Volume 116, Issue 3, Pages (March 1999)

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Volume 116, Issue 3, Pages 532-542 (March 1999) ECL cell tumor and poorly differentiated endocrine carcinoma of the stomach: Prognostic evaluation by pathological analysis  Guido Rindi, Cinzia Azzoni, Stefano La Rosa, Catherine Klersy, Donatella Paolotti, Sigrid Rappel, Manfred Stolte, Carlo Capella, Cesare Bordi, Enrico Solcia  Gastroenterology  Volume 116, Issue 3, Pages 532-542 (March 1999) DOI: 10.1016/S0016-5085(99)70174-5 Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 (A and B) Grade 1a ECL cell tumor associated with corpus-fundus atrophic gastritis, showing (A) delicate, trabecular-microlobular aggregates of small, regularly distributed, mildy atypical cells with no mitoses and (B) few Ki67-positive nuclei. (C) Grade 1b ECL cell tumor associated with atrophic gastritis, showing more solid aggregates of cells with moderately hyperchromatic nuclei, often with evident nucleolus. (D–F) Grade 2 sporadic ECL cell tumor with (D) prevalence of large, solid aggregates of irregularly distributed cells, with or without focal preservation of (E) trabecular and (F) microacinar structure; note focal necrosis (*); fairly large, polyedric nuclei; scattered mitoses (arrows); and (E) high Ki67 index (magnifications: A, B, C, E, and F, 250×; D, 100×; A, C, D, and F, H&E stain; B and E, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Grade 3 tumor (PDEC) showing (A) solid aggregates of hyperchromatic cells with large necrotic areas; (B) frequent, often atypical, mitoses with high Ki67 index; and (C) P53 immunoreactivity. (D and E) Partly necrotic neoplastic embolus in a peritumor blood vessel of a grade 3 endocrine carcinoma (D) and a lymph vessel microinvasion in a grade 1b tumor (E) (magnifications: A, 63×; B and C, 250×; D, 100×; E, 400×; A, D, and E, H&E stain; B and C, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Grade 3 tumor (PDEC) showing (A) solid aggregates of hyperchromatic cells with large necrotic areas; (B) frequent, often atypical, mitoses with high Ki67 index; and (C) P53 immunoreactivity. (D and E) Partly necrotic neoplastic embolus in a peritumor blood vessel of a grade 3 endocrine carcinoma (D) and a lymph vessel microinvasion in a grade 1b tumor (E) (magnifications: A, 63×; B and C, 250×; D, 100×; E, 400×; A, D, and E, H&E stain; B and C, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Grade 3 tumor (PDEC) showing (A) solid aggregates of hyperchromatic cells with large necrotic areas; (B) frequent, often atypical, mitoses with high Ki67 index; and (C) P53 immunoreactivity. (D and E) Partly necrotic neoplastic embolus in a peritumor blood vessel of a grade 3 endocrine carcinoma (D) and a lymph vessel microinvasion in a grade 1b tumor (E) (magnifications: A, 63×; B and C, 250×; D, 100×; E, 400×; A, D, and E, H&E stain; B and C, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Grade 3 tumor (PDEC) showing (A) solid aggregates of hyperchromatic cells with large necrotic areas; (B) frequent, often atypical, mitoses with high Ki67 index; and (C) P53 immunoreactivity. (D and E) Partly necrotic neoplastic embolus in a peritumor blood vessel of a grade 3 endocrine carcinoma (D) and a lymph vessel microinvasion in a grade 1b tumor (E) (magnifications: A, 63×; B and C, 250×; D, 100×; E, 400×; A, D, and E, H&E stain; B and C, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 Grade 3 tumor (PDEC) showing (A) solid aggregates of hyperchromatic cells with large necrotic areas; (B) frequent, often atypical, mitoses with high Ki67 index; and (C) P53 immunoreactivity. (D and E) Partly necrotic neoplastic embolus in a peritumor blood vessel of a grade 3 endocrine carcinoma (D) and a lymph vessel microinvasion in a grade 1b tumor (E) (magnifications: A, 63×; B and C, 250×; D, 100×; E, 400×; A, D, and E, H&E stain; B and C, immunoperoxidase with light hematoxylin counterstain). Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 3 Cumulative proportion of patients surviving (Kaplan–Meier curves) according to (A) angioinvasion, (B) tumor size, (C) number of mitoses, and (D) combination of clinicopathologic type with histological grade. The 2 curves of A and B as well as the 3 curves of C differ from each other significantly (P = 0.000). In D, a significant difference was found between grade 2+3 and grade 1 patients (P = 0.000) as well as between grade 2 and grade 3 (P = 0.02); differences between types inside grade 1 were not significant. Gastroenterology 1999 116, 532-542DOI: (10.1016/S0016-5085(99)70174-5) Copyright © 1999 American Gastroenterological Association Terms and Conditions