胃肠道神经内分泌肿瘤临床资料回顾附与腺癌共存病例分析

Clinical data review of gastrointestinal neuroendocrine neoplasms: analysis of coexisting cases with adenocarcinoma

目的分析消化道神经内分泌肿瘤的特性及其与腺癌共存的现象及临床病理特征。方法收集2013年1月至2018年2月于上海交通大学医学院附属瑞金医院北院诊断为胃肠道神经内分泌肿瘤(gastrointestinal neuroendocrine neoplasms, GI-NENs)的患者21例。总结患者的性别、年龄、临床表现、肿瘤部位、肿瘤直径、病理结果等资料,并探讨GI-NENs与腺癌共存患者的临床病理特点。结果入选患者男13例,女8例,年龄(54.48±12.44)岁(33～70岁),发病部位为直肠17例(80.9%),胃2例(9.5%),后腹膜1例(4.8%),乙状结肠1例(4.8%)。病理结果显示,免疫组化CgA阳性6例(28.6%),Syn阳性20例(95.2%),AE1/AE3阳性13例(61.9%)。G_1 17例(80.9%);G_2 3例(14.3%);G_3 1例(4.8%)。其中胃腺癌与NENs共存1例,乙结肠腺癌与NENs共存1例。结论 GEP-NENs常见于直肠,男性多于女性,中年发病多,恶性程度低,肿瘤多呈Syn、AE1/AE3阳性,后肠NENs多不表达CgA。NENs与腺癌共存现象值得临床关注。

Objective To explore the coexistence and clinicopathological features of digestive tract neuroendocrine neoplasms and adenocarcinoma. Methods Twenty-one cases of gastrointestinal neuroendocrine neoplasms (GI-NENs) diagnosed in Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine were enrolled from Jan. 2013 to Feb. 2018, clinical data including sex, age, clinical manifestation, tumor location, tumor diameter and pathological findings were summarized. The clinicopathological features of patients with GI-NENs and adenocarcinoma were analyzed. Results Of 21 patients, including 13 cases male, 8 cases female, the age was (54.48±12.44) years old, 17 lesions located at rectum (80.9%), 2 lesions located at stomach (9.5%), 1 lesion located at retroperitoneum (4.8%), lesion located at sigmoid colon (4.8%). Pathological findings showed that immunohistochemical CgA was positive in 6 cases (28.6%), Syn positive in 20 cases (95.2%), and AE1/AE3 positive in 13 cases (61.9%). G 1 was found in 17 cases (80.9%), G 2 in 3 cases (14.3%), and G 3 in 1 case (4.8%). In addition, one case of gastric adenocarcinoma coexisted with NENs and one case of coexistence of sigmoid adenocarcinoma and NENs were found. Conclusion GEP-NEN is common in rectum, male is more than female, middle age is many, the degree of malignancy is low, the tumor is Syn and AE1/AE3 positive, and NENs in the hindgut does not express CgA much. The coexistence of NENs and adenocarcinoma deserves clinical attention.