Endocrine cells in colorectal adenocarcinomas: Incidence, hormone profile and prognostic relevance

Abstract

The occurrence of endocrine cells in 350 cases of colorectal adenocarcinoma was studied by immunohistochemistry for chromogranin A (CGA). The hormone profile of endocrine tumor cells, the correlation between endocrine differentiation and presence of other colorectal epithelial-cell lineages and the prognostic relevance of endocrine differentiation in colorectal cancer were investigated. CGA-positive tumor cells were found in 30% of cases, 21% showing moderate positivity and 9.0% extensive positivity. Of CGA-positive tumors, 70% additionally produced neurohormones, mainly indigenous to normal colorectal epithelium: 55% showed immunoreactivity for glucagon-like substances, 20% for serotonin and 10% for somatostatin, PYY and HCG. No immunoreactivity was found for various neurohormones not normally produced by colorectal endocrine cells. CGA-positive tumors tended to be more aggressive than CGA-negative tumors. Especially, tumors with extensive CGA positivity showed shorter survival, which was most apparent within Dukes' stage C. In multivariate analysis, extensive CGA positivity was an independent indicator of poor prognosis. CGA immunoreactivity significantly correlated with mucin production, but not with expression of secretory component (SC), a columnar-cell marker. Mucin production significantly correlated with SC expression. Tumors positive for CGA but not for mucin and/or SC showed the worst prognosis. SC expression was a relatively favorable feature, and mucin-producing tumors showed intermediate behavior.

Increased neuroendocrine cells in resected metastases compared to primary colorectal adenocarcinomas

“…In the present series, cases having a neuroendocrine differentiated component in the primary tumors had a slightly shorter survival both from the time of diagnosis and the time from metastatic spread but statistical significance was reached for the latter case only, possible due to the relatively small sample size. Other literature data are in line with this observation [13,19,20], although some authors found no prognostic differences between neuroendocrine differentiated and conventional colorectal carcinoma [21]. No correlation was also observed with any clinical pathological parameter.…”

A population-based study of colorectal cancer histology in the United States, 1998–2001

“…4 In addition, tumor histology can be an important prognostic indicator. In CRC, studies suggest that both signet ring cell and small cell tumors are associated with an adverse prognosis, [5][6][7] whereas other histologic types may carry a more favorable prognosis. 8 The prognosis of CRC mucinous tumors is more controversial, and some studies have reported a worse outcome for these tumors.…”

Prevalence and Prognostic Significance of Neuroendocrine Cells in Esophageal Adenocarcinoma

“…Probably the most common pattern of neuroendocrine differentiation in GI neoplasms, however, is the presence of scattered tumor cells showing neuroendocrine differentiation in an otherwise typical adenocarcinoma. The presence of neuroendocrine cells in colonic adenocarcinomas (1)(2)(3)(4)(5) and gastric adenocarcinomas (6) has long been recognized. Although up to 42% of typical colon adenocarcinomas contain scattered chromogranin (CG)-positive cells (4), this finding does not seem to influence prognosis, and these tumors are not classified as mixed adenocarcinoma/ neuroendocrine tumors.…”