Should immunohistochemical expression of mismatch repair (MMR) proteins and microsatellite instability (MSI) analysis be routinely performed for poorly differentiated colorectal neuroendocrine carcinomas?
SUMMARY: Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are typically associated with poor outcomes. The mechanisms of their aggressiveness are still being investigated. Microsatellite instability (MSI) has recently been found in colorectal NECs showing aberrant methylation of the MLH1 gene and is associated with improved prognosis. We present a 76-year-old lady with an ascending colon tumour showing features of a pT3 N0 R0, large cell NEC (LCNEC) following right hemicolectomy. The adjacent mucosa showed a sessile serrated lesion (SSL) with low-grade dysplasia. Immunohistochemistry showed loss of expression for MLH1 and PMS2 in both the LCNEC and dysplastic SSL. Molecular analysis indicated the sporadic nature of the MLH1 mismatch repair (MMR) protein-deficient status. Our patient did not receive adjuvant therapy and she is alive and disease-free after 34 months follow-up. This finding, similar to early-stage MMR-deficient colorectal adenocarcinoma, is likely practice-changing and will be critical in guiding the appropriate treatment pathway for these patients. We propose that testing of MMR status become routine for early-stage colorectal NECs.
LEARNING POINTS: Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are known to be aggressive and typically associated with poor outcomes. A subset of colorectal NECs can display microsatellite instability (MSI) with mismatch repair (MMR) protein-deficient status. MMR-deficient colorectal NECs have been found to have a better prognosis compared with MMR-proficient NECs. MMR status can be detected using immunohistochemistry. Immunohistochemistry for MMR status is routinely performed for colorectal adenocarcinomas. Immunohistochemical expression of MMR protein and MSI analysis should be performed routinely for early-stage colorectal NECs in order to identify a subgroup of MMR-deficient NECs which are associated with a significantly more favourable prognosis.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:2020 |
|---|---|
| Enthalten in: |
Endocrinology, diabetes & metabolism case reports - 2020(2020) vom: 29. Juli |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Luong, Tu Vinh [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Revised 27.02.2024 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1530/EDM-20-0058 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM313054495 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM313054495 | ||
| 003 | DE-627 | ||
| 005 | 20240229163126.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1530/EDM-20-0058 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1308.xml |
| 035 | |a (DE-627)NLM313054495 | ||
| 035 | |a (NLM)32729847 | ||
| 035 | |a (PII)EDM200058 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Luong, Tu Vinh |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Should immunohistochemical expression of mismatch repair (MMR) proteins and microsatellite instability (MSI) analysis be routinely performed for poorly differentiated colorectal neuroendocrine carcinomas? |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a SUMMARY: Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are typically associated with poor outcomes. The mechanisms of their aggressiveness are still being investigated. Microsatellite instability (MSI) has recently been found in colorectal NECs showing aberrant methylation of the MLH1 gene and is associated with improved prognosis. We present a 76-year-old lady with an ascending colon tumour showing features of a pT3 N0 R0, large cell NEC (LCNEC) following right hemicolectomy. The adjacent mucosa showed a sessile serrated lesion (SSL) with low-grade dysplasia. Immunohistochemistry showed loss of expression for MLH1 and PMS2 in both the LCNEC and dysplastic SSL. Molecular analysis indicated the sporadic nature of the MLH1 mismatch repair (MMR) protein-deficient status. Our patient did not receive adjuvant therapy and she is alive and disease-free after 34 months follow-up. This finding, similar to early-stage MMR-deficient colorectal adenocarcinoma, is likely practice-changing and will be critical in guiding the appropriate treatment pathway for these patients. We propose that testing of MMR status become routine for early-stage colorectal NECs | ||
| 520 | |a LEARNING POINTS: Colorectal poorly differentiated neuroendocrine carcinomas (NECs) are known to be aggressive and typically associated with poor outcomes. A subset of colorectal NECs can display microsatellite instability (MSI) with mismatch repair (MMR) protein-deficient status. MMR-deficient colorectal NECs have been found to have a better prognosis compared with MMR-proficient NECs. MMR status can be detected using immunohistochemistry. Immunohistochemistry for MMR status is routinely performed for colorectal adenocarcinomas. Immunohistochemical expression of MMR protein and MSI analysis should be performed routinely for early-stage colorectal NECs in order to identify a subgroup of MMR-deficient NECs which are associated with a significantly more favourable prognosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 2020 | |
| 650 | 4 | |a Bowel obstruction | |
| 650 | 4 | |a CD-56 | |
| 650 | 4 | |a CDX2* | |
| 650 | 4 | |a CT scan | |
| 650 | 4 | |a Chromogranin A | |
| 650 | 4 | |a Colon biopsy* | |
| 650 | 4 | |a Colonoscopy | |
| 650 | 4 | |a Colorectal carcinoma* | |
| 650 | 4 | |a Duodenum | |
| 650 | 4 | |a Female | |
| 650 | 4 | |a Geriatric | |
| 650 | 4 | |a Hemicolectomy | |
| 650 | 4 | |a Histopathology | |
| 650 | 4 | |a Immunohistochemistry | |
| 650 | 4 | |a Immunostaining | |
| 650 | 4 | |a Insight into disease pathogenesis or mechanism of therapy | |
| 650 | 4 | |a July | |
| 650 | 4 | |a Ki67* | |
| 650 | 4 | |a Microsatellite instability* | |
| 650 | 4 | |a Mismatch repair protein* | |
| 650 | 4 | |a Molecular genetic analysis | |
| 650 | 4 | |a Neuroendocrine tumour | |
| 650 | 4 | |a Neuroendocrinology | |
| 650 | 4 | |a Oncology | |
| 650 | 4 | |a PET scan | |
| 650 | 4 | |a Pancytokeratins* | |
| 650 | 4 | |a Sessile serrated legion | |
| 650 | 4 | |a Somatostatin | |
| 650 | 4 | |a Somatostatin receptor* | |
| 650 | 4 | |a Synaptophysin | |
| 650 | 4 | |a United Kingdom | |
| 650 | 4 | |a White | |
| 700 | 1 | |a Nisa, Zaibun |e verfasserin |4 aut | |
| 700 | 1 | |a Watkins, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Hayes, Aimee R |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Endocrinology, diabetes & metabolism case reports |d 2013 |g 2020(2020) vom: 29. Juli |w (DE-627)NLM236279777 |x 2052-0573 |7 nnns |
| 773 | 1 | 8 | |g volume:2020 |g year:2020 |g day:29 |g month:07 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1530/EDM-20-0058 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 2020 |j 2020 |b 29 |c 07 | ||