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Open Access 05-07-2023 | Cushing's Syndrome | ORIGINAL ARTICLE

Renal neuroendocrine tumors: clinical and molecular pathology with an emphasis on frequent association with ectopic Cushing syndrome

Authors: Atsuko Kasajima, Nicole Pfarr, Alexander von Werder, Kristina Schwamborn, Jürgen Gschwend, Nasir Ud Din, Irene Esposito, Wilko Weichert, Marianne Pavel, Abbas Agaimy, Günter Klöppel

Published in: Virchows Archiv | Issue 4/2023

Abstract

Renal neuroendocrine tumors (RenNETs) are rare malignancies with largely unknown biology, hormone expression, and genetic abnormalities. This study aims to improve our understanding of the RenNETs with emphasis of functional, hormonal, and genetic features. Surgically resected RenNETs (N = 13) were retrieved, and immunohistochemistry and next-generation sequencing (NGS) were performed in all cases. In addition, all published RenNETs were systematically reviewed. Our cohort (4 men and 9 women, mean age 42, mean tumor size 7.6 cm) included 2 patients with Cushing syndrome (CS). WHO grade (23% G1, 54% G2, and 23% G3) and tumor progression did not correlate. CS-associated RenNETs (CS-RenNETs) showed a solid and eosinophilic histology and stained for ACTH, while the remaining non-functioning tumors had a trabecular pattern and expressed variably hormones somatostatin (91%), pancreatic polypeptide (63%), glucagon (54%), and serotonin (18%). The transcription factors ISL1 and SATB2 were expressed in all non-functioning, but not in CS-RenNETs. NGS revealed no pathogenic alterations or gene fusions. In the literature review (N = 194), 15 (8%) of the patients had hormonal syndromes, in which CS being the most frequent (7/15). Large tumor size and presence of metastasis were associated with shorter patients’ survival (p < 0.01). RenNETs present as large tumors with metastases. CS-RenNETs differ through ACTH production and solid-eosinophilic histology from the non-functioning trabecular RenNETs that produce pancreas-related hormones and express ISL1 and SATB2. MEN1 or DAXX/ARTX abnormalities and fusion genes are not detected in RenNETs, indicating a distinct yet unknown molecular pathogenesis.

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Title: Renal neuroendocrine tumors: clinical and molecular pathology with an emphasis on frequent association with ectopic Cushing syndrome
Authors: Atsuko Kasajima
Nicole Pfarr
Alexander von Werder
Kristina Schwamborn
Jürgen Gschwend
Nasir Ud Din
Irene Esposito
Wilko Weichert
Marianne Pavel
Abbas Agaimy
Günter Klöppel
Publication date: 05-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Cushing's Syndrome
Neuroendocrine Tumor
Published in: Virchows Archiv / Issue 4/2023
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-023-03596-5

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Renal neuroendocrine tumors: clinical and molecular pathology with an emphasis on frequent association with ectopic Cushing syndrome

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