Gastrointestinal Neuroendocrine Tumours: A Comprehensive Case Series with Histomorphological Correlation at Tertiary Care Hospital, Western India
DOI:
https://doi.org/10.21276/apalm.3809Keywords:
gastrointestinal neuroendocrine neoplasm, histomorphology, Ki-67 proliferation index, immunohistochemistryAbstract
Background: Gastrointestinal neuroendocrine neoplasms (GI-NENs) are rare and arise from enterochromaffin/Kulchitsky cells and exhibit variable clinical, morphological, and biological behavior. Their diagnosis and grading rely heavily on histopathology and proliferation indices as per the WHO 5th edition classification. Early diagnosis and surgical resection has better outcome.Aim: To describe the histopathological features, grading, immunohistochemical profile, and short-term outcomes of five GI-NENs.
Materials and Methods: Five cases of GI-NENs diagnosed over nine months were retrospectively analysed. Clinical details, tumour location, gross findings, histomorphology, mitotic activity, Ki-67 index, and immunohistochemistry (IHC) profiles were analyzed. All details taken from clinical case and laboratory records. Classification and grading were performed using the WHO 2022/5th edition criteria.
Results: Patients ranged from 16 to 54 years (mean 39 years) with female predominance. Duodenum was the most common site (three cases), followed by ileum (one case) and appendix (one case). Four tumours were well-differentiated NETs, low grade (three G2, one G1) and one was a poorly differentiated large-cell neuroendocrine carcinoma (NEC). Most NETs demonstrated strong Synaptophysin and Chromogranin A positivity. Ki-67 index ranged from <2% to 65%. Two patients with high-risk features (including NEC) succumbed to death within one month after surgery.
Conclusion: GI-NENs in this series primarily affected females and involved the duodenum most commonly. Well-differentiated low-grade NETs represented the predominant tumour type. Ki-67 proliferative index correlated well with histologic grade and clinical outcome, reaffirming its essential role in tumour stratification. Early diagnosis and accurate grading remain crucial for prognostication and management. As this is a retrospective study of case series, ethical committee approval was not mandatory as per our Institutional Ethics Committee.
References
1. Jeya J, Narmadhar R, Rajalakshmi V, Kalaivani S. Clinicopathological profile of neuroendocrine tumors of gastrointestinal tract. J Diagn Pathol Oncol 2018;3(4):286-89.
2. Modlin IM, Shapiro MD, Kidd M. Siegfried Oberndorfer: origins and perspectives of carcinoid tumors. Hum Pathol. 2004 Dec;35(12):1440-51.
3. Rindi G, Klimstra DS, et al. Neuroendocrine neoplasms of the digestive system. In: Nagtegaal ID, Odze RD, Klimstra DS, et al., editors. WHO classification of tumours: Digestive system tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. Available from: https://tumourclassification.iarc.who.int
4. Rindi G, Mete O, Uccella S, Basturk O, La Rosa S, Brosens LAA, et al. Overview of the 2022 WHO Classification of neuroendocrine neoplasms. Endocr Pathol. 2022;33(1):115-54.
5. Rosai J. Neuroendocrine tumors. In: Rosai J, editor. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia: Elsevier; 2018. p. 595.
6. Tang LH. Pancreatic neuroendocrine neoplasms: Landscape and horizon. Arch Pathol Lab Med. 2020;144(7):816-28.
7. Inzani F, Petrone G, Rindi G. The New World Health Organization Classification for pancreatic neuroendocrine neoplasia. Endocrinol Metab Clin North Am. 2018;47(3):463-70.
8. Amarapurkar DN, Juneja MP, Patel ND, et al. A retrospective clinico-pathological analysis of neuroendocrine tumors of the gastrointestinal tract. Trop Gastroenterol 2010;31:101-4.
9. Rothenstein J, Cleary SP, Pond GR, Dale D, Gallinger S, Moore MJ, Brierley J, Siu LL. Neuroendocrine tumors of the gastrointestinal tract: a decade of experience at the Princess Margaret Hospital. Am J Clin Oncol 2008;31(1):64-70.
10. Zeng YJ, Liu L, Wu H, Lai W, Cao JZ, Xu HY, Wang J, Chu ZH. Clinicopathological features and prognosis of gastroenteropancreatic neuroendocrine tumors: analysis from a single-institution. Asian Pac J Cancer Prev. 2013;14(10):5775-81.
11. Yucel B, Babacan NA, Kacan T, Eren AA, Eren MF, Bahar S, Celasun MG, Seker MM, Hasbek Z. Survival analysis and prognostic factors for neuroendocrine tumors in Turkey. Asian Pac J Cancer Prev. 2014 Jan;14(11):6687-92.
12. Muralidhar A, Mahadevan P. Spectrum of neuroendocrine neoplasms of GIT – a histomorphological study in a tertiary care centre. Journal of Medical Science. 2023;92(2):e813.
13. Maggard MA, O'Connell JB, Ko CY. Updated population-based review of carcinoid tumors. Ann Surg 2004;240:117-22.
14. Anna Fen-Yau Li, Alice Chia-Heng Li. Small cell carcinomas in gastrointestinal tract: immunohistochemical and clinicopathological features. J Clin Pathol 2010;63:620-25.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dhruvikabahen Hasmukhbhai Patel, Rupal Jaymin Shah, Nidhi Rajiv Patel
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
How to Cite
