直肠类癌临床病理分析及内镜治疗（附38例）

Clinicopathological characteristics and treatment of colorectal carcinoid tumors with endoscopy：a report analysis of 38 cases

目的 探讨直肠类癌的临床病理学特点及治疗方法.方法 回顾性分析38例直肠类癌的临床病理资料.结果 38例均为典型性类癌,均位于距肛门10 cm以内.内镜下多表现为典型的黏膜下肿物,色黄、质硬或韧,活动度差.所有病例神经内分泌分化标记物染色阳性.直径≤2 cm者34例,其中30例位于黏膜内,4例侵犯黏膜下层,内镜下行黏膜切除术治愈;4例直径〉2 cm,均侵犯肌层,行直肠癌根治术.肿瘤≤2 cm者Ki-67阳性表达率〈3%或阴性.34例获随访,均存活.结论 直肠类癌明确诊断依赖于组织病理学观察及免疫组化.直肠类癌生物学行为低度恶性,一般不侵犯肌层,也很少转移,多数病例可在内镜下行黏膜切除术治愈.

Objective To investigate the clinical and pathological characteristics of carcinoid tumor in rectum and its treatment. Methods The clinical and pathological data of 38 rectal carcinoid patients from Wuhan Center Hospital and Wuhan the Eighth Hospital from January 2005 to December 2009 and reviewed were analyzed retrospectively. Results All 38 cases were typical carcinoid, located in the rectum within 10 centimeters to the lower border of the anal canal.The classic characters were submuscosal tumor with yellow color and rigid or tough texture and always were lack of mobility. Carcinoid tumor of rectum often expressed markers of neuroendocrine differentiation on immunohistochemical staining.Among 38 cases, 34 cases were less than or equal to 2.0 cm in diameter and located in lamina propria （n=30） or invased submucosal layer （n=4）, these patients were cured by endoscopic mucosal resection （EMR）.Four cases were larger than 2.0 cm in diameter with muscularis externa invasion, treated by curative resection.All tumors 〈2.0 cm in diameter had a very lower Ki-67 labeling index （〈3% ）.34 patients survived at the latest follow-up. Conclusions The diagnosis of rectal carcinoid relies on histopathology and immunohistochemistry. The behavior of the rectal carcinoid shows low degree of malignant potentia. They rarely invade the muscularis externa or metastases. Most of them can be cured by endoscopic mucosal resection（EMR）.