title: Improved histologic and clinicopathologic criteria for prognostic evaluation of pancreatic endocrine tumors.
abstract: Currently used histopathologic criteria for the diagnosis of pancreatic endocrine tumors are still under discussion as far as to their capacity to identify prognostically different tumor subsets, which are potentially helpful for patient management. A recently developed TNM staging system and a variety of proposed histologic and clinicopathologic parameters still need to be fully validated. One hundred fifty-five pancreatic endocrine tumors encompassing all the main histologic types and stages, operated with intention to cure and then followed up for a median 126 months, were carefully investigated histologically to identify prognostically informative parameters at univariable, bivariable, and multivariable analysis. Ki67 index, mitotic rate, neuroinvasion with or without vascular, peritumoral or stromal infiltrative patterns, as well as tumor size, and association with endocrine syndromes other than insulinoma proved effective in predicting recurrence and disease-specific death among well-differentiated tumors. Poorly differentiated histologic features, more than 10 mitoses/10 high power fields, and necrosis were helpful in the identification of high-grade cancers with an invariably poor prognosis. The TNM system proved to be highly predictive of patient outcome and easy to combine with histologic and clinicopathologic parameters to classify pancreatic endocrine tumors into groups of increasing malignant potential.
authors: Department of Pathology, Ospedale di Circolo, 21100 Varese, Italy. anapat@ospedale.varese.it
authors: Stefano
authors: S
authors: La Rosa
authors: Catherine
authors: C
authors: Klersy
authors: Silvia
authors: S
authors: Uccella
authors: Linda
authors: L
authors: Dainese
authors: Luca
authors: L
authors: Albarello
authors: Angelica
authors: A
authors: Sonzogni
authors: Claudio
authors: C
authors: Doglioni
authors: Carlo
authors: C
authors: Capella
authors: Enrico
authors: E
authors: Solcia
mesh_terms: D007516:Adenoma, Islet Cell / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018273:Carcinoma, Islet Cell / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D019394:Ki-67 Antigen / Q000032:analysis; D008940:Mitotic Index; D009336:Necrosis / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen