胰腺神经内分泌肿瘤的临床、病理及超声内镜特点

Clinical, pathologic and endoscopic ultrasound characteristics of pancreatic neuroendocrine tumors

目的探讨胰腺神经内分泌肿瘤（PNETs）的临床、病理及EUS特征。方法回顾性分析2002年1月至2011年1月南京鼓楼医院收治的24例PNETs患者的资料。结果24例PNETs包括19例胰岛素瘤，1例胰岛细胞癌，2例胃泌素瘤，2例胰高血糖素瘤。18例（75％）为功能性PNETs，6例（25％）为无功能性PNETs。患者年龄19-64岁，平均（42±14）岁，男性占33．3％。胰岛细胞瘤患者主要表现为间断性上腹痛或腹部不适；胰高血糖素瘤患者表现为消瘦，皮肤游走性红斑；胃泌素瘤患者表现为腹泻、呕吐，呕吐物为大量清水样液体。CT检出率为86．7％（13／15），EUS检出率为100％（15／15），PET-CT检出率仅40％（2／5）。PNETs的EUS特征多为胰腺内圆形或椭圆形低回声包块，体积较小，境界清晰，内部回声均匀，周围无肿大淋巴结，较大肿瘤可见液化。22例行手术切除，2例未手术。PNETs均表达嗜铬素A（CgA）和突触素（Syn）蛋白。随访7-80个月，患者均健在。结论PNETs具有独特的临床表现，EUS有较高的定位诊断率，手术方法与胰腺癌相似，患者预后相对较好。

Objective To investigate the clinical, pathologic and endoscopic ultrasound characteristics of pancreatic neuroendocrine tumors （PNETs）. Methods Clinical data of 24 consecutive patients of PNETs who were admitted between January 2002 and January 2011 were reviewed. Results Among these 24 patients, 19 were diagnosed to have insulinomas, 1 was malignant insulinoma, 2 were gastrinomas, and 2 were glucagonomas. Eighteen （75%） cases of PNETs were functional PNETs, and 6 （25%） were nonfunctional PNETs. The mean age of the patients was （42 ± 14 ） years old ranging from 19 - 64 years old, and the percentage of male patient was 33.3%. The main symptoms of insulinomas were intermittent abdominal pain or discomfort, and the main manifestations of glueagonomas were weight loss, skin migratory erythema; and the main symptoms of gastrinomas were diarrhea, vomiting with large amounts of water-like liquid. The detection rate of CT was 86.7% （ 13/15 ） , and the detection rate of EUS was 100% （ 15/15）, but PET-CT detected only 40% of tumors （2/5）. The endoscopic ultrasound characteristics of PNETs were circular or oval hypoechoic mass, and the volume was small with clear boundary and homogeneous echo. There was no enlarged lymph node, and liquid was detected in big tumor. Twenty-two patients received operation and 2 patients did not. PNETs expressed CgA and Syn protein. All patients of PNETs were alive with 7 to 80 months follow-up. Conclusions The clinical characteristics of PNETs were unique. EUS has a high accuracy for detecting andlocalizing PNETs. The surgical method is similar to that of pancreatic cancer, and the prognosis is relatively good.