Pulmonary v gastrointestinal carcinoid v pancreatic endocrine tumour

The morphological similarity between carcinoid tumours of various sites along with their similar expression of neuroendocrine markers makes it difficult to predict the site of origin of a metastatic neuroendocrine tumour.

	CK7+ / CK20+	CK7+ / CK20-	CK7- / CK20+	CK7- / CK20-	CDX-2	Pax8	PDX-1	NESP-55	TTF-1
pulmonary carcinoid	0/161, 0/92	9/161, 2/92	0/161, 0/92	7/161, 7/92	0/153, 0/204	0/205	0/204	1/204	11/161, 8/153, 7/204
gastric carcinoid	0/81	1/81	0/81	7/81	1/63, 0/54	1/55	3/54	0/54	1/81, 0/63, 0/54
duodenal carcinoid					4/6 (3/4 duodenal, 1/2 ampullary)3, 0/54	5/55	4/54	0/54	0/6 (0/4 duodenal, 0/2 ampullary)3, 0/54
small intestinal carcinoid	0/191	0/191	4/191	15/191	6/6 (ileal)3, 30/314		0/31(ileal)4	0/31(ileal)4	0/191, 0/6 (ileal)3, 0/31(ileal)4
large intestinal carcinoid	2/171	2/171	4/171	8/171	12/18(rectal)3, 0/12(rectal)4		2/12(rectal)4	1/12(rectal)4	0/171, 0/183, 0/12(rectal)4
appendiceal carcinoid	0/21	0/21	1/21	1/21	6/73, 11/114	4/195	6/114	0/114	0/23, 0/114
gastrointestinal overall	2/461, 0/152	3/461, 2/152	9/461, 1/152	32/461, 12/152	29/433	10/295			1/463
pancreatic endocrine tumour	2/121	4/121	2/121	4/121	6/203, 7/394	42/635	11/39(staining strong in 10 cases)4	16/39(staining strong)4	0/121, 0/203, 0/394

TTF-1 is highly specific for pulmonary carcinoids. CK20 positivity indicators a non-pulmonary primary site of a carcinoid. CDX-2 and Islet 1 are also helpful in this differential.

References

1 Cai, Y. C., Banner, B., Glickman, J., Odze, R. D. Cytokeratin 7 and 20 and thyroid transcription factor 1 can help distinguish pulmonary from gastrointestinal carcinoid and pancreatic endocrine tumors. Human Pathol 2001;32:1087-1093

2 Chu, P., Wu, E., Weiss, L. M. Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: a survey of 435 cases. Mod Pathol 2000;13:962-972

3 Saqi A, Alexis D, Remotti F, et al. Usefulness of CDX2 and TTF-1 in differentiating gastrointestinal from pulmonary carcinoids. Am J Clin Pathol 2005; 123:394-404

4 Srivastava A,Hornick JL. mmunohistochemical staining for CDX-2, PDX-1, NESP-55, and TTF-1 can help distinguish gastrointestinal carcinoid tumors from pancreatic endocrine and pulmonary carcinoid tumors. Am J Surg Pathol 2009; 33:626-32

5 Long KB, Srivastava A, Hirsch MS, Hornick JL. PAX8 Expression in well-differentiated pancreatic endocrine tumors: correlation with clinicopathologic features and comparison with gastrointestinal and pulmonary carcinoid tumors. Am J Surg Pathol. 2010 May;34(5):723-9.

Data to be added:

Wilander, E., Scheibenpflug, L. Cytokeratin expression in small intestinal and appendiceal carcinoids. A basis for classification. Acta Oncol 1993; 32:131-134

This page last revised 1.5.2010