Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2016

01-07-2016 | Colorectal Cancer

Mixed Adeno-neuroendocrine Carcinoma: An Aggressive Clinical Entity

Authors: Shayna Brathwaite, MD, Jonathan Rock, MD, Martha M. Yearsley, MD, Tanios Bekaii-Saab, MD, Lai Wei, PhD, Wendy L. Frankel, MD, John Hays, MD, Christina Wu, MD, Sherif Abdel-Misih, MD

Published in: Annals of Surgical Oncology | Issue 7/2016

Login to get access

Abstract

Background

Mixed adeno-neuroendocrine carcinoma (MANEC) is a rare pathologic diagnosis recently defined by the World Health Organization in 2010. Due to poor understanding of MANEC as a clinical entity, there is significant variation in the management of these patients. The purpose of our study was to characterize MANEC to develop evidence-based treatment strategies.

Methods

The Ohio State University patient database was queried for the diagnosis of MANEC and 46 patients were identified. For comparison, the database also was queried for goblet cell carcinoid (GCC) of the appendix, signet ring cell carcinoma, and carcinoid/neuroendocrine tumor of the appendix. Charts were then retrospectively reviewed for clinicopathologic characteristics, patient treatment, and survival data.

Results

The mean age of diagnosis of MANEC was 54 years. Eighty-seven percent of MANEC arose from the appendix, with 28 % of patients undergoing appendectomy and 35 % undergoing right hemicolectomy as their index operation. Immunohistochemical staining was positive for chromogranin (82 %), synaptophysin (97 %), and CD56 (67 %). Sixty-seven percent of patients presented with stage IV disease and 41 % had nodal metastases. Overall survival was 4.1 years, which was statistically significantly different (p ≤ 0.05) compared with carcinoid tumors (13.4 years), GCC (15.4 years), and signet ring carcinoma (2.2 years).

Conclusions

MANEC is a more aggressive clinical entity than both GCC of the appendix and carcinoid/neuroendocrine tumors of the appendix. Based on these findings, we recommend patients with MANEC tumors undergo aggressive multidisciplinary cancer management and close surveillance.
Literature
1.
Komminoth PA, Capella C, Klimstra DS, Klöppel G, Solcia E, Rindi G. Neuroendocrine neoplasms of the appendix. In: WHO classification of tumours of the digestive system. 4th ed. Lyon: IARC Press; 2010.
2.
Rindi G, Bordi C, La Rosa S, et al. Gastroenteropancreatic (neuro)endocrine neoplasms: the histology report. Dig Liver Dis. 2011;43 Suppl 4:S356–60.CrossRefPubMed
3.
Lewin K. Carcinoid tumors and the mixed (composite) glandular-endocrine cell carcinomas. Am J Surg Pathol. 1987;11 Suppl 1:71–86.CrossRefPubMed
4.
Capella C, La Rosa S, Uccella S, Billo P, Cornaggia M. Mixed endocrine–exocrine tumors of the gastrointestinal tract. Semin Diagn Pathol. 2000;17(2):91–103.PubMed
5.
Holt N, Gronbaek H. Goblet cell carcinoids of the appendix. Sci World J. 2013;2013:543696–702.CrossRef
6.
7.
La Rosa S, Marando A, Furlan D, Sahnane N, Capella C. Colorectal poorly differentiated neuroendocrine carcinomas and mixed adenoneuroendocrine carcinomas: insights into the diagnostic immunophenotype, assessment of methylation profile, and search for prognostic markers. Am J Surg Pathol. 2012;36(4):601–11.CrossRefPubMed
8.
Power DG, Asmis TR, Tang LH, Brown K, Kemeny NE. High-grade neuroendocrine carcinoma of the colon, long-term survival in advanced disease. Med Oncol. 2011;28 Suppl 1:S169–74.CrossRefPubMed
9.
Shia J, Tang LH, Weiser MR, et al. Is nonsmall cell type high-grade neuroendocrine carcinoma of the tubular gastrointestinal tract a distinct disease entity? Am J Surg Pathol. 2008;32(5):719–31.CrossRefPubMed
10.
La Rosa S, Marando A, Sessa F, Capella C. Mixed adenoneuroendocrine carcinomas (MANECs) of the gastrointestinal tract: an update. Cancers. 2012;4(1):11–30.CrossRefPubMedPubMedCentral
11.
Scholzen T, Gerdes J. The Ki-67 protein: from the known and the unknown. J Cell Physiol. 2000;182(3):311–22.CrossRefPubMed
12.
Lowe K, Khithani A, Liu E, et al. Ki-67 labeling: a more sensitive indicator of malignant phenotype than mitotic count or tumor size? J Surg Oncol. 2012;106(6):724–7.CrossRefPubMed
13.
Hamilton SR, Aaltonen LA, (eds.). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press; 2000.
14.
Goede AC, Caplin ME, Winslet MC. Carcinoid tumour of the appendix. Br J Surg. 2003;90(11):1317–22.CrossRefPubMed
15.
Nussbaum DP, Speicher PJ, Gulack BC, et al. Management of 1- to 2-cm carcinoid tumors of the appendix: using the national cancer data base to address controversies in general surgery. J Am Coll Surg. 2015;220(5):894–903.CrossRefPubMed
16.
Mullen JT, Savarese DM. Carcinoid tumors of the appendix: a population-based study. J Surg Oncol. 2011;104(1):41–4.CrossRefPubMed
17.
Benedix F, Reimer A, Gastinger I, et al. Primary appendiceal carcinoma—epidemiology, surgery and survival: results of a German multi-center study. Eur J Surg Oncol. 2010;36(8):763–71.CrossRefPubMed
18.
Moertel CG, Weiland LH, Nagorney DM, Dockerty MB. Carcinoid tumor of the appendix: treatment and prognosis. N Engl J Med. 1987;317(27):1699–701.CrossRefPubMed
19.
Murray SE, Lloyd RV, Sippel RS, Chen H, Oltmann SC. Postoperative surveillance of small appendiceal carcinoid tumors. Am J Surg. 2014;207(3):342–5; discussion 345.
20.
Kulke MH, Shah MH, Benson AB, et al. Neuroendocrine tumors, version 1.2015. J Natl Compr Canc Netw. 2015;13(1):78–108.PubMed
21.
McCusker ME, Cote TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer. 2002;94(12):3307–12.CrossRefPubMed
Metadata
Title
Mixed Adeno-neuroendocrine Carcinoma: An Aggressive Clinical Entity
Authors
Shayna Brathwaite, MD
Jonathan Rock, MD
Martha M. Yearsley, MD
Tanios Bekaii-Saab, MD
Lai Wei, PhD
Wendy L. Frankel, MD
John Hays, MD
Christina Wu, MD
Sherif Abdel-Misih, MD
Publication date
01-07-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5179-2

Other articles of this Issue 7/2016

Annals of Surgical Oncology 7/2016 Go to the issue

Healthcare Policy and Outcomes

Fighting Global Disparities in Cancer Care: A Surgical Oncology View

Bone and Soft Tissue Sarcomas

Abdominal Desmoid Tumors: Hands Off?

Breast Oncology

Is Sentinel Lymph Node Biopsy Indicated at Completion Mastectomy for Ductal Carcinoma In Situ?

Bone and Soft Tissue Sarcomas

Analysis of Clinical and Molecular Factors Impacting Oncologic Outcomes in Undifferentiated Pleomorphic Sarcoma

Melanomas

Clinical Response and Regional Toxicity Following Isolated Limb Infusion Compared with Isolated Limb Perfusion for In-Transit Melanoma

Hepatobiliary Tumors

High Resectability Rate of Initially Unresectable Colorectal Liver Metastases After UGT1A1-Adapted High-Dose Irinotecan Combined with LV5FU2 and Cetuximab: A Multicenter Phase II Study (ERBIFORT)