胃肠混合性腺神经内分泌癌的回顾性病例分析

Gastrointestinal Mixed Adenoneuroendocrine Carcinoma:A Retrospective Case Analysis

背景:近年来,胃肠胰腺神经内分泌肿瘤发病率不断上升,为推动疾病的防治,我国制定了中国胃肠胰腺神经内分泌肿瘤病理学诊断共识。目的:探讨胃肠混合性腺神经内分泌癌(MANEC)的临床病理特点。方法:选取2002年4月～2009年1月天津大港油田总医院确诊的胃肠腺癌患者100例,对肿瘤组织标本行免疫组化染色,检测突触素(Syn)、嗜铬粒素A(CgA)、癌胚抗原(CEA)、细胞角蛋白8/18(CK8/18)、Ki-67的表达。分析MANEC患者的临床资料,包括性别、年龄、临床症状、病理特征、治疗方法以及预后。结果:100例胃肠腺癌患者中,MANEC 6例。MANEC临床表现以腹痛、腹胀、便血常见。MANEC发生于胃小弯2例、回盲部1例、升结肠1例、直肠2例。镜下可见MANEC由腺癌和神经内分泌癌两种成分构成,CEA、CK8/18、Syn、CgA的阳性率分别为100%、100%、83.3%、50.0%。6例患者均接受手术治疗,5例在短时间内复发和(或)腹腔转移。结论:MANEC确诊主要依赖于组织学证据和免疫组化标记,预后较普通腺癌差。

Background： The prevalence of gastroenteropancreatic neuroendocrine carcinoma （MANEC） is increasing in recent years. In order to promote the prevention and treatment of the disease, domestic consensus on the pathologic diagnosis of MANEC has been issued. Aims： To investigate the clinicopathological characteristics of gastrointestinal mixed adenoneuroendocrine carcinoma. Methods： A total of 100 patients with gastrointestinal adenocarcinoma from April 2002 to January 2009 at General Hospital of Dagang Oil Field were enrolled. The expressions of synaptophysin （Syn）, chromogranin （CgA）, carcino-embryonic antigen （CEA）, cytokeratin 8/18 （CK8/18） and Ki-67 were detected by immunohistochemistry. Retrospective analysis of clinical data including gender, age, clinical symptom, pathology characteristics and prognosis was performed. Results： Of the 100 gastrointestinal adenocarcinoma patients, 6 cases （6%） were MANEC. The main clinical manifestations were abdominal pain, abdominal distention and hemafecia. MANCE was located in stomach in 2 cases, in ileocecal junction in 1 case, in ascending colon in 1 case, in rectum in 2 cases. MANCE was composited by adenocarcinoma and neuroendocrine neoplasm. All of the 6 patients received surgical treatment, 5 cases relapsed and/or metastasized within a short time. Conclusions： It is difficult to distinguish between MANEC and poorly differentiated adenocarcinoma. The diagnosis of MANEC is rested on histology and immunohistochemistry. The prognosis of MANCE is poorer than the common adenocarcinoma.