52例胃神经内分泌肿瘤临床病理分析

A clinico pathological study of neuroendocrine tumors in stomach

目的对胃内分泌肿瘤进行分型，并探讨其临床病理意义。方法收集５２例胃神经内分泌肿瘤，应用组织学及免疫组织化学ＡＢＣ法及透射电镜技术对肿瘤及其瘤旁粘膜进行观察。参照Ｂｏｒｄｉ和Ｒｉｎｄｉ分类将肿瘤分成Ⅰ、Ⅱ、Ⅲ型，并设有阳性、阴性和替代对照组。结果胃神经内分泌肿瘤可分为３个临床病理类型，其病理学特点、生物学行为及治疗方案均有不同。Ⅰ型伴有萎缩性胃炎型类癌（２６例）：分为单发及多发两型。单发型多为息肉状，肿瘤多局限于粘膜层及粘膜下层；瘤旁粘膜均伴有萎缩性胃炎，胃窦Ｇ细胞增生，胃体内分泌细胞增生及异型增生；患者均伴有高胃泌素血症；该型可行息肉摘除术进行治疗；多发型可行胃窦切除术治疗。Ⅱ型散发型类癌（１６例）：均为单发，肿瘤浸润性较强，多浸润至肌层及浆膜层；瘤旁粘膜多不伴有内分泌细胞增生，患者多无高胃泌素血症；该型肿瘤需行胃大部切除术进行治疗。Ⅲ型胃神经内分泌癌（１０例）：为高度恶性肿瘤，转移率高，预后差；应行胃切除术及术后化疗。

Objective To study the patholigcal classification of gastric neuroendocrine tumors and its clinico pathological significance. Methods Paraffin sections of totally 52 gastric neuroendocrine tumors including 42 caicinoid tumors were studied with immunohistochemical technique, which involved 9 endocrine markers of hormones antibodies and electronic microscopy for investigating the endocrine cells and the contiguons gastric mucosa of the neuroendocrine tumors. Results The 52 gastric neuroendocrine tumors were divided into three types: Type Ⅰ, carcinoid, associated with atrophic gastritis, altogeher 26 cases. Tumor extension was limited in the mucosa or submucosa, accompanying with hypergastrinemia and G cell hyperplasia. This type is consistently preceded by and associated with generalized proliferation of endocrine cells in the mucosa at fundus. Type Ⅱ, carcinoid of sporadic type, totally 16 cases, not associating with hypergastrinemia, was more aggressive. Type Ⅲ, Neuroendocrine carcinomas (10 cases), were highly aggressive tumors. Conclusion A correct identification of different types of gastric endocrine tumors is important and implicit for the treatment and prognoisis of neuroendocrine tumors.