Application of INSM1 in Diagnosis and Grading of Laryngeal Neuroendocrine Carcinoma

Abstract

Objective: Chromogranin (CHG), synaptophysin (Syn), and CD56 are generally used in a panel to support diagnoses of laryngeal neuroendocrine carcinomas (NECs). However, the absence of expression of these markers does not completely exclude the diagnosis. INSM1 is a novel marker that is considered sufficiently sensitive and specific for NE differentiation. The aim of this study is not only to detect its sensitivity and specificity, but also to evaluate its application in grading for laryngeal NECs.Methods: The clinicopathological characteristics of the 25 cases with laryngeal NECs were retrospectively analyzed. The expressions of INSM1, CHG, Syn, and CD56 were detected by immunohistochemistry.Results: Of the 25 laryngeal NECs, INSM1 had higher sensitivity (92%) than Syn (84%), CHG (76%) and CD56 (76%). The average H scores of INSM1, CD56, Syn, and CHG were 160, 37.5, 300, 300 for well-differentiated neuroendocrine carcinoma (WD-NEC); 190, 149, 209, 215 for moderately differentiated neuroendocrine carcinoma (MD-NEC); 251, 208, 104, 25 for poorly differentiated neuroendocrine carcinoma with small cell (SCNEC); 109, 160, 98, 26 for large cell types (LCNEC), respectively. Of these 98 non-neuroendocrine tumors, INSM1 expression was seen in nine (9%) tumors, all were squamous cell carcinoma. And INSM1 staining was generally focal.Conclusion: INSM1 has high sensitivity and specificity in diagnosis of laryngeal NECs. For grading laryngeal NECs, Syn and CHG showed significant advantages in the diagnosis of WD-NEC and MD-NEC, whereas INSM1 and CD56 showed greater diagnostic value in the diagnosis of SCNEC and LCNEC, especially in SCNEC.

Giant laryngeal neuroendocrine neoplasm causing airway obstruction: A case report and literature review

“…[8] Yuan et al performed immunohistochemical staining of INSM1, CgA, Syn, and CD56 in pathological samples of 25 laryngeal NENs and the results showed that INSM1 had a higher sensitivity (92%) and specificity (91%) compared to the other 3. [16] Ki-67 as a proliferative marker, combined with mitotic counting and necrosis, can be used to grade laryngeal NENs. The applications of calcitonin, CEA, and TTF1 in head and neck tumors have primarily focused on thyroid tumors.…”

Analysis of Insulinoma-Associated Protein 1 Expression in Pituitary Neuroendocrine Tumors

“…INSM1 is a transcription factor that induces differentiation in neuroendocrine cells or tumor cells in various organs, and many reports have shown its usefulness in diagnosis and treatment, including molecular-targeted therapy. In various tumors, such as thoracic tumors, laryngeal neuroendocrine carcinomas, and pancreatic neuroendocrine tumors, differences in sensitivity, specificity, and staining have been reported compared with classical markers, such as synaptophysin, chromogranin, and CD56 [ 5 , 14 , 12 ].…”

Atypical Carcinoid of the Larynx: A Case Report

“…10 Ki-67 is deemed to be the most frequently used biomarker of prognosis, which is the basis for grading of NET. 2 In addition, Yuan et al 11 have suggested that INSM1 is of great significance in the diagnosis and classification of NEC of the larynx.…”