66例直肠神经内分泌肿瘤肠镜下特征和病理特征分析

Analysis of endoscopic and pathological features of 66 cases with rectum neuroendocrine neoplasm

目的分析直肠神经内分泌肿瘤（NEN）的肠镜下特征和病理特征。方法收集2005年1月至2012年5月66例直肠NEN患者的肠镜资料和病理资料，按照世界卫生组织胃肠胰腺NEN病理分类分级标准对其进行分类和分级，采用卡方检验和Fisher确切概率法分析神经内分泌瘤（NET）和神经内分泌癌（NEC）转移的相关因素。结果66例直肠NEN分布于距肛门3～15cm处。54例最大径≤1em，肠镜下多表现为黏膜下半球形息肉状隆起；9例最大径〉1～2cm，其中5例表现为黏膜下局限性增厚或广基息肉状隆起；3例最大径〉2cm，表现为菜花状或隆起型肿物致管腔环形狭窄。61例为NET（G1级），3例为NEC（G3级），2例混合性腺神经内分泌癌由NEC和腺癌两种成分组成。NET和NEC转移与患者性别无关（x2=0．158，P〉0．05），与年龄无关（Fisher确切概率法，P〉0．05），与肿瘤最大径有关（Fisher确切概率法，P〈0．05）。结论NEN是一组肠镜下特征和病理特征各异的肿瘤，NET和NEC转移似与患者性别和年龄无关，似与肿瘤最大径有关。

Objective To analyze the endoscopic and pathological characteristics of rectum neuroendocrine neoplasm （NEN）. Methods From January 2005 to May 2012, the endoscopic and pathological data of 66 patients with rectum NEN were collected and graded according to historistic grade of gastroenteropancreatic-neuroendocrine neoplasm （GEP-NEN） by World Health Organization （WHO）. The factors related with the metastasis of neuroendocrine tumor （NET） and neuroendocrine cancer （NEC） were analyzed by Chi-square test and Fisher exact probability method. Results The locations of 66 NEN cases were between three and 15 cm from the anus. The diameters of 54 cases were less than 1 cm and under endoscopy the appearance of most tumors was submucosal hemispherical polypoid bulge. The diameters of nine cases were over 1 cm but less than 2 cm, of which the appearance of five cases was submucosal thickening or sessile polypoid bulge. The diameter of three cases was over 2 em and the appearance was cauliflower-like or polypoid tumor which caused annular lumen stenosis. Sixty one cases were NET （grade G1）, three cases were NEC （grade G3） and two cases were mixed adenoendocrine carcinoma with both NEC and adenocarcinoma components. The metastasis of NET and NEC was not related with gender （Z2 = 0. 158, P〈0.05） and age （Fisher exact probability method, P〉 0.05）, however was related with the diameter of tumor （Fisher exact probability method, P〈0.05）. Conclusions NEN is a tumor with variety endoscopic characteristics and pathological features. The metastasis of NET and NEC seems not related with gender and age, butrelated with diameter.