title: High neuroendocrine component is a factor for poor prognosis in gastrointestinal high-grade malignant mixed adenoneuroendocrine neoplasms.
abstract: BACKGROUND
  High-grade malignant mixed adenoneuroendocrine carcinoma (MANEC) is a highly malignant combined neoplasm formed by an adenocarcinomatous component and a poorly differentiated (Grade 3) neuroendocrine (NE) carcinoma.
  
  
  METHODS
  Tumors from 21 patients with gastrointestinal high-grade malignant MANECs or tumors with varying percentages of Grade 3 NE component were examined, and the NE component was confirmed by morphological analysis and immunohistochemical staining. Patients were divided into high NE (NE component > 50% in the primary tumor) and low NE (NE component ≤ 50% in the primary tumor) component groups.
  
  
  RESULTS
  High NE component was a poor prognostic factor for patients with high grade MANEC (p = 0.021). Out of 13 patients with high-grade malignant MANEC, eight had a pure NE component, one had a pure adenocarcinomatous component, and four had mixed-type cancer in the metastatic lymph nodes. We further enrolled eight patients who had a Grade 3 NE component in the primary tumor and found that the pure NE component in tumor emboli and distant liver metastases were more frequent in the high NE than in the low NE component group (p = 0.012 and p = 0.046, respectively).
  
  
  CONCLUSIONS
  The predominant tumor component in primary tumors was a prognostic factor and could predict tumor emboli and liver metastases pathology in high-grade malignant MANECs.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ming-Huang
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Ying-Ju
authors.initials: YJ
authors.lastname: Kuo
authors.affiliation: Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: Ying-Chu
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Peter Mu-Hsin
authors.initials: PM
authors.lastname: Chang
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ming-Han
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Jeng
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. Electronic address: ychao@vghtpe.gov.tw.
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis
keywords: high-grade malignant mixed adenoneuroendocrine carcinoma; neuroendocrine component; prognosis