十二指肠生长抑素瘤伴肝转移1例并文献复习

Primary somatostatin cell tumor of duodenum with liver metastasis: a report of 1 case and review of literature

目的探讨以肝脏转移灶为首发症状的十二指肠生长抑素瘤的临床病理特点及诊断。方法回顾性分析1例十二指肠生长抑素瘤伴肝转移的临床表现、病理组织学、免疫表型特点及误诊的原因,并结合文献进行复习。结果患者行B超检查考虑为“肝囊肿”。2年后经上消化道内镜于十二指肠降段查见一个盘状病变,病理报告为十二指肠黏膜及黏膜下类癌。随后,肝穿证实为十二指肠类癌肝转移。经免疫组化标记,肿瘤细胞表达以som atostatin为主,最后病理诊断:十二指肠生长抑素瘤伴肝转移。结论本例临床表现及病理形态较为特异,需要依据病理组织学及免疫组化检查予以确诊。对于异时肝转移癌仅凭影像学检查难以准确地揭示疾病的内在本质,只具有参考价值。

Purpose To investigate the clinicopathologic features and diagnosis of primary duodenal somatostatin cell tumor with a first presentation of liver metastasis. Methods The clinical presentations, histological features, immunophenotype and misdiagnosis reasons were studied retrospectively in one case of primary duodenal somatostatin cell tumor with liver metastasis, and related literature was reviewed, Results The patient was first considered as a “ cyst of liver” by ultrasound examination. After two years, a dish-like lesion was found in the descending part of the duodenum when having endoscopic examination of upper-digestive tract, and carcinoid tumor was diagnosed pathologically. The liver lesion was confirmed as metastasis from duodenal carcinoid tumor by biopsy subsequently. Finally, the lesions in duodenum and liver were surgically removed and they were positive for somatostatin detected by immunostaining. Conclusions The clinical presentations and pathologic morphologic features of this case are unique, and it needs to make a diagnosis by the means of combining pathomorphology with features of immunophenotype. The imaging examination could play an important role in diagnosis, but sometime there is certainly difficult to disclose accurately the nature of the disease.