Histologic characterization and improved prognostic
evaluation of 209 gastric neuroendocrine neoplasms
Stefano La Rosa MD
, Frediano Inzani MD
, Alessandro Vanoli MD
Catherine Klersy MD
, Linda Dainese MD
, Guido Rindi MD, PhD
Carlo Capella MD
, Cesare Bordi MD
, Enrico Solcia MD
Department of Pathology, Ospedale di Circolo, 21100 Varese, Italy
Department of Pathology, U.C.C.S Policlinico Gemelli, 00186 Rome, Italy
Department of Human and Hereditary Pathology, University of Pavia, 27100 Pavia, Italy
Scientific Direction, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
Department of Human Morphology, University of Insubria, 21100 Varese, Italy
Department of Pathology and Laboratory Medicine, University of Parma, 43100 Parma, Italy
Received 18 December 2010; revised 22 January 2011; accepted 28 January 2011
Summary Gastric neuroendocrine neoplasms differ considerably in histology, clinicopathologic
background, stage, and patient outcome, implying a wide spectrum of therapeutic options, hence the
need for improved diagnostic and prognostic criteria to select appropriate therapy. Here, we tested the
European NeuroEndocrine Tumor Society and the novel World Health Organization 2010 grade and
stage classifications together with additional clinicopathologic and histologic parameters in a series of
209 gastric neuroendocrine neoplasms with a median follow-up of 89 months. Fifty-one grade 3
neuroendocrine carcinomas and 15 mixed endocrine-exocrine carcinomas of poor outcome were
separated from 143 neuroendocrine tumors, including 132 G1 or G2 enterochromaffin-like (ECL) cell
neoplasms and 11 G1 gastrin-cell, somatostatin-cell, or serotonin-cell tumors. Most G1 cases had
excellent prognosis, even when metastatic, whereas G2 and G3 neoplasms had worse or very severe
prognosis, respectively. The European NeuroEndocrine Tumor Society–World Health Organization
2010 proliferative grading system well correlated with patient survival. Structural histologic parameters
were equally predictive and when combined with the European NeuroEndocrine Tumor Society–World
Health Organization 2010 grading system in a “global grade” improved tumor prognostic stratification.
The European NeuroEndocrine Tumor Society–World Health Organization 2010 staging system proved
effective. Introduction of novel T (T
or deep submucosal) and N categories (N
, b3 nodes
, ≥3) allowed a simplified, equally informative 3-stage TNM system. Such improved
diagnostic and prognostic criteria for gastric neuroendocrine neoplasms are proposed and discussed.
© 2011 Elsevier Inc. All rights reserved.
Gastric neuroendocrine neoplasms, also known as
endocrine neoplasms or “carcinoids,” account for a relatively
small and heterogeneous population that differ considerably
Financial support: This investigation was supported, in part, by
grants from the Italian Ministry of Health to Fondazione IRCCS Policlinico
San Matteo and to Varese Ospedale di Circolo and from the Universities of
Pavia, Insubria and Parma.
Conflict of interest: The authors declare no conflict of interest.
E-mail address: firstname.lastname@example.org (S. La Rosa).
0046-8177/$ – see front matter © 2011 Elsevier Inc. All rights reserved.
Human Pathology (2011) 42, 1373–1384