1st Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS Foundation National Cancer Institute, Milan, Italy.
Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy.
Endocrine. 2018 Apr;60(1):28-30. doi: 10.1007/s12020-017-1365-7. Epub 2017 Jul 21.
Gastroenteropancreatic neuroendocrine neoplasms grade 3, all of them with >20% Ki-67, can be heterogeneous on the basis of their morphological features, comprising well and poorly differentiated neoplasms; the former are named tumors and the latter carcinomas. Several papers about gastroenteropancreatic neuroendocrine neoplasms grade 3 heterogeneity have been reporting over the last years by clinicians and pathologists, indicating that the differential diagnosis between named tumors grade 3 and named carcinomas grade 3 may be relevant in defining a different approach in terms of characterization of disease, staging, and treatment. To well define the sub-type of gastroenteropancreatic neuroendocrine neoplasms grade 3 pathologist's expertise in recognizing tumor morphology, immunohistochemical, and molecular techniques were reported remarkable. Although current evidence about grade 3 gastroenteropancreatic neuroendocrine neoplasms heterogeneity is still far from producing validated specific therapies for specific subcategories, the hypotheses generated from the several retrospective analyses published so far on this topic represent solid bases for designing prospective therapeutic clinical trials in homogenous clinical settings.
胃肠胰神经内分泌肿瘤 3 级，所有 Ki-67 均>20%，基于其形态学特征可能存在异质性，包括分化良好和分化差的肿瘤；前者称为肿瘤，后者称为癌。近年来，临床医生和病理学家发表了几篇关于胃肠胰神经内分泌肿瘤 3 级异质性的论文，表明命名为肿瘤的 3 级和命名为癌的 3 级之间的鉴别诊断可能与疾病特征、分期和治疗的不同方法有关。为了明确胃肠胰神经内分泌肿瘤 3 级的亚型，病理学家在识别肿瘤形态、免疫组织化学和分子技术方面的专业知识被证明是非常重要的。尽管目前关于胃肠胰神经内分泌肿瘤 3 级异质性的证据还远远不能为特定亚类提供经过验证的特异性治疗方法，但迄今为止就这一主题发表的几项回顾性分析提出的假设为在同质临床环境中设计前瞻性治疗性临床试验提供了坚实的基础。
