title: Neurenteric Cyst or Neuroendodermal Cyst? Immunohistochemical Study and Pathogenesis.
abstract: BACKGROUND
  Neurenteric cysts are rare central nervous system lesions derived from an endodermal origin. There is no consensus concerning pathogenesis because of the paucity of occurrences. We report an immunohistochemical study of 10 cases with neurenteric cysts and postulate its pathogenesis.
  
  
  METHODS
  Ten patients underwent surgical treatment for neurenteric cysts from 1995 to 2015. We retrospectively reviewed clinical, radiologic, operative, and pathologic findings for these patients. Immunohistochemical stains were completed in all cases to distinguish cell type and origin.
  
  
  RESULTS
  Three cell types were identified: pseudostratified-ciliated, goblet-columnar, and simple cuboidal cells. All cases were positive for cytokeratin 7, and negative for cytokeratin 20, caudal-type homeobox 2, mucin 2, thyroid transcription factor 1, human chorionic gonadotropin, placental alkaline phosphatase, and cluster of differentiation 31. Four of them had positive staining for mucin 5AC, with expression only in goblet-columnar cells. According to the immunohistochemical results, the cells resembled the respiratory tract (pseudostratified-ciliated), stomach (goblet-columnar), and respiratory bronchioles (simple cuboidal). Seventy-five percent of cases with recurrence had a goblet-columnar component, emphasizing the importance of total resection of the cyst and complete pathologic examination.
  
  
  CONCLUSIONS
  We postulate that the cystic tumor was derived from multipotent endodermal cells that migrated and traveled along the neuroectoderm, with incomplete differentiation into various cell types as a result of an unsuitable microenvironment. Because the neurenteric canal was only the channel of migration rather than a component of the cysts, the term neuroendodermal cysts is more precise in presenting the embryopathogenesis.
authors: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
authors: Chun-Ting
authors: CT
authors: Chen
authors: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
authors: Hung-Yi
authors: HY
authors: Lai
authors: Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
authors: Shih-Ming
authors: SM
authors: Jung
authors: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China. Electronic address: 8702021@adm.cgmh.org.tw.
authors: Ching-Yi
authors: CY
authors: Lee
authors: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
authors: Chieh-Tsai
authors: CT
authors: Wu
authors: Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
authors: Shih-Tseng
authors: ST
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000378:metabolism; D000071616:CDX2 Transcription Factor / Q000378:metabolism; D002493:Central Nervous System Diseases / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D002648:Child; D006063:Chorionic Gonadotropin / Q000378:metabolism; D003560:Cysts / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D004707:Endoderm; D005260:Female; D058851:GPI-Linked Proteins / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007527:Isoenzymes / Q000378:metabolism; D053554:Keratin-20 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D055271:Mucin 5AC / Q000378:metabolism; D055262:Mucin-2 / Q000378:metabolism; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D009687:Nuclear Proteins / Q000378:metabolism; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D012008:Recurrence; D012189:Retrospective Studies; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors / Q000378:metabolism; D055815:Young Adult
chemical_list: D000071616:CDX2 Transcription Factor; D006063:Chorionic Gonadotropin; D058851:GPI-Linked Proteins; D007527:Isoenzymes; D053554:Keratin-20; D053552:Keratin-7; D055271:Mucin 5AC; D055262:Mucin-2; C000614412:NKX2-1 protein, human; D009687:Nuclear Proteins; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors; D000469:Alkaline Phosphatase; C019839:alkaline phosphatase, placental
keywords: Endodermal cysts; Immunohistochemical; Neurenteric cysts; Neuroendodermal cysts; Pathogenesis