DR OO ODUJOKO PATHOLOGY RESIDENT DANBURY HOSPITAL Clinical Summary A 70yearold woman with recently diagnosed adenocarcinoma of the lung received PET scan for staging Imaging revealed increased metabolic activity in the lesser curvature of the stomach ID: 918489
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Slide1
GUT-C PRESENTATION10/22/2020
DR O.O. ODUJOKO
PATHOLOGY RESIDENT
DANBURY HOSPITAL
Slide2Clinical Summary
A 70-year-old woman with recently diagnosed adenocarcinoma of the lung received PET scan for staging.
Imaging revealed increased metabolic activity in the lesser curvature of the stomach.
Slide3Clinical Summary
An EGD revealed a
subepithelial
single
medium sized 2.5 cm
nodule with superficial ulceration on the lesser curvature of the
stomach.
She had an ultrasound guided endoscopic core biopsy of the lesion.
Slide4PAST MEDICAL HISTORY
In
April, 2013, she had
a colonoscopy
and polypectomy in the
cecum
, left colon and
rectosigmoid
colon
.
Tubular adenoma in
the
cecum
and
hyperplastic polyps in the left colon and
rectosigmoid
colon.
Slide5Slide6Slide7Slide8Slide9Slide10Slide11DIFFERENTIAL DIAGNOSES
Slide12?
Slide13Differential diagnoses
Metastatic
l
ung adenocarcinoma
Metastatic hepatocellular carcinoma
Hepatoid
gastric
adenocarcinoma
Neuroendocrine tumor
Slide14CK CAM5.2
Slide15CK 7
Slide16HEP-PAR1
Slide17TTF-1
Slide18S100
Slide19CHROMOGRANIN AND SYNAPTOPHYSIN: POSITIVE
Slide20Ki67
Less than
3
%
of the tumor cells reveal nuclear staining.
Slide21Differential diagnosis
Metastatic lung adenocarcinoma: This as with other metastasis typically present as a submucosal nodule.
Usually positive for TTF-1
.
Hepatoid
gastric adenocarcinoma
Positive for
HepPar-1 and CK7
Metastatic hepatocellular carcinoma
Positive for HepPar
-
1
Slide22DIAGNOSIS
WELL DIFFERENTIATED NEUROENDOCRINE NEOPLASM, GRADE 1 WITH PROMINENT ONCOCYTIC MORPHOLOGY
Slide23Frequency of Gastric NETs
The widespread application in the use of upper GI
endosccopy
with more sophisticated techniques for
histopathologic
evaluation of gastric biopsies have increased frequency of gastric NETs.
In the past, gastric NETs were reported to account for 2-3% of all gastrointestinal NETs
More recent studies suggest that its incidence may reach 11% of all GI NETs.
Slide24Clinical features of gastric neuroendocrine tumor
Odze
RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. Third Edition. Philadelphia, Pennsylvania, USA. Elsevier Saunders. Chapter 29, P 814. Table 29.3
Slide25Other unusual histologic variants
Slide26Clear cell change in a well differentiated neuroendocrine tumor.
Odze
RD, Goldblum
JR.
Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. Third Edition. Philadelphia, Pennsylvania, USA. Elsevier Saunders.
Chapter 29, P 807. Figure 29.4
Slide27Lipid-rich neuroendocrine tumor.
Odze
RD, Goldblum
JR. Third Edition.
Surgical Pathology of the GI Tract, Liver, Biliary Tract and
Pancreas.
Philadelphia, Pennsylvania, USA. Elsevier
Saunders Chapter 29, P 808. Figure 29.10
Slide28Neuroendocrine tumor with myxoid stroma
Odze
RD, Goldblum
JR. Third Edition.
Surgical Pathology of the GI Tract, Liver, Biliary Tract and
Pancreas.
Philadelphia, Pennsylvania, USA. Elsevier
Saunders Chapter 29, P 809. Figure 29.14
Slide29Types of Gastric NETs
Type I NETs: Arise on a background of atrophic gastritis, commoner in women.
Type II NETs: Usually seen in ZES/MEN type I
Type III or sporadic gastric NETs. It usually develops in middle-aged persons. Frequently presents as a large lesion greater than 10mm with
angioinvasion
and lymph node metastasis.
Type IV has been postulated to be due to
achlorhydria
as a result of a defect in gastric acid secretion by gastric parietal cells. It is usually single, poorly differentiated with extremely poor prognosis
Slide30Types of Gastric NETs
Type I ECL cell NETs are multiple in approximately 60% of cases
Most are less than 1cm and 97% are less than 1.5cm
Patients with type II NETs have an enlarged stomach with thickened gastric wall due to severe hypertrophic-
hypersecretory
gastropathy
Type III ECL cell NETs are usually single and in a third of cases are greater than 2cm.
Infiltration of the
muscularis
propria
and of the serosa is found in 76% and 53% of cases.
Slide31Location
ECL NETs of types I,II and III are all located in the mucosa of the body-fundus or body-
antrum
border of the stomach.
Gastrin cell NETs are located in the
antro
-pyloric region
EC cell
tumours
may occur in any part of the stomach.
Slide32Noteworthy points
Slightly unusual presentation of a fairly common neoplasm
More abundant eosinophilic cytoplasm than usual (
Oncocytic
variant)
Specimen somewhat disrupted by biopsy procedure
Slide33I will be glad to answer any questions
Slide34References
Ting-ting Li, Feng
Qiu
,
Zhi
Rong
Qian, Jun Wan, Xiao-Kun Qi, Ben-Yan Wu. Classification,
clinicopathologic
features and treatment of Gastric neuroendocrine tumors. World Journal of Gastroenterology. 2014
Diagnostic Histopathology of Tumors by CDM Fletcher. Third Edition.
WHO blue book of Pathology of the Gastrointestinal tract. Revised fourth edition.
Odze
RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. Third Edition. Philadelphia, Pennsylvania, USA. Elsevier Saunders.