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Small cell carcinomas in gastrointestinal tract: immunohistochemical and clinicopathological features
  1. Anna Fen-Yau Li1,2,
  2. Alice Chia-Heng Li3,
  3. Chih-Yi Hsu2,
  4. Win-Yin Li2,
  5. Han-Shui Hsu4,5,
  6. Jeou-Yuan Chen6
  1. 1School of Medicine, National Yang-Ming University, Taipei, Taiwan
  2. 2Department of Pathology, Taipei Veterans General Hospital, Taiwan
  3. 3The Webb School, Claremont, California, USA
  4. 4Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  5. 5Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
  6. 6Institute of Biomedical Sciences, Academia Sinica, Taiwan
  1. Correspondence to Dr Anna Fen-Yau Li, Department of Pathology, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Road, Taipei 112, Taiwan; fyli{at}vghtpe.gov.tw

Abstract

Aims To test the incidence of the expression of the immunohistochemical markers that aid diagnosis of gastrointestinal tract small cell carcinoma (GI-SmCC) and to evaluate the incidence of mixed endocrine–exocrine carcinomas in GI-SmCC.

Methods Immunohistochemical studies of three antibodies against epithelial markers (CK8, AE1/AE3, EMA), four neuroendocrine differentiation markers (synaptophysin (Syn), neuron specific enolase (NSE), neuronal cell adhesion molecules (CD56), chromogranin A (CgA)), and a transcription factor (thyroid transcription factor 1 (TTF-1)) were performed. The incidence of non-endocrine carcinoma component was evaluated in 42 GI-SmCCs (11 in the oesophagus, 15 in the stomach, 15 in the colon, and 1 in the small intestine).

Results The percentages of GI-SmCC with positive immunoreactivity were: CK8 92.9%, AE1/AE3 76.2%, EMA 71.4%, Syn 100%, NSE 100%, CD56 90.5%, CgA 61.9%, TTF-1 21.4%. The low molecular weight cytokeratin CK8 is more commonly expressed in GI-SmCC than is the expression of AE1/AE3 or EMA. Synaptophysin and NSE are expressed in all GI-SmCCs studied. Non-endocrine carcinoma components were demonstrated in 8 patients (4 in the oesophagus and 4 in the stomach).

Conclusion In detecting GI-SmCC, epithelial marker CK8 is more sensitive than AE1/AE3 or EMA, and neuroendocrine differentiation markers synaptophysin and NSE are the most useful markers. TTF-1 positivity is not uncommon in GI-SmCC, but cases with negative TTF-1 staining may indicate an extra-pulmonary primary. Non-endocrine carcinoma components were demonstrated in about 30% of oesophagus and stomach SmCC; the neoplasms should be diagnosed as mixed endocrine–exocrine carcinoma.

  • Gastrointestinal tract
  • small cell carcinoma
  • immunohistochemical study
  • gastrointestinal disease
  • immunohistochemistry
  • neuroendocrine tumours
  • surgical pathology

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Footnotes

  • Funding The work was funded by the National Science Council (NSC 98-2320-B-010-015) and Taipei Veterans General Hospital (V99C1-126).

  • Competing interests None.

  • Ethics approval Obtained from the Taipei Veterans General Hospital Research Ethics Committee (VGHIRB No. 97-12-42A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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