Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2016; 22(40): 8956-8966
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8956
Neuroendocrine neoplasms of liver - A 5-year retrospective clinico-pathological study applying World Health Organization 2010 classification
Deepak Kalyansingh Burad, Thomas Alex Kodiatte, Sayd Mohamed Rajeeb, Ashish Goel, Chundamannil Eapen Eapen, Banumathi Ramakrishna
Deepak Kalyansingh Burad, Thomas Alex Kodiatte, Banumathi Ramakrishna, Department of Pathology, Christian Medical College, Vellore 632004, Tamil Nadu, India
Sayd Mohamed Rajeeb, Ashish Goel, Chundamannil Eapen Eapen, Department of Hepatology, Christian Medical College, Vellore 632004, Tamil Nadu, India
Author contributions: Burad DK contributed to data collection, data analysis and wrote the paper; Kodiatte TA contributed to data analysis and references; Rajeeb SM contributed to clinical data collection and analysis; Goel A analysed the clinical data and wrote the clinical part; Eapen CE provided clinical advice; Ramakrishna B designed and supervised the study, and wrote the paper.
Institutional review board statement: This study was approved by Institutional review board of Christian Medical College, Vellore, India.
Informed consent statement: This study is exempt from informed consent, since it is a retrospective study and the data collection and analysis were carried out without disclosing patient’s identity.
Conflict-of-interest statement: All the authors declare that there are no commercial, personal and any other potential conflicting interests related to the submitted manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Banumathi Ramakrishna, MD, MAMS, Former Professor and Head, Department of Pathology, Christian Medical College, Vellore 632004, Tamil Nadu, India. banu_ramakrishna@hotmail.com
Telephone: +91-416-2282005 Fax: +91-416-2232035
Received: June 15, 2016
Peer-review started: June 17, 2016
First decision: July 12, 2016
Revised: July 29, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: October 28, 2016
Processing time: 133 Days and 0.7 Hours
Abstract
AIM

To study the clinicopathological characteristics of neuroendocrine neoplasms (NEN) on liver samples and apply World Health Organization (WHO) 2010 grading of gastroenteropancreatic (GEP) NEN.

METHODS

Clinicopathological features of 79 cases of NEN of the liver diagnosed between January 2011 to December 2015 were analyzed. WHO 2010 classification of GEP NEN was applied and the tumors were graded as G1, G2 or G3. Two more categories, D1/2 (discordant 1/2) and D2/3 (discordant 2/3) were also applied. The D1/2 grade tumors had a mitotic count of G1 and Ki-67 index of G2. The D2/3 tumors had a mitotic count of G2 and Ki-67 index of G3. The follow up details which were available till the end of the study period (December 2015) were collected.

RESULTS

Of the 79 tumors, 16 each were G1 and G2, and 18 were G3 tumors. Of the remaining 29 tumors, 13 were assigned to D1/2 and 16 were D2/3 grade. Male preponderance was noted in all tumors except for G2 neoplasms, which showed a slight female predilection. The median age at presentation was 47 years (range 10-82 years). The most common presentation was abdominal pain (81%). Pancreas (49%) was the most common site of primary followed by gastrointestinal tract (24.4%) and lungs (18%). Radiologically, 87% of the patients had multiple liver lesions. Histopathologically, necrosis was seen in only D2/3 and G3 tumors. Microvascular invasion was seen in all grades. Metastasis occurred in all grades of primary NEN and the grades of the metastatic tumors and their corresponding primary tumors were similar in 67% of the cases. Of the 79 patients, 36 had at least one follow up visit with a median duration of follow up of 8.5 mo (range: 1-50 mo). This study did not show any impact of the grade of tumor on the short term clinical outcome of these patients.

CONCLUSION

Liver biopsy is an important tool for clinicopathological characterization and grading of NEN, especially when the primary is not identified. Eighty-seven percent of the patients had multifocal liver lesions irrespective of the WHO grade, indicating a higher stage of disease at presentation. Follow up duration was inadequate to derive any meaningful conclusion on long term outcome in our study patients.

Keywords: Liver; Neuroendocrine neoplasms; Ki-67; Gastroenteropancreatic neuroendocrine neoplasms; Metastasis; Microvascular invasion

Core tip: Neuroendocrine neoplasms (NEN) in liver are commonly metastatic. The clinicopathological features of NEN diagnosed on liver samples were analyzed and graded applying World Health Organization (WHO) 2010 classification of gastroenteropancreatic NEN. A marked male preponderance was noted in all WHO grades except for G2 tumors, wherein a slight female predilection was seen. Necrosis was noted only in higher grade tumors. Most patients had multifocal liver lesions favoring metastasis and higher stage of disease at presentation. Follow up duration was inadequate to derive any meaningful conclusion on long term outcome in our study patients.