EUS-FNA细胞学在诊断胰腺神经内分泌肿瘤中的应用价值

Application of EUS-FNA cytology in diagnosis of pancreatic neuroendocrine tumors

目的探讨超声内镜引导下细针穿刺(endoscopic ultrasound guided fine needle aspiration,EUS-FNA)细胞病理学对胰腺神经内分泌肿瘤(pancreatic neuroendocrine tumors,PanNETs)的诊断价值。方法对11例PanNETs的EUS-FNA细胞学涂片及免疫细胞化学染色涂片进行观察分析,同时收集临床及术后组织病理资料。结果11例中10例细胞病理学诊断为PanNETs,1例诊断为胰腺实性假乳头状瘤。其中11例PanNETs中G1级3例,细胞学主要表现为较为均匀一致的细胞,也可见成团细胞,细胞大小较为一致,偶可见瘤巨细胞;G2级7例,细胞大多散在分布,细胞成浆细胞样。G3级1例,细胞似裸核,弥散分布,染色质粗糙。免疫细胞化学染色结果示,肿瘤细胞Syn(11/11)及CgA(10/11)均阳性,Ki-67增殖指数1%~25%,与术后组织病理表达相近。结论胰腺EUS-FNA细胞病理学联合免疫细胞化学染色可以对神经内分泌肿瘤作出正确诊断,但也有其局限性。

Objective To explore the value of endoscopic ultrasound guided fine needle aspiration(EUS-FNA)cytopathology in the di-agnosis of pancreatic neuroendocrine tumors(PanNETs).Methods EUS-FNA cytological and immunocytochemical staining smears of 11 patients with PanNETs were observed and analyzed,and clinical and postoperative histopathological data were collected.Results Of the 11 patients,10 were diagnosed as PanNETs and 1 was pancreatic solid pseudpapilloma.Among the 11 patients,3 patients were G1 level.The cell size of these patients was relatively uniform,and the cells were clustered or scattered,with occasional megakaryocytes.Seven were G2 level,whose cells were mostly scattered and shaped like plasma cells.One was G3 level,whose cells were distributed in a diffuse man-ner with rough chromatin.The results of immunocytochemical staining were similar to those of histopathologic staining,and the tumor cells were positive for Syn(11/11)and CgA(10/11).In addition,Ki-67 proliferation index was 1%-25%.Conclusions EUS-FNA cytology combined with immunocytochemical staining can be used to diagnose PanNETs,but EUS-FNA cytology diagnosis has limitations.