病理分级标准的差异对胰岛素肿瘤诊断的意义

Significance of different pathological classification standard in diagnosis of insulinoma

目的探讨不同病理分级标准下胰岛素肿瘤（Insulinomas）临床分型与病理分级的差异及其与临床病理特点、预后的关系。方法以世界卫生组织消化系统肿瘤分类（2010）为基础,在中国胃肠胰神经内分泌肿瘤病理诊断共识（2011）、（2013）补充下对既往诊断的胰岛素肿瘤组织行HE染色和Cg A、Syn、insulin、Ki-67免疫组化检测,根据不同病理分级标准重新诊断,对比评估。结果共收集27例胰岛素肿瘤患者标本。Ki-67index以2%、20%为病理分级临界值时,27例患者诊断为NET G1期16例,NET G2期9例,NEC 2例;Ki-67index以5%、20%为病理分级临界值时,27例患者诊断为NET G1期21例、NET G2期4例、高增殖活性的NET 2例、NEC 0例。27例患者Insulin、Cg A、Syn阳性表达率依次为66.67%、74.07%、100%。肿瘤组织学类型与肿瘤大小、病程相关（χ2=8.834、32.693,P=0.026、0.008）,与肿瘤远处转移、局部组织浸润、性别、年龄、民族、ABO血型无关（χ2=5.83、5.83、4.079、43.153、0.484、3.536,均P〉0.05）;NET G1期、NET G2期两组患者生存时间比较差异无统计学意义（P〉0.05）。结论两种分级方案的诊断结果有所差异,中国共识提出的＂高增殖活性的NET＂能解决Ki-67index 20%~60%的非低分化肿瘤命名和归类混乱问题。

Objective To explore the differences of clinical classification and pathological staging in insulinomas under different pathological classification standards,and its relationship with the clinicopathological features and prognosis. Methods HE staining was used to detect insulinomas tissue which was previously diagnosed according to《WHO classification of digestive neuroendocrine neoplasms》（ 2010） and《China gastrointestinal pancreatic neuroendocrine tumor pathological diagnosis consensus》（ 2011）（ 2013）,and the expression of insulin,Cg A,Syn and Ki- 67 were detected by immunohistochemistry,and then diagnosis was performed by different pathological classification standards,and was compared to previously diagnosed. Results A total of 27 insulinomas tissue samples were collected. When cut-off levels of 2% and 20% for Ki-67,16 cases were diagnosed as grade 1 of NET,grade 2 of NET was 9 cases and 2 patients was NEC; when cut-off levels of 5% and 20% for Ki-67,the patients diagnosed as grade 1 of NET,grade 2 of NET and NEC were 21,4,0,respectively,and 2 cases were high proliferation activity of NET. The positive expression rate of insulin,Cg A,Syn in insulinomas was 66. 67%,74. 07%,100%,respectively. The histologic categories were correlated with tumor size,course of disease（ χ2= 8. 834、32. 693,P = 0. 026、0. 008）,and had no correlation with tumor distant metastasis,local invasion,gender,age,nationality,ABO blood group（ χ2= 5. 83、5. 83、4. 079、43. 153、0. 484、3. 536,P 〉 0. 05）. Kaplan-Meier survival curves showed that there was no significant difference in survival between grade 1 of NET group and grade 2 of NET group（ P 〉 0. 05）. Conclusion There is difference of the two pathological grading schemes in diagnosing insulinoma. ＂High proliferative activity of NET ＂ advanced by China can solve the problems of naming and classification for non-poorly differentiated tumors with Ki-67 index 20% to 60%.