Clinicopathological characteristics and prognosis of 232 patients with poorly differentiated gastric neuroendocrine neoplasms

Figure 1 Endoscopic detection of poorly differentiated gastric neuroendocrine neoplasms. A: Circumferential raised lesions on the cardia with uneven surfaces; B: Irregular bumps on the side of the minor curvature of the cardia, accompanied by erosions, ulcers, and unclear boundaries that bled easily when contacted; C: A raised ulcer with a diameter of 4 cm was observed in the small curvature of the antrum; D: A deep ulcer with a diameter of approximately 0.5 cm on the posterior wall of the gastric fundus was observed, and the base was not clear.

Figure 2 Morphology and immunohistochemical staining of large cell neuroendocrine carcinoma in the cardia. A: Morphology (hematoxylin and eosin staining, × 400); B: Chromogranin A-positive staining [immunohistochemical (IHC), × 200]; C: Synaptophysin-positive staining (IHC, × 200); D: Ki-67 index: 90% (IHC, × 200).

Figure 3 Morphology and immunohistochemical staining of gastric small cell neuroendocrine carcinoma. A: Morphology (hematoxylin and eosin staining, × 400); B: CD56-positive staining [immunohistochemical (IHC), × 400]; C: Synaptophysin-positive staining (IHC, × 200); D: Ki-67 index: 90% (IHC, × 200).

Figure 4 Morphology and immunohistochemical staining of mixed adenoneuroendocrine carcinoma. A and B: Morphology of gastric small cell neuroendocrine carcinoma mixed with adenocarcinoma (hematoxylin and eosin staining, × 400); C: Gastric small cell neuroendocrine carcinoma mixed with adenocarcinoma (hematoxylin and eosin staining, × 200). Alcian blue/periodic acid–Schiff (AB-PAS) staining (× 200): The left side of the picture shows adenocarcinoma (AB-PAS positive); D: Chromogranin A-positive staining (× 200). The right side of the picture shows small cell neuroendocrine carcinoma.

Figure 5  Distribution of nonspecific clinical symptoms in 190 patients with poorly differentiated gastric neuroendocrine neoplasms.

Figure 6 Kaplan-Meier survival analysis (P < 0. 05). A: Tumor number (P = 0.01); B: Tumor diameter (P = 0.01); C: Invasion (P = 0.02); D: American Joint Committee on Cancer stage (P < 0.001); E: Distant metastasis (P < 0.001); F: Treatment for patients without distant metastases (P < 0.001). AJCC: American Joint Committee on Cancer; OS: Overall survival.