直肠神经内分泌肿瘤临床病理特点及分级

Clinicopathological features and classifications of rectal neuroendocrine tumors

目的探讨直肠神经内分泌肿瘤的病理特征及分级。方法对49例直肠神经内分泌肿瘤进行临床及病理资料整理,应用SP法免疫组化染色。结果神经内分泌肿瘤Ⅰ级42例,神经内分泌肿瘤Ⅱ级4例,其中3例伴肠系膜淋巴结转移。组织构型上可分为实性小巢状或岛状、梁状、腺管状、混合性4种。神经内分泌肿瘤Ⅲ级3例,2例为大细胞神经内分泌癌,其中1例伴腹股沟淋巴结转移,1例为小细胞癌,伴肝脏转移。免疫表型除外会诊5例未做免疫组化,其余均做免疫组化SYN、Cg A及Ki-67,其中SYN所有病例均阳性,Cg A阳性8例,Ki-67因级别不同,增殖指数相差较大。结论直肠神经内分泌肿瘤Ⅰ级最多见,生物学行为低度恶性,一般不侵犯肌层,也很少转移,大多数病例可以在内镜下行黏膜切除术获得治愈。Ⅱ级和Ⅲ级生物学行为侵袭性,伴淋巴结转移及肝转移。免疫组化SYN、Cg A及Ki-67染色可作为神经内分泌肿瘤的常规免疫标记物。

Objective To investigate the clinicopathological features, and classification of rectal neuroendocrine tumors.Methods Clinicopathological materials of rectal neuroendocrine tumors of 49 cases were retrospectively reviewed and SP staining was applied to examine. Results There were 42 cases of gade G1, 4 cases of grade G2 of which 3 cases had mesorectal metastasis, and 3 cases of grade G3, including 2 cases of large cell NEC with one inguinal metastasis and a case of small cell NEC with liver metastasis. Morphologically, NETs are classified into 4 pattens, including solid nests, trabecular growth patten, tubuloacinar arrangement and mixed type. Immunohistochemistry staining has been taken in hospitalized patients, except for 5 patients of consultation. The tumor cells were inmmumoreactive for synaptophysin（44 cases）, chromogranin A（8 cases）and was varied of Ki-67. Conclusion It has been suggested that grade G1 is much more common in rectum, compared with gade G2 and gade G3, which have gentle biological behaviors, comprising less musularis invasion and less distant metastasis. most of grade G1 patients got cured by endoscopic mucosal resection. I mmunohistochemically, rectal NETs stain for the neuroendocrine markers synaptophysin, chromogranin A and Ki-67.