Management of neuroendocrine carcinomas of the pancreas (WHO G3): A tailored approach between proliferation and morphology

Stefano Crippa, Stefano Partelli, Giulio Belfiori, Marco Palucci, Francesca Muffatti, Olga Adamenko, Luca Cardinali, Claudio Doglioni, Giuseppe Zamboni, Massimo Falconi

Research output: Contribution to journalReview articlepeer-review


Neuroendocrine carcinomas (NEC) of the pancreas are defined by a mitotic count > 20 mitoses/10 high power fields and/or Ki67 index > 20%, and included all the tumors previously classified as poorly differentiated endocrine carcinomas. These latter are aggressive malignancies with a high propensity for distant metastases and poor prognosis, and they can be further divided into small-and large-cell subtypes. However in the NEC category are included also neuroendocrine tumors with a well differentiated morphology but ki67 index > 20%. This category is associated with better prognosis and does not significantly respond to cisplatin-based chemotherapy, which represents the gold standard therapeutic approach for poorly differentiated NEC. In this review, the differences between well differentiated and poorly differentiated NEC are discussed considering both pathology, imaging features, treatment and prognostic implications. Diagnostic and therapeutic flowcharts are proposed. The need for a revision of current classification system is stressed being well differentiated NEC a more indolent disease compared to poorly differentiated tumors.

Original languageEnglish
Pages (from-to)9944-9953
Number of pages10
JournalWorld Journal of Gastroenterology
Issue number45
Publication statusPublished - Dec 7 2016


  • Chemotherapy
  • Metastases
  • Morphology
  • Neuroendocrine carcinomas
  • Pancreatic neuroendocrine tumors
  • Prognosis
  • Proliferation
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology


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