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

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

GUT ENDOCRINE TUMORS TUMOR GRADING AND CLASSIFICATION

ENETS GRADING PROPOSAL

ENETS TNM WORKING PROPOSALPANCREAS

Size increase

ENETS STAGING PROPOSALPANCREAS

Size increase

Mets presence

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

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

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 +

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)

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