Prognostic criteria in nonfunctioning pancreatic endocrine tumours

To identify prognostic subgroups among non-functioning (nonsyndromic) pancreatic endocrine tumours, a series of 61 tumours were analysed systematically for macroscopic, histopathological and immunohistochemical variables potentially predictive of malignancy. High-grade nuclear atypia, elevated mitot...

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Bibliographic Details
Published in:Virchows Archiv : an international journal of pathology 1996-12, Vol.429 (6), p.323-333
Main Authors: LA ROSA, S, SESSA, F, CAPELLA, C, RIVA, C, LEONE, B. E, KLERSY, C, RINDI, G, SOLCIA, E
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Carcinoma - metabolism
Carcinoma - pathology
Carcinoma - physiopathology
Endocrine Gland Neoplasms - metabolism
Endocrine Gland Neoplasms - pathology
Endocrine Gland Neoplasms - physiopathology
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Female
Humans
Immunohistochemistry
Ki-67 Antigen - analysis
Male
Medical sciences
Middle Aged
Mitosis
Necrosis
Neoplasm Invasiveness
Pancreatic Neoplasms - metabolism
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - physiopathology
Prognosis
Risk Factors
Survival Analysis
Tumors. Hypoglycemia
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Summary:To identify prognostic subgroups among non-functioning (nonsyndromic) pancreatic endocrine tumours, a series of 61 tumours were analysed systematically for macroscopic, histopathological and immunohistochemical variables potentially predictive of malignancy. High-grade nuclear atypia, elevated mitotic rate and multifocal necrosis allowed us to separate 5 poorly differentiated carcinomas from 56 well differentiated tumours. Among the latter, 29 well-differentiated carcinomas showing gross local invasion or metastases were identified. Vascular or perineural microinvasion, Ki67 proliferative index > 2%, mitotic rate > or = 2, size > or = 4 cm, capsular penetration, nuclear atypia, lack of progesterone receptors and presence of calcitonin were among the variables correlated with malignancy. The first two were the most sensitive and specific. Their presence or absence was used in the 27 tumours lacking evidence of malignancy at the time of surgery to separate 11 cases with increased risk of malignancy (in 2 of which metastases developed during follow-up) from 16 cases with limited risk. The resulting four prognostic groups of non-functioning pancreatic endocrine tumours (limited- and increased-risk tumours, well-differentiated carcinomas and poorly differentiated carcinomas) showed distinct survival curves, which were significantly affected by vascular microinvasion, Ki67 proliferative index and metastases.
ISSN:0945-6317
1432-2307
DOI:10.1007/BF00198436