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Case Reports
. 2019 Jun 13;12(2):434-442.
doi: 10.1159/000501200. eCollection 2019 May-Aug.

Diagnosis of Mixed Adenoneuroendocrine Carcinoma (MANEC) after Neoadjuvant Chemotherapy for Pancreatic and Gastric Adenocarcinoma: Two Case Reports and a Review of the Literature

Ester Oneda  1 , Barbara Liserre  2 , Denise Bianchi  2 , Luigina Rota  1 , Giordano Savelli  3 , Fausto Zorzi  2 , Alberto Zaniboni  1
Affiliations
Case Reports

Diagnosis of Mixed Adenoneuroendocrine Carcinoma (MANEC) after Neoadjuvant Chemotherapy for Pancreatic and Gastric Adenocarcinoma: Two Case Reports and a Review of the Literature

Ester Oneda et al. Case Rep Oncol. .

Abstract

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract involving both epithelial and neuroendocrine (NE) components, each of which represents at least 30% of the tumor. Because of the low frequency of this histotype, only a few cases have been described. In this report we discuss two cases treated with neoadjuvant chemotherapy: a pancreatic adenocarcinoma and a gastric adenocarcinoma. The histopathological specimens examined after surgery showed an additional NE component with a possible indication of the MANEC histotype. We hypothesize two possible explanations: tumor NE cells are more chemo-resistant than adenocarcinoma cells, and cytotoxic injury induces NE differentiation in tumor cells. The clinical significance and prognostic value of endocrine differentiation, however, remain controversial issues.

Keywords: Mixed adenoneuroendocrine carcinoma; Neoadjuvant chemotherapy; Neuroendocrine differentiation.

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Figures

Fig. 1
Fig. 1
A. The tumor consists of clusters of glandular structures (H&E stain, 40× magnification). B. Drop of mucus in violet near nuclei (PAS-D +). C. Cells marked by the neuroendocrine marker CD56 (10× magnification). D. Neoplastic cells marked by neuroendocrine marker synaptophysin.
Fig. 2
Fig. 2
A. Morphology of the tumor in the neuroendocrine component (H&E stain, 2.5× magnification). B. Epithelial-glandular part of the tumor, CD56 negative. C. Details of the epithelial component (H&E stain, 10× magnification) D. Neoplastic cells marked by neuroendocrine marker synaptophysin in a double stain with ki67 for the neuroendocrine component.
See this image and copyright information in PMC

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