title: The role of immunohistochemistry, electron microscopy, and ultrastructural cytochemistry in the diagnosis of mixed carcinoma-neuroendocrine neoplasms.
abstract: We studied four mixed carcinoma-neuroendocrine neoplasms from gastrointestinal tract and pancreas by routine light microscopy (LM), immunohistochemistry (IH), electron microscopy (EM), and ultrastructural cytochemistry (UC). By LM, the individual tumors showed fairly pure neuroendocrine (carcinoid) or epithelial (papillary) patterns, mixed neuroendocrine-carcinoma features and poorly-differentiated tumor in sheets and nests which did not lend itself to morphologic characterization. IH demonstrated mixed expression, within different areas of the same neoplasm, of epithelial antigens (keratins and carcinoembryonic antigen [CEA]) and neuroendocrine markers (neuron-specific enolase [NSE], bombesin and neurohormonal peptides). By EM, each tumor showed ultrastructural features of epithelial and neuroendocrine differentiation which varied substantially in terms of number of cells involved and their distribution; two of the neoplasms showed biphasic differentiation within single cells. The nature of the neurosecretory granules was verified with the uranaffin reaction (UR). This study illustrates the value of combining LM, IH, EM and UC for the identification of mixed carcinoma-neuroendocrine lesions.
mesh_terms: D000368:Aged; D001839:Bombesin / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002277:Carcinoma / Q000032:analysis / Q000175:diagnosis* / Q000648:ultrastructure; D005260:Female; D005768:Gastrointestinal Hormones / Q000032:analysis; D005770:Gastrointestinal Neoplasms / Q000032:analysis / Q000175:diagnosis* / Q000648:ultrastructure; D006651:Histocytochemistry; D006801:Humans; D007158:Immunologic Techniques; D007633:Keratins / Q000032:analysis; D008297:Male; D010190:Pancreatic Neoplasms / Q000032:analysis / Q000175:diagnosis* / Q000648:ultrastructure; D010751:Phosphopyruvate Hydratase / Q000032:analysis
chemical_list: D002272:Carcinoembryonic Antigen; D005768:Gastrointestinal Hormones; D007633:Keratins; D010751:Phosphopyruvate Hydratase; D001839:Bombesin