A Histopathology review (30 September 2026) traces the terminology of mixed gastrointestinal epithelial-neuroendocrine tumours through to the 2026 WHO classification of digestive system tumours.
Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) still requires two morphologically recognisable components, each making up at least 30% of the tumour, with clear neuroendocrine marker expression in the neuroendocrine component. A tumour whose non-neuroendocrine component is only a precursor or intramucosal lesion is not MiNEN: the recommended wording is, for example, neuroendocrine carcinoma arising in an adenoma, not mixed adenoma-neuroendocrine carcinoma.
The sixth edition introduces amphicrine-like carcinoma for tumours in which neuroendocrine and non-neuroendocrine differentiation are intimately intermixed, in the same cells or morphologically similar cells, rather than forming separate zones. Both are families rather than single diagnoses, both need immunohistochemical confirmation, and molecular data favour a common clonal origin rather than collision.
- Diagnose MiNEN only when each component is at least 30% of the tumour and morphologically recognisable.
- Report a neuroendocrine carcinoma with an adenoma as 'neuroendocrine carcinoma arising in an adenoma', not MiNEN.
- Use 'amphicrine-like carcinoma' when neuroendocrine and glandular differentiation are intermixed rather than zonal.
- Confirm the neuroendocrine component with immunohistochemistry before using either term.
- Grade and describe each component separately in the report so oncologists can plan treatment.
Why it matters
Loose use of MiNEN for neuroendocrine carcinoma arising in an adenoma blurs a term oncologists use to choose treatment.
Don't overread it
This is a narrative review of the classification; it does not add outcome data for amphicrine-like carcinoma.
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