Neuroendocrine differentiation

In pathology, the term neuroendocrine differentiation refers to the presence of cells that show characteristics of both nerve cells (neurons) and hormone-producing (endocrine) cells. This means that the cells have features allowing them to produce, store, and release hormones, similar to how certain cells in the body’s nervous and endocrine systems operate. This trait can be seen in normal healthy cells and tumours (both noncancerous and cancerous).

Why is neuroendocrine differentiation important?

For pathologists, identifying neuroendocrine differentiation is particularly important when assessing a malignant (cancerous) tumour for the following reasons:

• Diagnosis: It helps in accurately diagnosing the type of cancer, and distinguishing neuroendocrine tumors from other tumor types.
• Prognosis: The presence of neuroendocrine differentiation can influence the aggressiveness of the cancer, its potential response to treatment, and the patient’s overall prognosis.
• Treatment planning: Certain therapies may be more effective for tumors with neuroendocrine characteristics. Knowing this information allows healthcare providers to tailor treatment plans more effectively.

How do pathologists identify neuroendocrine differentiation?

Pathologists use a combination of microscopic examination and a special test called immunohistochemistry (IHC) to identify neuroendocrine differentiation.

• Microscopic examination: Pathologists first examine the cells under a microscope, looking for physical characteristics typical of neuroendocrine cells, such as specific shapes or patterns. For example, cells that show this type of differentiation often have granular or speckled chromatin. Pathologists frequently refer to this pattern as “salt and pepper”.
• Immunohistochemical markers: These are the most definitive tests for neuroendocrine differentiation. Pathologists apply special dyes to the tissue samples that bind to proteins commonly found in neuroendocrine cells. Some of these markers include synaptophysin, chromogranin, and CD56.

What types of cancers show neuroendocrine differentiation?

While neuroendocrine differentiation can occur in various types of cancers, it is most commonly associated with:

• Neuroendocrine tumors (NETs): These tumors originate from the neuroendocrine cells found throughout the body, such as in the gastrointestinal tract, pancreas, and lungs.
• Small cell lung cancer (SCLC): A type of lung cancer that almost always shows neuroendocrine differentiation.
• Prostate cancer: Certain prostate cancers may show neuroendocrine differentiation, particularly those that are aggressive or resistant to hormone therapy.
• Other cancers: Occasionally, cancers from other sites, such as the breast or bladder, may also exhibit neuroendocrine differentiation, affecting their management and treatment.

About this article

Doctors wrote this article to help you read and understand your pathology report. Contact us if you have questions about this article or your pathology report. For a complete introduction to your pathology report, read this article.

Other helpful resources

Atlas of pathology