Mixed neuroendocrine and adenocarcinoma of gastrointestinal tract - A complex diagnosis and therapeutic challenge

Sep 21, 2026

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Editorial addressing a case of gastroesophageal junction adenocarcinoma mixed with neuroendocrine carcinoma, focusing on the rarity and heterogeneity of mixed neuroendocrine and non-neuroendocrine neoplasms (MiNENs) and mixed adeno-neuroendocrine cancer (MANEC). Highlights high malignant potential, rapid growth, poor prognosis, and limited standard therapy due to unclear classification. Emphasizes diagnosis using morphological, immunohistochemical, and marker-based assessment, requiring separate careful grading of endocrine and epithelial components. Discusses aggressive behavior, prognostic impact of neuroendocrine proportion, and the need for multidisciplinary management.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Editorial

Core Tip

Mixed neuroendocrine and non-neuroendocrine neoplasms (MiNENs) and MANEC

Incidence and clinical context

Diagnostic and therapeutic considerations

| W | J | G | O | World Journal of
Gastrointestinal Oncology | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Oncol 2024 June 15; 16(6): 2295-2299 DOI: 10.4251/wjgo.v16.i6.2295 ISSN 1948-5204 (online) EDITORIAL Mixed neuroendocrine and adenocarcinoma of gastrointestinal tract: A complex diagnosis and therapeutic challenge Santosh Shenoy Specialty type: Oncology Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B Novelty: Grade B Creativity or Innovation: Grade B Scientific Significance: Grade B P-Reviewer: Grossi U, Italy Received: January 8, 2024 Revised: March 5, 2024 Accepted: April 10, 2024 Published online: June 15, 2024 Santosh Shenoy, Department of General Surgery, Kansas City VA Medical Center, University of Missouri-Kansas City, Kansas City, MO 64128, United States Corresponding author: Santosh Shenoy, FACS, MD, Professor, Department of General Surgery, Kansas City VA Medical Center, University of Missouri -Kansas City, 4801 E Linwood, Kansas City, MO 64128, [United States.](United States. shenoy2009@hotmail.com)[ shenoy2009@hotmail.com](United States. shenoy2009@hotmail.com) Abstract In this editorial we comment on the manuscript describing a case of adenocarcinoma mixed with a neuroendocrine carcinoma of the gastroesophageal junction. Mixed neuroendocrine and non-neuroendocrine neoplasms of the gastrointestinal system are rare heterogeneous group of tumors characterized by a high malignant potential, rapid growth, and poor prognosis. Due to the rarity of these cancers, the standard therapy is poorly defined. The diagnosis of these tumors is based on combination of morphological features, immunohistochemical and neuroendocrine and epithelial cell markers. Both endocrine and epithelial cell components can act independently of each other and thus, careful grading of each component separately is required. These cancers are aggressive in nature and the potential of each component has paramount importance in the choice of treatment and response. Regardless of the organ of origin, these tumors portend poor prognosis with increased proportion of neuroendocrine component. Multidisciplinary services and strategies are required for the management of these mixed malignancies to provide the best oncological outcomes. The etiopathogenesis of these mixed tumors remains obscure but poses interesting question. We briefly discuss a few salient points in this editorial. Key Words: Mixed adenocarcinoma and neuroendocrine carcinoma; Mixed neuroendocrine and non-neuroendocrine neoplasm; Mixed adeno-neuroendocrine cancer; Cell reprograming; Tumor plasticity ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved. WJGO [https://www.wjgnet.com](https://www.wjgnet.com) 2295 June 15, 2024 Volume 16 Issue 6 Shenoy S. Synchronous neuroendocrine and non-neuroendocrine neoplasms Core Tip: Mixed neuroendocrine and non-neuroendocrine neoplasms and mixed adeno-neuroendocrine cancer of the gastrointestinal system are a rare heterogeneous group of tumors with high malignant potential, rapid growth, and poor prognosis. The occurrence of cells with both neuroendocrine and non-neuroendocrine morphological features co-exist in varying amounts, and these tumors occur in almost all organs. The origin of these mixed cancers is not clearly defined but may be the result of certain genetic alterations and growth stimulation by the neuroendocrine peptides produced by neuroendocrine component. Regardless of the organ of origin, these tumors portend poor prognosis with increased proportion of neuroendocrine component. Multidisciplinary services and strategies are required for the management of these mixed malignancies to provide the best oncological outcomes. Citation: She

FAQs

Why are mixed neuroendocrine and non-neuroendocrine neoplasms considered difficult to treat?

They are rare and heterogeneous, with poorly defined standard therapy. Limited diagnostic and treatment guidance contributes to clinical complexity.

How is diagnosis of these mixed tumors established?

Diagnosis relies on combined morphological assessment plus immunohistochemical neuroendocrine and epithelial cell markers. Each component requires careful grading separately.

What role does the neuroendocrine component play in prognosis and treatment planning?

An increased proportion of neuroendocrine component is associated with poor prognosis. The potential of each component is considered crucial when choosing treatment and assessing response.

Sep 21, 2026

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