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Days before and after admission (admission = d 0) d -476 d -452 d -364 d -266 Chromogranin A 896 ** 748 ** 717 ** (plasma *,**) 5-HIES (urine/24 h, 153 1-10 mg/24h) Days before and after admission (admission = d 0) d -58 d -56 d -6 d 6 Chromogranin A 1120 * 16310 * 33580 * (plasma *,**) 5-HIES (urine/24 h, 121 132,4 (#) 1-10 mg/24h) ** CIS Bio Radioimmunoassay (normal levels < 84.7 ng/ml).
Tissue biopsy with characteristic histopathology and positive immunohistochemical markers demonstrating neuroendocrine differentiation (chromogranin, synaptophysin, neuron-specific enolase, and thyroid transcription factor-1) are required to establish and confirm the diagnosis of LCNEC [13-15].
Differential diagnosis Immunohistochemistry Clear-cell renal- PAX8 +; CAIX +, inhibin - cell carcinoma Paraganglioma/ Chromogranin +, synaptophysin +, pheochromocytoma S100 + (sustentacular cells) Adrenal cortical MART-1 +, calretinin +, inhibin +, Melan carcinoma A +, CAM 5.2 + (30% of cases) Solitary STAT-6+ fibrous tumor
* If chromogranin A concentrations are found to be increased initially, chromogranin A measurement might be the test of choice to diagnose a recurrence in the follow-up (although not performed in the present study).
The histopathologic report revealed a neuroendocrine carcinoma with expression of glucagon, chromogranin A, synaptophysin and Ki 67--2%.
(2,9) In addition, chromogranin A is another reliable marker for neuroendocrine tumors, including pheochromocytoma and is increasingly used in the diagnostic workup and follow-up of patients with these tumors.
The tumor often stains positive for neuroendocrine markers such as synaptophysin, CD 56, and chromogranin A [8].
All four cases were non-reactive for LCA, S-100, synaptophysin and chromogranin. Three cases (4.05%) were diagnosed as poorly differentiated neuroendocrine carcinoma.
Immunostaining for chromogranin showed diffuse cytoplasmic reactivity (inset).
Throughout the past twenty years, their world class scientists have been the first to develop and produce top quality ELISA kits for ANCA, anti-CCP, Complement and Chromogranin A assays which are used throughout the world.
These neoplasms are both synaptophysin positive, yet only pheochromocyoma is positive for chromogranin (2).
CD 117, DOG 1, S100, CD34, chromogranin, synaptophysin, CD56, CD57, PGP9.5, and desmin were all negative.