Compozite colonic adenoma-microcarcinoid tumor, is really a coincidence? Case report

Yıl 2017, Cilt: 8 Sayı: 3, 130 - 133, 02.03.2017

Mehmet Zengin , Hüsniye Esra Paşaoğlu

https://doi.org/10.18663/tjcl.286217

Öz

Mixed adenoneuroendocrine cancers are rare tumors. The
association of colonic tubulary adenomas with microcarcinoid tumors has been
reported very rarely in the literature. As known, the neuroendocrine component
in these tumors display a broad spectrum with marked variability in histopathology
properties; such as glandular pattern, spindle cell pattern, squamous-osteoid
metaplasia or pleomorphism. Rarely, they may be very poorly differentiated and
may resemble undifferentiated carcinoma or lymphoma. In addition,
immunohistochemical analysis of carcinoid tumors associated with some syndromes
such as Zollinger-Ellison and carcinoid has shown that, most are multihormonal
as well as one amine or peptide may predominate and the amines and peptides in
the primary tumor do not often match to those normally found in the overlying
endocrine cells. However, an increasing number of tumors have recently been
described including mixtures of neoplastic endocrine and non-endocrine
epithelial cells. Furthermore, there are different types of tumors in which endocrine
and epithelial cell characteristics are observed in the same cell. Similar to
all this literature information, morphological and immunohistochemical findings
in our case show that, the two neoplastic components originate from a common
precursor cell.

Anahtar Kelimeler

Compozite adenoma, microcarcinoid, tubulary

Kompozit kolonik adenom-mikrokarsinoid tümör, gerçekten tesadüf mü? Olgu sunumu

Öz

Mikst adenonöroendokrin kanserler nadir rastlanan
tümörlerdir. Kolonik tübüler adenomlar ile mikrokarsinoid tümörlerin
birlikteliği ise literatürde son derece ender bildirilmiştir. Bilindiği üzere,
bu tümörlerdeki nöroendokrin bileşen glandüler patern, iğsi hücreli patern,
skuamöz-osteoid metaplazi veya pleomorfizm gibi belirgin hitopatolojik
değişkenlik gösteren geniş bir yelpaze sergiler. Nadiren çok az farklılaşmış
olabilir ve undiferansiye karsinom ya da lenfomaya benzeyebilirler. Bununla
beraber, karsinoid veya Zollinger-Ellison gibi birtakım sendromlarla ilişkili
karsinoid tümörlerin immünohistokimyasal analizinde, bir amin veya peptit
baskın olabileceği gibi çoğunun mültihormonal olduğu gösterilmiştir ve primer
tümördeki aminler ve peptidler, üstte bulunan endokrin hücrelerde normal olarak
bulunanlarla çoğu zaman eşleşmez. Ayrıca son zamanlarda, neoplastik endokrin ve
endokrin dışı epitel hücrelerinin karışımlarını içeren artan sayıda tümör tarif
edilmiştir. Dahası, endokrin ve epitel hücresi özelliklerinin aynı hücre içinde
gözlendiği farklı tümör türleri de mevcuttur. Bütün bu literatür bilgileri ile
benzer olarak, olgumuzda izlenen morfolojik ve immünhistokimyasal bulgular iki
neoplastik bileşenin ortak bir öncü hücreden kaynaklandığını göstermektedir.

Anahtar Kelimeler

Kompozit adenom, mikrokarsinoid, tübüler

Kaynakça

• 1. Rindi G, Arnold R, Bosman FT, et al. WHO classification of tumours of the digestive system, nomenclature and classification of neuroendocrine neoplasms of the digestive system. International agency for research on cancer, Lyon; 2010: 13–14.
• 2. Lewin K. Carcinoid tumors and the mixed (composite) glandular-endocrine cell carcinomas. Am J Surg Pathol 1987; 11: 71–86.
• 3. Lyda MH, Fenoglio CM. Adenoma-carcinoid tumors of the colon. Arch Pathol Lab Med 1998; 122: 262–265.
• 4. Moyana TN, Qizilbash AH, Murphy F. Composite glandular-carcinoid tumors of the colon and rectum: Report of two case. Am J Surg Pathol 1988; 12: 607-11.
• 5. Vanden IHF, Vanden BLJ, Verhofstad AA, Bosman FT. Neuroendocrine cells in colorectal adenomas. J Pathol 1986; 148: 231–7.
• 6. Bansal M, Fenoglio CM, Robboy SJ, King DW. Are metaplasias in colorectal adenomas truly metaplasias? Am J Pathol 1984; 115: 253–65.
• 7. Vortmeyer AO, Merino MJ, Wang CY, et al. Concordance of genetic alterations in poorly differentiated colorectal neuroendocrine carcinomas and associated adenocarcinomas. J Natl Cancer Inst 1997; 89; 1448-53.
• 8. Zissis D, Zizi SA, Grammatoglou X, et al. Combined carcinoid and mixed (composite) glandular endocrine cell carcinoma of the stomach in atrophic gastritis. 2009 Jan-Mar; 14 (1): 127-30.
• 9. Reinecke P, Borchard F. Pattern of gastric endocrine cells in microcarcinoidosis: An immunohistochemical study of 14 gastric biopsies. Virchows Arch 1996; 428: 237–41.
• 10. Haidar A, Dixon MF. Solitary microcarcinoid in ulcerative colitis. Histopathology 1992; 21: 487–8.
• 11. Matsumoto T, Jo Y, Mibu R, et al. Multiple microcarcinoids in a patient with long standing ulcerative colitis. J Clin Pathol 2003; 56: 963-5.
• 12. Salaria SN, Abu Alfa AK, Alsaigh NY, Montgomery E, Arnold CA. Composite intestinal adenoma-microcarcinoid clues to diagnosing an underrecognised mimic of invasive adenocarcinoma. J Clin Pathol 2013; 66: 302–6.
• 13. Pulitzer M, Xu R, Suriawinata AA, Waye JD, Harpaz N. Microcarcinoids in large intestinal adenomas. Am J Surg Pathol 2006; 30: 1531–6.
• 14. Li Y, Yau A, Schaeffer D, et al. Colorectal glandular-neuroendocrine mixed tumor: Pathologic spectrum and clinical implications. Am J Surg Pathol 2011; 35: 413–25.
• 15. Thosani N, Rao B, Ertan A, Guha S. Wide spectrum of neuroendocrine differentiation in identical appearing colon polyps: A report of 2 mixed endocrine-glandular polyps. Turk J Gastroenterol 2014 Dec; 25: 242-3.
• 16. Lin J, Goldblum JR, Bennett AE, Bronner MP, Liu X. Composite intestinal adenoma-microcarcinoid. Am J Surg Pathol 2012; 36: 292-295.