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Mastrosimini MG, Mafficini A, Tondulli L, Milella M, Piccoli P, Mattiolo P, Fassan M, Hong SM, Scarpa A, Luchini C. Recurrent gastric amphicrine tumor with neuroendocrine and pancreatic acinar cell differentiation and somatic MEN1 inactivation arisen during immunotherapy. Virchows Arch 2023; 483:415-419. [PMID: 37581694 DOI: 10.1007/s00428-023-03624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
Amphicrine neoplasms (ANs) are poorly understood epithelial malignancies composed of cells with co-existing exocrine-neuroendocrine features. Here, we report a recurrent mucin-producing gastric amphicrine tumor co-expressing neuroendocrine (chromogranin-A, synaptophysin, and CD56) and pancreatic acinar cell (BCL10 and trypsin) markers, arisen in a 64-year-old woman during adjuvant immunotherapy for melanoma. Ki-67 was < 2%. The gastric background context was atrophic gastritis. Next-generation sequencing showed MEN1 mutation (p.P71fs*42) coupled with loss of heterozygosity. The key lessons were as follows: (1) gastric ANs can show the co-existence of exocrine mucin-producing elements with neuroendocrine and pancreatic acinar differentiation; (2) they may represent a new entity arising in the context of atrophic gastritis and during immunotherapy; (3) they should be considered in the diagnostic workup of gastric neuroendocrine tumors; and (4) their molecular profile can show striking similarities with well-differentiated neuroendocrine tumors. These findings may be of help to improve the knowledge and the biological taxonomy of ANs.
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Affiliation(s)
- Maria G Mastrosimini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
| | - Andrea Mafficini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
- ARC-Net Research Center, University of Verona, Verona, Italy
| | - Luca Tondulli
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Michele Milella
- Department of Medicine, Section of Oncology, University and Hospital Trust of Verona, Verona, Italy
| | - Paola Piccoli
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University of Padua, and Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy
- ARC-Net Research Center, University of Verona, Verona, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Piazzale Scuro, 10, 37134, Verona, Italy.
- ARC-Net Research Center, University of Verona, Verona, Italy.
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Zhang D, Li P, Szankasi P, Liao X. Mixed adenoneuroendocrine carcinoma of the gallbladder, amphicrine type: Case report and review of literature. Pathol Res Pract 2020; 216:152997. [PMID: 32534704 DOI: 10.1016/j.prp.2020.152997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
Abstract
Amphicrine type mixed adenoneuroendocrine carcinoma (MANEC), also known as amphicrine carcinoma, is an exceedingly rare neoplasm comprising of tumor cells simultaneously demonstrating both neuroendocrine and exocrine differentiation. Majority of reported cases were found in tubular gastrointestinal tracts such as colon. Herein, we report the first case of amphicrine carcinoma in gallbladder in a 57-year-old female who presented with abdominal pain, vomiting, and gallbladder mass on imaging followed by radical cholecystectomy. Macroscopically, the tumor was a polypoid solid mass with a firm and tan-white cut surface located at the gallbladder fundus. Histologically, the tumor cells were composed of monotonous-appearing signet-ring cells with fine chromatin, variably conspicuous nucleoli, brisk mitotic figures, and spotty necrosis. They were loosely clustered, forming nests and cords but no glandular formation. Immunohistochemically, the entire tumor showed strong and diffuse immunoreactivity for CDX2, p53, and synaptophysin, with patchy positivity for CD56, chromogranin, and INSM1. Kreyberg stain highlighted both intracytoplasmic and extracellular mucin. Ki-67 proliferation index was approximately 70%. Next-generation sequencing performed on a 724 cancer-related gene panel identified TP53 mutation at c.844C>T (p.R282W). To our knowledge, this is the first case of amphicrine carcinoma in gallbladder. It highlights the complex dynamism and controversial pathogenesis of this unique entity, the exact mechanism and clinicopathologic behavior of which are not yet understood.
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Affiliation(s)
- Dongwei Zhang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Peng Li
- Department of Pathology and Laboratory Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Philippe Szankasi
- Department of Pathology and Laboratory Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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Huang D, Ren F, Ni S, Tan C, Weng W, Zhang M, Xu M, Wang L, Xu Q, Sheng W. Amphicrine carcinoma of the stomach and intestine: a clinicopathologic and pan-cancer transcriptome analysis of a distinct entity. Cancer Cell Int 2019; 19:310. [PMID: 31832022 PMCID: PMC6873408 DOI: 10.1186/s12935-019-1031-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022] Open
Abstract
Background and aim Amphicrine carcinoma, in which endocrine and epithelial cell constituents are present within the same cell, is very rare. This study characterized the clinicopathologic and survival analysis of this tumor, further compared the genetic diversities among amphicrine carcinoma and other tumors. Materials and methods The clinicopathologic characteristics and survival outcomes of amphicrine carcinoma in this study were analyzed. The pan-cancer transcriptome assay was utilized to compare the genetic expression profile of this entity with that of conventional adenocarcinoma or neuroendocrine tumors. Results Ten cases (all in male patients) were identified in the stomach or intestine, with a median patient age of 62 years. There were characteristic patterns in the tumors: tubular, fusion or single-file growth of goblet- or signet ring-like cells. Four tumors were classified as low-grade and 6 as high-grade according to the histologic architecture. All cases were positive for neuroendocrine markers (synaptophysin and chromogranin A) and showed intracellular mucin in the amphicrine components. Four cases exhibited mRNA expression patterns showing transcriptional homogeneity with conventional adenocarcinomas and genetic diversity from neuroendocrine tumors. During the follow-up period, 3 patients died of disease, all of whom had high-grade tumors. Patients with high-grade amphicrine carcinoma had worse outcomes than those with low-grade tumors. Conclusions This study confirms the morphological, immunostaining and transcriptome alterations in amphicrine carcinoma distinct from those in conventional adenocarcinomas and neuroendocrine tumors, but additional studies are warranted to determine the biological behavior and therapeutic response.
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Affiliation(s)
- Dan Huang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Fei Ren
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Shujuan Ni
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Cong Tan
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Weiwei Weng
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Meng Zhang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Midie Xu
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Lei Wang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Qinghua Xu
- CanHelp Genomics, Hangzhou, Zhejiang People's Republic of China
| | - Weiqi Sheng
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
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