Prostate gland & seminal vesicles
Neuroendocrine tumors
Neuroendocrine overview
Author: Debra L. Zynger, M.D.
Topic Completed: 1 June 2016
Minor changes: 24 November 2020
Copyright: 2003-2021, PathologyOutlines.com, Inc.
PubMed search: Prostatic neuroendocrine carcinoma
Table of Contents
Definition / general | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stainsCite this page: Zynger D. Neuroendocrine overview. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/prostateneuroendo.html. Accessed January 17th, 2021.
Definition / general
- Neuroendocrine cells are found in normal prostate glands between basal cells and secretory cells
- Neuroendocrine differentiation can be seen in prostate cancer and is categorized based on the extent as:
- Neuroendocrine cells in usual prostate adenocarcinoma
- Adenocarcinoma with Paneth cell-like neuroendocrine differentiation
- Well differentiated neuroendocrine tumor (formerly termed carcinoid)
- Small cell neuroendocrine carcinoma
- Large cell neuroendocrine carcinoma
- Reported frequency of neuroendocrine cells in usual prostate adenocarcinoma is variable (10 - 100%) and the presence does not change clinical management (Hum Pathol 2000;31:406, Am J Surg Pathol 2014;38:756)
- Paneth cell-like neuroendocrine differentiation in prostatic adenocarcinoma has no established prognostic significance (Am J Surg Pathol 2006;30:980)
- Well differentiated neuroendocrine tumor (formerly termed carcinoid) is extremely rare, should only be diagnosed if conventional prostate cancer is not present, and has a good prognosis despite presenting with disease that is locally advanced or within regional lymph nodes
- Small cell neuroendocrine carcinoma of the prostate has a prior history of conventional prostate cancer in half of cases, and is important to recognize because platinum based chemotherapy is utilized for treatment
- Most cases of large cell neuroendocrine carcinoma occur after long term androgen ablation (Am J Surg Pathol 2006;30:684)
Case reports
- 48 year old man with large cell neuroendocrine carcinoma (Int J Clin Exp Pathol 2014;7:9061)
- 49 year old man with Paneth cell-like change in nonneoplastic prostate with AMACR positivity (Int J Clin Exp Pathol 2014;7:3454)
- 64 year old man with neuroendocrine differentiation after hormone therapy (J Med Life 2012;5:101)
- 74 year old man with small cell neuroendocrine carcinoma and skin metastasis (J Med Case Rep 2014;8:146)
- 75 year old with large cell neuroendocrine carcinoma after androgen ablation (Can J Urol 2015;22:7752)
Microscopic (histologic) description
- Neuroendocrine cells in normal prostate ducts and acini are not identifiable on routine H&E
- Paneth cell-like neuroendocrine differentiation in prostatic adenocarcinoma is characterized by cells with bright, eosinophilic granules
- Small cell neuroendocrine carcinoma of the prostate has similar morphology to other organs (sheets of small cells with minimal cytoplasm, indistinct cell borders, nuclear molding, crush, necrosis, apoptotic bodies, high mitotic rate, uniform chromatin, lack of nucleoli) although intermediate cell size and pinpoint nucleoli are acceptable for this diagnosis
Microscopic (histologic) images
Contributed by Debra Zynger, M.D.
Prostatic small cell neuroendocrine carcinoma
Prostatic
adenocarcinoma
with 100% NE
differentiation
Metastatic prostatic
small cell
neuroendocrine
carcinoma
Positive stains
- Neuroendocrine markers: synaptophysin, chromogranin, CD56, neuron-specific enolase, bombesin
- AE1/3, CAM5.2
- Small cell neuroendocrine carcinoma: TTF1 positive in 50 - 100% (limits the ability of TTF1 to differentiate prostate and lung neuroendocrine carcinoma); c-kit, BCL2, EGFR, p53 also positive (Mod Pathol 2000;13:238, Am J Surg Pathol 2006;30:705, Am J Surg Pathol 2008;32:65)
- Paneth cell-like change in nonneoplastic prostate may be AMACR positive (Int J Clin Exp Pathol 2014;7:3454)
Negative stains
- PSA, P501s, PSMA, AR negative or focally positive (Am J Surg Pathol 2006;30:705, Am J Surg Pathol 2008;32:65)
- CK20
