胃神经内分泌肿瘤误诊为胃腺癌临床病理分析

Clinicopathological analyses of gastric neuroendocrine tumor misdiagnosis as gastric adenocarcinoma

目的：探讨胃神经内分泌肿瘤的临床及病理特点,减少误诊误治。方法：对所获军事医学科学院附属医院病理科诊断为胃神经内分泌肿瘤1例病例的临床及病理资料进行回顾性分析。结果：本例胃镜检查示贲门、胃底、胃体近贲门部不规则肿物增生隆起,大小约12.0 cm×7.0 cm,质较硬,边缘不齐,病理诊断为胃腺癌,分化Ⅱ-Ⅲ级。后经我院病理会诊及免疫组化结果证实为高增殖活性神经内分泌肿瘤（NET）,伴坏死。结论：胃活检标本较小,同时取材钳夹时可能造成原有细胞形态及排列的破坏,较容易误诊。因此,应加强对HE切片的观察,并利用免疫组化技术验证诊断及鉴别诊断,同时结合临床病史、综合影像学检查给出诊断意见,以避免或减少误诊误治。

Objective： Though investigating the clinical and pathological features of gastric neuroendocrine tumor to reduce misdiagnosis and mistreatment. Methods： Clinical and pathological data was retrospectively analyzed in one case of gastric neuroendocrine tumor, which was diagnosed by Affiliated Hospital of Military Medical Sciences. Results： The case found that it had an irregulaJc neoplasm proliferation uplift of a diameter about 12.0 cm x 7.0 cm in cardia, gastric fundus, gastric body which was nearly the cardia. Qualitative was hard, edge was not neat, the pathological diagnosis was gastric adenocarcinoma, and the differentiation grade was from II to III. After confirmed by our pathologic consultation and immunohistochemical results showed high proliferative activity neuroendocrine tumor （NET）with necrosis. Conclusion. Gastric biopsy specimens are smaller, drawn clamps may cause the original cell morphology and the arrangement destruct, and it is easy misdiagnosis. 2-herefore, we should strengthen the observation of the hematoxylin-eosin sliced, and by using immunohistochemical technique to verify the diagnosis and differential diagnosis, and combined with clinical history, imaging examination and immunohistochemical results diagnosis methods, in order to avoid or reduce their errors.