine Tumors: Just the Basics George Fisher, MD PhD Topics that we will not discuss Some types of lung cancer: Small cell neuroendocrine lung cancer Large cell neuroendocrine lung cancer Some
More informationLUNG STAGING FORM LATERALITY: LEFT RIGHT BILATERAL
LUNG STAGING FORM LATERALITY: LEFT RIGHT BILATERAL ( ) Tx Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging
More informationAPPENDIX 5 PATHOLOGY 1. Handling and gross examination of gastrointestinal and pancreatic NETs
APPENDIX 5 PATHOLOGY 1. Handling and gross examination of gastrointestinal and pancreatic NETs Specimen handling and gross examination should be performed according to the Royal College of Pathologists
More informationGOBLET CELL CARCINOID. Hanlin L. Wang, MD, PhD University of California Los Angeles
GOBLET CELL CARCINOID Hanlin L. Wang, MD, PhD University of California Los Angeles Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to
More informationGOBLET CELL CARCINOID
GOBLET CELL CARCINOID Hanlin L. Wang, MD, PhD University of California Los Angeles Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to
More informationImaging in gastric cancer
Imaging in gastric cancer Gastric cancer remains a deadly disease because of late diagnosis. Adenocarcinoma represents 90% of malignant tumors. Diagnosis is based on endoscopic examination with biopsies.
More informationColorectal Cancer Structured Pathology Reporting Proforma DD MM YYYY
Colorectal Cancer Structured Pathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.03). Family name Given name(s) Date of birth DD MM YYYY S1.02 Clinical details
More information3/22/2017. Disclosure of Relevant Financial Relationships. Ki-67 in Pancreatic Neuroendocrine Neoplasms According to WHO 2017.
Disclosure of Relevant Financial Relationships Ki-67 in Pancreatic Neuroendocrine Neoplasms According to WHO 2017. USCAP requires that all planners (Education Committee) in a position to influence or control
More information3/23/2017. Differentiation: Differentiation: Immunohistochemistry. Well Differentiated vs. Poorly Differentiated Neuroendocrine Neoplasms
Disclosure Statement When Immunostains Can Get You Into Trouble (and how they can help you out): Neuroendocrine Neoplasms Arthur Purdy Stout Society March 5, 2017 Dr. Klimstra receives royalty payments
More informationSCOPE TODAYS SESSION. Case 1: Case 2. Basic Theory Stuff: Heavy Stuff. Basic Questions. Basic Questions
MONDAY TEACHING SCOPE TODAYS SESSION Case 1: Basic Questions Case 2 Basic Questions Basic Theory Stuff: AJCC TNM + Stage Group for Carcinoid of the Appendix Management of Carcinoid of the Appendix (NCCN)
More informationColor Codes Pathology and Genetics Medicine and Clinical Pathology Surgery Imaging
Saturday, November 5, 2005 8:30-10:30 a. m. Poorly Differentiated Endocrine Carcinomas Chairman: E. Van Cutsem, Leuven, Belgium 9:00-9:30 a. m. Working Group Sessions Pathology and Genetics Group leaders:
More informationA retrospective analysis of neuroendocrine tumour of pancreas: a single institute study
International Journal of Research in Medical Sciences Chheda YP et al. Int J Res Med Sci. 2015 Nov;3(11):3041-3045 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20150928
More informationTumours of the Oesophagus & Gastro-Oesophageal Junction Histopathology Reporting Proforma
Tumours of the Oesophagus & Gastro-Oesophageal Junction Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given
More informationGastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors
Gastrointestinal Neuroendocrine Tumors: A Closer Look at the Characteristics of These Diverse Tumors Jaume Capdevila, MD, PhD Vall d'hebron University Hospital Vall d'hebron Institute of Oncology (VHIO)
More informationThe College of American Pathologists offers these
Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla Mary Kay Washington, MD, PhD; Laura H. Tang, MD, PhD; Jordan Berlin,
More informationThe Rodger C. Haggitt Memorial Lecture
The Rodger C. Haggitt Memorial Lecture I got an email on 4/22/14 from Hala El Zamaity inviting me to give this lecture and giving me this topic: The ever changing TNM classification and its implication
More informationNET und NEC. Endoscopic and oncologic therapy
NET und NEC Endoscopic and oncologic therapy Classification well-differentiated NET - G1 and G2 - carcinoid poorly-differentiated NEC - G3 - like SCLC well differentiated NET G3 -> elevated proliferation
More informationImmunohistochemical consistency between primary tumors and lymph node metastases of gastric neuroendocrine carcinoma
Uchiyama et al. World Journal of Surgical Oncology 2012, 10:115 WORLD JOURNAL OF SURGICAL ONCOLOGY RESEARCH Open Access Immunohistochemical consistency between primary tumors and lymph node metastases
More informationNeuroEndocrine Tumors Diagnostic and therapeutic challenges: introduction
NeuroEndocrine Tumors Diagnostic and therapeutic challenges: introduction Prof Eric Van Cutsem, MD, PhD Gastroenterology/Digestive Oncology Leuven, Belgium Eric.VanCutsem@uzleuven.be Diagnostic & therapeutic
More informationSelect problems in cystic pancreatic lesions
Disclosure Select problems in cystic pancreatic lesions Five Prime Therapeutics shareholder Adicet Bio shareholder Bristol-Meyer Squibb advisory board grace.kim@ucsf.edu Pancreatic cystic lesions Intraductal
More informationGastric and Oesophageal Neuroendocrine tumours. Dr Tim Bracey, Consultant Pathologist MBChB PhD MRCS FRCPath
Gastric and Oesophageal Neuroendocrine tumours Dr Tim Bracey, Consultant Pathologist MBChB PhD MRCS FRCPath Intestinal (and BO) endocrine cells in crypt bases NE cell (granules towards vessels) Paneth
More informationDisclosure of Relevant Financial Relationships
Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS
More informationWHO e TNM: Importanza della classificazione nell approccio terapeutico
WHO e TNM: Importanza della classificazione nell approccio terapeutico Marco Volante Mauro Papotti Dipartimento di Scienze Cliniche e Biologiche Ospedale San Luigi Orbassano, Torino Rare tumors Heterogeneous
More informationProtocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla
Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Small Intestine and Ampulla Protocol applies to well-differentiated neuroendocrine tumors of
More informationImaging of Neuroendocrine Metastases
Imaging of Neuroendocrine Metastases Aoife Kilcoyne, Shaunagh McDermott, Colin McCarthy,Manuel Patino, Dushyant Sahani, Michael Blake Abdominal Imaging Division Massachusetts General Hospital Disclosure
More informationCollecting Cancer Data: GIST/NET 1/9/14
Collecting Cancer Data: Gastrointestinal Stromal Tumor (GIST) Gastrointestinal Neuroendocrine Tumors (NET) 2013 2014 NAACCR Webinar Series January 9, 2014 Q&A Please submit all questions concerning webinar
More informationFig. 59 Malignant phaeochromocytoma, hepatic metastasis.
Fig. 59 Malignant phaeochromocytoma, hepatic metastasis. X 120 Hyperte nsion Fig. 60 Malignant sympathetic paraganglioma, lymph node metastasis Primary in bladder. x 1 20 Hypertension Fig. 61 Malignant
More informationSmall Intestine. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6 th edition
Small Intestine Protocol applies to all invasive carcinomas of the small intestine, including those with focal endocrine differentiation. Excludes carcinoid tumors, lymphomas, and stromal tumors (sarcomas).
More informationNANETS Treatment Guidelines
NANETS GUIDELINES NANETS Treatment Guidelines Well-Differentiated Neuroendocrine Tumors of the Stomach and Pancreas Matthew H. Kulke, MD,* Lowell B. Anthony, MD,Þ David L. Bushnell, MD,þ Wouter W. de Herder,
More informationPancreatic Cancer: The ABCs of the AJCC and WHO
Pancreatic Cancer: The ABCs of the AJCC and WHO Aatur D. Singhi, MD PhD Assistant Professor University of Pittsburgh Medical Center Department of Pathology singhiad@upmc.edu Case presentation Objectives
More informationGreater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy
Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy Authors: Dr Gordon Armstrong, Dr Sue Pritchard 1. General Comments 1.1 Cancer reporting: Biopsies
More informationRare GI Malignancies
Rare GI Malignancies Jordan Karlitz, MD Associate Professor of Medicine, Division of Gastroenterology Director, Hereditary GI Cancer and Genetics Program Tulane University School of Medicine Outline Gastrointestinal
More informationSurgical Therapy of GEP-NET: An Overview
Surgical Therapy of GEP-NET: An Overview Pierce K.H Chow MBBS, MMed, FRCSE, FAMS, PhD Professor, Duke-NUS Graduate School of Medicine Senior Consultant Surgeon, Singapore General Hospital Visiting Senior
More informationNeuroendocrine Carcinoma. Lebanon Neuroendocrine Neoplasms of H&N Nov /7/2011. Broad Classification:
H&N Neuroendocrine Neoplasms: Classification and Diagnostic Considerations Adel K. El-Naggar, M.D., Ph.D. The University of Texas MD Anderson Cancer Center, Houston, Texas Broad Classification: A. Epithelial:
More informationWhen Immunostains Can Get You Into Trouble (and how they can help you out): Neuroendocrine Neoplasms
When Immunostains Can Get You Into Trouble (and how they can help you out): Neuroendocrine Neoplasms Arthur Purdy Stout Society March 5, 2017 David S. Klimstra, MD Chairman, Department of Pathology James
More information11/21/13 CEA: 1.7 WNL
Case Scenario 1 A 70 year-old white male presented to his primary care physician with a recent history of rectal bleeding. He was referred for imaging and a colonoscopy and was found to have adenocarcinoma.
More informationSmall cell neuroendocrine carcinoma icd 10
Small cell neuroendocrine carcinoma icd 10 1-10-2017 Free, official coding info for 2018 ICD - 10 -CM C34.90 - includes detailed rules, notes, synonyms, ICD -9- crosswalks, DRG. In most series, LCLC's
More informationIndex. Surg Oncol Clin N Am 15 (2006) Note: Page numbers of article titles are in boldface type.
Surg Oncol Clin N Am 15 (2006) 681 685 Index Note: Page numbers of article titles are in boldface type. A Ablative therapy, for liver metastases in patients with neuroendocrine tumors, 517 with radioiodine
More informationMolly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010
LSU HEALTH SCIENCES CENTER NSCLC Guidelines Feist-Weiller Cancer Center Molly Boyd, MD Glenn Mills, MD Syed Jafri, MD 1/1/2010 Initial Evaluation/Intervention: 1. Pathology Review 2. History and Physical
More informationProtocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach
Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach Protocol applies to well-differentiated neuroendocrine tumors of the stomach. Carcinomas
More informationPNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs.
GI and Pancreatic NETs The Postgraduate Course in Breast and Endocrine Surgery Disclosures Ipsen NET Advisory Board Marines Memorial Club and Hotel San Francisco, CA Eric K Nakakura San Francisco, CA March
More informationAppendix 4: WHO Classification of Tumours of the pancreas 17
S3.01 The WHO histological tumour type must be recorded. CS3.01a The histological type of the tumour should be recorded based on the current WHO classification 17 (refer to Appendices 4-7). Appendix 4:
More informationWendy L Frankel. Chair and Distinguished Professor
1 Wendy L Frankel Chair and Distinguished Professor Case 1 59 y/o woman Abdominal pain No personal or family history of cancer History of colon polyps Colonoscopy Polypoid rectosigmoid mass Biopsy 3 4
More informationStaging Challenges in Lower GI Cancers. Disclosure of Relevant Financial Relationships. AJCC 8 th edition and CAP protocol updates
Staging Challenges in Lower GI Cancers Sanjay Kakar, MD University of California, San Francisco March 05, 2017 Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education
More informationPancreas Quizzes c. Both A and B a. Directly into the blood stream (not using ducts)
Pancreas Quizzes Quiz 1 1. The pancreas produces hormones. Which type of hormone producing organ is the pancreas? a. Endocrine b. Exocrine c. Both A and B d. Neither A or B 2. Endocrine indicates hormones
More informationProtocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach
Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Stomach Version: Protocol Posting Date: June 2017 Includes ptnm requirements from the 8 th Edition,
More informationOUTLINE OUTLINE 25/04/2018. Massimo Milione MD, PhD. General Features and Classifications. Ki67 role?
25/04/2018 Massimo Milione MD, PhD Department of Pathology and Laboratory Medicine Fondazione IRCCS Istituto Nazionale Tumori Milano- Italy massimo.milione@istitutotumori.mi.it OUTLINE General Features
More informationDiagnosis abnormal morphology and /or abnormal biochemistry
Diagnosis abnormal morphology and /or abnormal biochemistry MEN 1 GEP Tumours Pancreatico-Nodal (-Duodenal) Affects 35-80% of MEN1 patients Functioning or non functioning Hyperplasia microadenoma macrotumours
More informationPancreatic neuroendocrine cancer with liver metastases and multiple peritoneal metastases: report of one case
Case Report Pancreatic neuroendocrine cancer with liver metastases and multiple peritoneal metastases: report of one case Yang Wang, Dongbing Zhao Department of Abdominal Surgery, Cancer Institute & Hospital,
More informationProtocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Colon and Rectum
Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Colon and Rectum Version: Protocol Posting Date: June 2017 Includes ptnm requirements from the
More informationAJCC 7th Edition Handbook Errata as of 9/21/10
5 81 Larynx ICD-O-3 Topography Codes Delete C32.3 Laryngeal cartilage 5 81 Larynx ICD-O-3 Topography Codes Add an asterisk after C32.8 5 81 Larynx ICD-O-3 Topography Codes Add an asterisk after C32.9 5
More informationGastric Cancer in a Young Postpartum Female. Kings County Hospital Center SUNY Downstate Case Conference May 24, 2012
Gastric Cancer in a Young Postpartum Female Kings County Hospital Center SUNY Downstate Case Conference May 24, 2012 Case HPI: 31 yo F, G5P3, 3 weeks s/p C-section, with gastric outlet obstruction. Pt
More informationAlison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD
November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal
More informationThe pathology of neuroendocrine tumours of the gut
The pathology of neuroendocrine tumours of the gut Professor Neil A Shepherd Gloucester & Cheltenham, UK Histopathology Regional Teaching Bristol May 11 2016 The pathology of neuroendocrine tumours (NETs)
More informationCase year old female presented with asymmetric enlargement of the left lobe of the thyroid
Case 4 22 year old female presented with asymmetric enlargement of the left lobe of the thyroid gland. No information available relative to a prior fine needle aspiration biopsy. A left lobectomy was performed.
More informationDefinition of Synoptic Reporting
Definition of Synoptic Reporting The CAP has developed this list of specific features that define synoptic reporting formatting: 1. All required cancer data from an applicable cancer protocol that are
More informationCase 4 Diagnosis 2/21/2011 TGB
Case 4 22 year old female presented with asymmetric enlargement of the left lobe of the thyroid gland. No information available relative to a prior fine needle aspiration biopsy. A left lobectomy was performed.
More informationColon and Rectum. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6th edition
Colon and Rectum Protocol applies to all invasive carcinomas of the colon and rectum. Carcinoid tumors, lymphomas, sarcomas, and tumors of the vermiform appendix are excluded. Protocol revision date: January
More informationProtocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Duodenum and Ampulla of Vater
Protocol for the Examination of Specimens From Patients With Neuroendocrine Tumors (Carcinoid Tumors) of the Duodenum and Ampulla of Vater Version: Protocol Posting Date: June 2017 Includes ptnm requirements
More informationCarcinoma of the Renal Pelvis and Ureter Histopathology
Carcinoma of the Renal Pelvis and Ureter Histopathology Reporting Proforma (NEPHROURETERECTOMY AND URETERECTOMY) Includes the International Collaboration on Cancer reporting dataset denoted by * Family
More informationAn Unexpected Cause of Hypoglycemia
An Unexpected Cause of Hypoglycemia Stacey A. Milan, MD FACS Surgical Oncology Nothing to disclose Disclosures Objectives Identify indications for workup of hypoglycemia Define work up for hypoglycemic
More informationKidney Case 1 SURGICAL PATHOLOGY REPORT
Kidney Case 1 Surgical Pathology Report February 9, 2007 Clinical History: This 45 year old woman was found to have a left renal mass. CT urography with reconstruction revealed a 2 cm medial mass which
More informationCollaborative Stage for TNM 7 - Revised 06/30/2008 [ Schema ]
Collaborative Stage for TNM 7 - Revised 06/30/2008 [ Schema ] CS Tumor Size 000 No mass/tumor found 001-988 001-988 millimeters (code exact size in millimeters) 989 989 millimeters or larger 990 Microscopic
More information8. The polyp in the illustration can be described as (circle all that apply) a. Exophytic b. Pedunculated c. Sessile d. Frank
Quiz 1 Overview 1. Beginning with the cecum, which is the correct sequence of colon subsites? a. Cecum, ascending, splenic flexure, transverse, hepatic flexure, descending, sigmoid. b. Cecum, ascending,
More informationGastrinoma: Medical Management. Haley Gallup
Gastrinoma: Medical Management Haley Gallup Also known as When to put your knife down Gastrinoma Definition and History Diagnosis Historic Management Sporadic vs MEN-1 Defining surgical candidates Nonsurgical
More informationQ&A Session NAACCR Webinar Series Collecting Cancer Data: Pancreas January 05, 2012
Q&A Session NAACCR Webinar Series Collecting Cancer Data: Pancreas January 05, 2012 Q: Will sticky notes be transferrable from the previous electronic version of CS to the updated version? A: It is our
More informationImmunohistochemistry and Bladder Tumours
Immunohistochemistry and Bladder Tumours Dr. Andrew J. Evans MD PhD FRCPC Consultant in Genitourinary Pathology University Health Network Toronto, ON Objec ves Review markers of urothelial differen a on
More informationType 2 gastric neuroendocrine tumor: report of one case
Case Report Type 2 gastric neuroendocrine tumor: report of one case Yuanliang Li, Xin Su, Huangying Tan Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing 100029, China Correspondence
More information4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD
MUSC Pathology Symposium Kiawah Island April 18, 2018 Jesse K. McKenney, MD 1 Urothelial Carcinoma with Alternative Differentiation 2 Urothelial Carcinoma with Alternative Differentiation Recognition as
More informationClinical Study Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcomein33PatientsinaTertiaryCareCenter
Hindawi Publishing Corporation Journal of Oncology Volume 2008, Article ID 212067, 5 pages doi:10.1155/2008/212067 Clinical Study Small Bowel Tumors: Clinical Presentation, Prognosis, and Outcomein33PatientsinaTertiaryCareCenter
More informationGastrointestinal Carcinoid Tumor Early Detection, Diagnosis, and Staging
Gastrointestinal Carcinoid Tumor Early Detection, Diagnosis, and Staging Detection and Diagnosis Catching cancer early often allows for more treatment options. Some early cancers may have signs and symptoms
More informationProtocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Appendix
Protocol for the Examination of Specimens from Patients with Neuroendocrine Tumors (Carcinoid Tumors) of the Appendix Protocol applies to well-differentiated neuroendocrine tumors of the appendix. Goblet
More informationC ORPUS UTERI C ARCINOMA STAGING FORM (Carcinosarcomas should be staged as carcinomas)
CLINICAL C ORPUS UTERI C ARCINOMA STAGING FORM PATHOLOGIC Extent of disease before S TAGE C ATEGORY D EFINITIONS Extent of disease through any treatment completion of definitive surgery y clinical staging
More information3/22/2017. Disclosure of Relevant Financial Relationships. Disclosure of Relevant Financial Relationships. Grading G1. Grading. Ki67 index V.
Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to influence or control the content of CME disclose any relevant financial relationship
More informationUICC TNM 8 th Edition Errata
UICC TNM 8 th Edition Errata ions are in italics Page 28 Oropharynx p16 positive Pathological Stage II,T2 N2 M0 T3 N0,N1 M0 Stage II,T2 N2 M0 T3,T4 N0,N1 M0 Page 61 Oesophagus Adenocarcinoma Pathological
More informationNeuroendocrine Tumors
Neuroendocrine Tumors Neuroendocrine tumors arise from cells that release a hormone in response to a signal from the nervous system. Neuro refers to the nervous system. Endocrine refers to the hormones.
More informationUpdate on staging colorectal carcinoma, the 8 th edition AJCC. General overview of staging. When is staging required? 11/1/2017
Update on staging colorectal carcinoma, the 8 th edition AJCC Dale C. Snover, MD November 3, 2017 General overview of staging Reason for uniform staging Requirements to use AJCC manual and/or CAP protocols
More informationJoseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital
Joseph Misdraji, M.D. GI pathology Unit Massachusetts General Hospital jmisdraji@partners.org Low-grade appendiceal mucinous neoplasm (LAMN) High-grade appendiceal mucinous neoplasm (HAMN) Adenocarcinoma
More informationGastric mixed adenoneuroendocrine carcinoma occurring 30 years after a gastroenterostomy
Case report Gastric mixed adenoneuroendocrine carcinoma occurring 30 years after a gastroenterostomy Mihaela Mădălina Gavrilescu 1,2, Ionuț Huțanu*,1,2, Ana-Maria Mușină 1,2, Mihaela Buna-Arvinte 1,2,
More informationNeuro-endocrine and pancreatic non-adenocarcinomas. Marc Engelbrecht, AMC, Amsterdam
Neuro-endocrine and pancreatic non-adenocarcinomas Marc Engelbrecht, AMC, Amsterdam Pancreatic Tumors q Epithelial Exocrine q Mesenchymal Ductal Adenocarcinoma (85-95%) Metastasis Lymfoma Acinar Cell Carcinoma
More informationUICC TNM 8 th Edition Errata
UICC TNM 8 th Edition Errata ions are in italics Head and Neck Tumours Pages 20, p27, p34, p38, p41, and p49 ly pn2a Metastasis in a single ipsilateral lymph node, less than 3cm in greatest dimension with
More informationNO DISCLOSURES. 1. Incipient neoplasia: Dysplasia/Tis NEUROENDOCRINE TUMORS OF THE GI AND PANCREATOBILIARY TRACT
3002: CYTO- HISTOLOGY OF NEUROENDOCRINE NEOPLASMS OF LUNG, GASTROINTESTINAL TRACT AND PANCREAS Momin Siddiqui, MD, FIAC Professor Divisional Director and Chief of Cytopathology Emory University Hospital
More informationColorectal adenocarcinoma leading cancer in developed countries In US, annual deaths due to colorectal adenocarcinoma 57,000.
Colonic Neoplasia Remotti Colorectal adenocarcinoma leading cancer in developed countries In US, annual incidence of colorectal adenocarcinoma 150,000. In US, annual deaths due to colorectal adenocarcinoma
More informationUrinary Bladder: WHO Classification and AJCC Staging Update 2017
Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Houston Society of Clinical Pathologists 58 th Annual Spring Symposium Houston, TX April 8, 2017 Jesse K. McKenney, MD Classification
More informationNeuroendocrine Tumors
Neuroendocrine Tumors FCDS Annual Conference Boca Raton Marriott at Boca Center July 28, 2016 Steven Peace, BS, CTR Anatomy and Physiology of the (Neuro)Endocrine System WHO Classification, Tumor Grade
More informationNEUROENDOCRINE CARCINOID TUMORS PANCREATIC NEUROENDOCRINE TUMORS
University of Miami Jackson Memorial Hospital Role of the Surgeon in the Approach to Neuroendocrine tumors Dido Franceschi, MD Professor of Surgery University of Miami Karzinoide Siegfried Oberndorfer,
More informationSTAGE CATEGORY DEFINITIONS
CLINICAL Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery TX Tis Tis (DCIS) Tis (LCIS) Tis (Paget s) T1 T1mi T1a T1b T1c a b c
More informationEsophagus, Esophagus GE Junction, Stomach
Esophagus, Esophagus GE Junction, Stomach Education and Training Team Collaborative Stage Data Collection System Version v02.03 Learning Objectives Understand rationale behind changes and updates Understand
More informationRadiology Pathology Conference
Radiology Pathology Conference Nadia F. Yusaf, M.D. PGY-3 1/29/2010 Presentation material is for education purposes only. All rights reserved. 2010 URMC Radiology Page 1 of 90 Case 1 60 year- old man presents
More informationCODING STAGE: TNM AND OTHER STAGING SYSTEMS. Liesbet Van Eycken Otto Visser
CODING STAGE: TNM AND OTHER STAGING SYSTEMS Liesbet Van Eycken Otto Visser OVERVIEW PART I Introduction What is stage? Why stage? History and publications of TNM Classification Clinical and pathologic
More information