Large cell neuroendocrine - Adenocarcinona mixed tumour of colon: Collision tumour with peculiar behaviour. What do we know about these tumours?

Abstract

IntroductionMixed glandular-endocrine carcinomas are rare tumours of gastrointestinal tract (MANEC). They are more frequent in stomach and hardly one hundred cases have been described in colon. According to Lewis, they are classified into collision (side by side pattern), composite (intermingled) or amphicrine (neuroendocrine and glandular features inside a same cell). Collision tumours are related to biclonal theory: two simultaneous cancerogenic events. Conversely, multidirectional differentiation from a stem cell is accepted as origin of composite tumours.The aim of this paper is to analyse the behaviour of these tumours, with an especial concern about how these tumours metastasise, and the different theories about carcinogenesis.Presentation of caseWe report a rare case of collision adenocarcinoma-large cell neuroendocrine tumour of colon that after a three-year period of follow-up has presented a retroperitoneal recurrence that features adenocarcinoma and large cell neuroendocrine components.DiscussionAfter an exhaustive review of the English literature, we found that only two cases of collision tumour of colon with metastases showing glandular and endocrine components have been described up to date, so we report the third case, and the first happening in transverse colon.ConclusionWe conclude that not all collision tumours follow the biclonal theory and more studies are needed to clarify the origin of these neoplasms, and consequently, to reach an adequate treatment.

Mixed Adenoneuroendocrine Carcinoma of the Gastroesophageal Junction: A Rare Find

“…7 Another hypothesis suggests that their origin is from dedifferentiated adenocarcinoma of a neuroendocrine phenotype.…”

Digestive System Mixed Neuroendocrine-Non-Neuroendocrine Neoplasms

“…The treatment of metastatic MiNEN should logically target the neoplastic component responsible for the metastatic spreading rather than rely on the characteristics of the primary, since the neuroendocrine and non-neuroendocrine components can metastasize together but also separately, even in collision MiNEN [82] . Nevertheless, metachronous metastases are rarely biopsied, and nuclear medicine tools cannot help distinguishing between adenocarcinoma and PDNEC because, for example, both components display 18 FDG positron-emitting tomography positivity, and negative somatostatin receptor scintigraphy due to lack of somatostatin receptors expression [83] .…”

Management of MANEC of the colon and rectum: A comprehensive review of the literature

“…Included studies. A total of 18 studies (14 case reports and 4 retrospective cohorts) reported outcomes for patients with colorectal MANEC and were finally considered eligible for analysis (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Data on 93 patients (62 male and 31 female; age range of 32-96 years) was retrieved from the selected studies.…”