胃肠胰神经内分泌肿瘤病理诊断的困境与挑战

Difficulties and challenges in pathological diagnosis of gastrointestinal pancreatic neuroendocrine tumors

第5版消化系统肿瘤WHO分类将胃肠胰神经内分泌肿瘤的分类和命名进行了更新,重新定义了G3。高分化神经内分泌瘤G3(NET G3)与低分化神经内分泌癌(NEC)的鉴别诊断是重点也是难点,具有重要的临床意义。本文主要基于最新版WHO和2020版中国胃肠胰神经内分泌肿瘤病理诊断共识提出二者的鉴别问题,主要从四个方面综合分析,包括肿瘤的形态分化、增殖活性、基因改变及疾病进程。但即使有了以上鉴别诊断方法,在病理诊断工作中还是会存在一些困境与挑战。在此进行简要阐述,共同探讨,为临床提供参考。

In the 5th edition of WHO Classification of Digestive System Tumours,the classification and designation of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN)were updated,and G3 was redefined.Therefore,the differential diagnosis between well-differentiated neuroendocrine tumour G3(NETG3)and poorly differentiated neuroendocrine carcinomas(NEC)is both important and difficult,which has important clinical treatment and prognostic significance.Based on the latest WHO and 2020 Chinese consensus on pathological diagnosis of GEP-NEN,this paper proposed a comprehensive analysis on the differential diagnosis of gastrointestinal pancreatic neuroendocrine tumor from four aspects,including tumor morphological differentiation、tumor proliferative activity,gene change and disease progression.However,even with the above four diagnostic tools,there are still some difficulties and challenges in the work of pathological diagnosis.This paper briefly expounds and discusses them together,in order to improve the clinical application value.