胃低分化神经内分泌癌的病理学特征与早期诊断相关性研究

Correlational study between pathological features and early diagnosis of gastric poorly differentiated neuroendocrine carcinoma

目的分析胃低分化神经内分泌癌临床病理特征,为疾病的早期诊断和评估提供帮助。方法分析1993年1月~2011年5月我院收治的经手术切除、病理证实为胃神经内分泌癌患者51例的临床资料。结果 51例患者术前诊断为胃低分化神经内分泌癌31例,鳞癌11例,腺癌9例。术后病理诊断显示,贲门部位发生肿瘤32例,胃窦10例,胃体9例;以近端肿瘤居多（32例,62.7%）;诊断时多为进展期（33例,64.7%）,伴有局部淋巴结和远处转移;镜下肿瘤细胞体积较小,胞质稀少,排列呈巢状,多伴有坏死。结论胃低分化神经内分泌癌术前诊断误诊率高,应提高对其独特生物学特征的认识,术前合理选择辅助检查,有助于提高早期诊断水平。

Objective To analyze the clinical pathology characteristic of gastric poorly differentiated neuroendocrine carcinoma,in order to provide basis for early diagnosis and appraisal of the disease.Methods The clinical datas of 51 patients with gastric poorly differentiated neuroendocrine carcinomas who were diagnosed by surgical resection and pathology from January 1993 to May 2011 were analyzed retrospectively.Results Preoperative diagnosis of 51 cases of patients,31 patients were diagnosed with gastric poorly differentiated neuroendocrine carcinomas,11 patients were diagnosed with squamous cell carcinoma,9 patients were diagnosed with adenocarcinoma.Postoperative pathologic diagnosis showed that 32 cases of tumors located at cardia,10 cases located at antrum,9 cases located at gastric body.The tumors more often located at near-end of stomach（32 cases,62.7%）.Carcinomas were most at progressivestage period when they were diagnosed（33 cases,64.7%）,with the regional lymph node metastasis and distant metastasis.Under the microscope observation,the volume of tumor cell was small,less cytoplasm,which arranged in nests and associated with necrosis mostly.Conclusion The rate of misdiagnosis is high in the preoperative diagnosis.Improving the understanding of the unique biological characteristics of gastric poorly differentiated neuroendocrine carcinoma and choosing the proper laboratory examinations are helpful to improve the level of early diagnosis.