Deepthi Rao
ProPath, USA
Title: Pancreatic Neuroendocrine Tumor diagnosis in the age of precision medicine
Biography
Biography: Deepthi Rao
Abstract
High-grade neuroendocrine neoplasms (World Health Organization Grade 3) classification of the pancreas include both well-differentiated neuroendocrine tumor (WD-NET) and poorly differentiated neuroendocrine carcinoma (PD-NEC). Previously, the diagnosis of this group of tumors was based on both the histopathology of the tumor and the assessment of proliferation fraction. However, it is extremely challenging to differentiate the WDNET Grade 3 from the PDNEC due to the lack of well-defined histologic criteria, and the utilization of guidelines with mitotic count and immunohistochemistry for Ki-67 (>20 mitoses/10 high-power fields or Ki67>20%) shows significant overlap. However, there can be major differences in treatment strategies and clinical outcome. Thus, there is a growing need for additional practical modalities to consistently facilitate the accurate differentiation between the two categories among the high-grade pancreatic neuroendocrine neoplasms. In the age of precision medicine and molecular biomarkers, the evaluation of immunohistochemical staining for surrogate biomarkers of known genotypes of WD-NET and PD-NEC, can be crucial in establishing a final definitive classification. These biomarkers are DAXX, ATRX, Tp53 and Retinoblastoma protein. The loss of DAXX or ATRX protein expression supports the diagnosis of WD-NET, whereas the abberant expression of Tp53, and/or Retinoblastoma protein aids the diagnosis of PD-NEC which can result in the appropriate clinical management and prognosis.