It is important to be aware of the unusual morphologic variants of pancreatic endocrine tumors, and select immunohistochemical markers can help avoid misdiagnosis (3). The mitotic rate is an important measure of aggressiveness in PETs. Well-differentiated PETs are defined to have less than 20 mitotic figures per 10 high power fields (hpf); neoplasms with 20 or more mitoses per 10 hpf are GW-572016 solubility dmso considered poorly differentiated (high grade) neuroendocrine carcinomas (Table 1). In many PETs, mitotic figures are nearly undetectable, a search of 50
hpf (or more) may be required for a Inhibitors,research,lifescience,medical single mitotic figure. Some PETs have a higher proliferative rate; and the finding of 2 or more mitotic figures per 10 hpf places a PET in a worse prognostic category. Necrosis is also variably present; most commonly it is accompanied with an increased in proliferative rrate, thus signifing a more aggressive PET (5) (Figure 1). Table 1 Inherited Inhibitors,research,lifescience,medical genetic neuroendocrine syndromes Figure 1 A.
H&E stained section of a well-differentiated pancreatic neuroendocrine tumor (G1) showing an organoid/nested growth pattern; B. immunostaining revealed low Ki-67 (<2%); C. strong expression Inhibitors,research,lifescience,medical of synaptophysin; D. weak expression of insulin. ... Pathogenesis of PETs Most pancreatic neuroendocrine tumors occur sporadically (90%). Inhibitors,research,lifescience,medical However, they may be part of hereditary syndromes: multiple endocrine neoplasia type 1 (MEN1 syndrome), von Hippel-Lindau disease (VHL), von Recklinghausen’s disease or neurofibromatosis type 1 (NF-1), and tuberous
sclerosis (TSC) (5). In these cases, the underling genetic abnormalities play a significant role in the development of PETs which are often Inhibitors,research,lifescience,medical found to be mutlifocal. The pathological features of familial/hereditary PETs are generally similar to the sporadic form, although PETs arising in VHL syndrome patients may have clear cell features (6). Germline loss-of-function MEN-1 mutation leads to the formation of numerous microadenomas, mostly resulting in non-functional PETs and insulinomas (7). NF-1 or TSC1/2 mutations result in loss of function of their protein products neurofibromin and tuberin, respectively. Notably, the intact proteins suppress the function of a common target, namely mTOR (mammalian target of rapamycin) (7). Furthermore, hypoxia-induced to factor (HIF)-dependent mTOR activation links disturbed mTOR signaling to VHL disease (8,9). mTOR is a key regulator of cell growth and integrates a wide variety of cellular inputs, such as growth factors, nutrients, energy status and hypoxia-induced stress, thus, it is a good therapeutic target for PETs. Somatic MEN1 gene mutations accompanied by a loss of the wild-type allele are demonstrated in 10-27% of insulinomas and 39-45% of gastrinomas.