胃肠道神经内分泌肿瘤的内镜表现及病理学特征

Endoscopic findings and clinicopathological features of gastrointestinal neuroendocrine neoplasm

目的分析内镜检查胃肠道神经内分泌肿瘤(NEN)的表现及病理学诊断特点。方法对南京市浦口区中心医院及南京市第一医院病理科2011年5月至2017年5月收集的经内镜检出并经病理活检证实为胃肠道NEN的29例患者进行回顾性分析。通过内镜检查和光学显微镜对组织形态学变化进行综合分析,采用免疫组织化学方法检测细胞广谱角蛋白(AE1/AE3)、细胞角蛋白(CK8/18)、嗜铬粒素(Cg A)、突触素(Syn)、神经元特异性烯醇化酶(NSE)、神经细胞黏附分子(CD56)及核抗原(Ki-67)在肿瘤细胞中的表达情况。结果胃肠道NEN患者均为单发,胃肠道神经内分泌癌(NEC)和胃肠道混合性腺神经内分泌癌(MANEC)为溃疡型肿物。AE1/AE3、CK8/18、Cg A、Syn、NSE、CD56的阳性率分别为96.77%、80.65%、77.42%、88.71%、53.23%、79.03%。胃肠道高分化神经内分泌肿瘤(NET)核抗原(Ki-67)阳性指数≤20%,NEC、MANEC核抗原(Ki-67)阳性指数>20%。结论 NEN缺乏典型的临床表现,通过内镜不能对其进行确切诊断,但其病理组织学特异性较为明显,AE1/AE3、CK8/18、Cg A、Syn等免疫组化检测对病理诊断起到重要作用。

Objective To analyze the endoscopic findings and clinicopathological features of gastrointestinal neuroendocrine neoplasm（NEN）. Methods The records of 29 gastrointestinal NEN patients who had been confirmed by endoscopy and biopsy pathology from May. 2011 to May. 2017 were reviewed and analyzed. The morphological change was observed by light microscope. Immunohistochemical method was used to examine the expressions of AE1/AE3,CK8/18,Cg A,Syn,NSE,CD56 and Ki-67 in the cancer cells. Results Single tumor was detected in all gastrointestinal NEN patients. Gastrointestinal neuroendocrine carcinoma（NEC） and gastrointestinal mixed neuroendocrine carcinoma（MANEC） were ulcer tumor. The positive rates of AE1/AE3,CK8/18,Cg A,Syn,NSE,CD56 were 96. 77%,80. 65%,77. 42%,88. 71%,53. 23%,79. 03%,respectively. The positive rate of Ki-67 in gastrointestinal NET was not more than 20%. The positive rate of NEC and MANEC was more than 20%. Conclusion Typical clinical manifestations of gastrointestinal NEN lack,and accurate diagnosis can not be made by endoscopy. But histopathological specificity of NEN is obvious. Immunohistochemical method such as AE1/AE3,CK8/18,Cg A,Syn can take subsidiary function in pathological diagnosis.