胃混合性腺神经内分泌癌临床病理特征分析  

Clinicopathological features of gastric mixed adenoneuroendocrine carcinoma

作　　者：李志彬 柯彬[1] 孙琳 刘宁[1] 梁寒 Zhibin LI Bin KE Lin SUN Ning LIU Han LIANG(Department of Gastric Cancer, Tianjin Medical University Cancer institute and Hospital,National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin＇s Clinical Research Center for Cancer, Tianjin 300060, China Depart- ment of General Surgery, The First People＇s Hospital of Shangqiu, Shangqiu 476100, China Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China)

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市恶性肿瘤临床医学研究中心,天津市300060 [2]河南省商丘市第一人民医院胃肠肝胆外科 [3]天津医科大学肿瘤医院病理科

出　　处：《中国肿瘤临床》2017年第19期953-957,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号:81401952);天津市卫生局科技基金项目(编号:2014KZ082)资助~~

摘　　要：目的:探讨胃混合性腺神经内分泌癌(mixed adenoneuroendocrine carcinoma,MANEC)的临床病理特征。方法:回顾性分析2011年1月至2016年12月天津医科大学肿瘤医院收治的35例胃MANEC患者的临床病理资料,采用EnVision法检测嗜铬蛋白A(synaptophysin,Syn)、突触素(chromogranin A,CgA)、CEA、CK8/18和Ki-67的表达情况。结果:本研究35例胃MANEC患者中男性32例,女性3例,平均年龄为(61.6±7.5)岁。肿瘤位于贲门17例、胃体9例、胃窦8例、残胃1例。该病无特异性临床表现,术前易被误诊为腺癌,诊断主要依赖病理。肿瘤由腺癌和神经内分泌癌成分构成,免疫组织化学结果显示腺癌成分中CEA(+)32例,CK8/18(+)33例;神经内分泌癌成分中Syn(+)33例,CgA(+)27例。所有患者均行手术治疗,术后3年内17例患者死亡,且均为Ⅲ期或Ⅳ期。结论:胃MANEC多见于中老年男性,发病率低,发病时多为中晚期。在结构形态上由两种肿瘤成分构成,确诊依赖于病理及免疫组织化学检查。手术是其主要的治疗方式,但预后较差。Objective： To explore the clinicopathologic characteristics of gastric mixed adenoneuroendocrine carcinoma（MANEC）. Methods：From January 2011 to December 2016, the clinical and pathological data of 35 patients with gastric MANEC who were diagnosed and surgically treated in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. Results： The average age of the32 men and 3 women in this study was 61.6±7.5 years. Tumor locations were as follows： 17 related to gastric cardia, 9 related to gastric body, 8 related to gastric antrum, and 1 related to gastric stump. Clinical symptoms were non-specific and the diagnosis relies on postoperative pathological examination. Using the histological microscope, the affected structures were detected in neuroendocrine systems and tissue linings. Immunohistochemical staining showed that carcinoembryonic antigen（CEA） and cytokeratins 8 and 18（CK8/18） were expressed in 32 and 33 adenocarcinoma-related cases, respectively, whereas synaptophysin（Syn） and chromogranin A（CgA） were revealed in 33 and 27 neuroendocrine-related cases, respectively. All patients received surgical resection. A total of 17 incidents of death were reported at three years after the operation, and most of the patients were at clinical stage Ⅲ or Ⅳ. Conclusion： Gastric MANEC is a rare neoplasm and is often diagnosed at its advanced stage and mainly occurs in the aged population. Neuroendocrine structures and glandular tissues are the most frequent location of such condition. Diagnosis relies on both immunohistochemical and histological examinations. Surgical resection is the most effective treatment, but the prognosis of this condition remains poor.

关 键 词：胃肿瘤 混合性腺神经内分泌癌 临床 病理学 预后 

分 类 号：R735.2[医药卫生—肿瘤]