三例胆囊神经内分泌癌的病理特点及诊疗体会  

Pathological features, diagnosis and treatment of gallbladder neuroendocrine carcinomas:a report of 3 cases

作　　者：杜洋 范培芝[1] 钟振东 朱岱阳 刘剑鸣[2] 易为民[2] 彭创[2] 孙增鹏 刘苏来[2] DU Yang;FAN Pei-zhi;ZHONG Zhen-dong;ZHU Dai-yang;LIU Jian-ming;YI(Wei-min2,PENG Chuang2,SUN Zeng-peng2,LIU Su-lai2.1Department of General Surgery,Hunan Provincial People’s Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410002,China;Department of Hepatobiliary Surgery,Hunan Provincial People’s Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410002,China)

机构地区：[1]湖南师范大学附属第一医院/湖南省人民医院普外三科,湖南长沙410002 [2]湖南师范大学附属第一医院/湖南省人民医院肝胆外科,湖南长沙410002

出　　处：《肝胆胰外科杂志》2020年第1期26-31,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：中国博士后科学基金资助项目（2017M620347）;湖南省自然科学基金资助项目（2019JJ50320）;长沙市科技局科研项目（kq1706032）

摘　　要：目的探讨胆囊神经内分泌癌(gallbladder-neuroendocrine carcinomas,GB-NECs)的病理特点及诊疗预后。方法收集2015年5月至2019年5月期间湖南师范大学附属第一医院收治的3例GB-NECs,回顾性分析该3例患者的病史、实验室检查、影像学检查、治疗方案,探讨患者术后病理特点及其预后。结果3例患者中男1例,女2例,年龄52~68岁,2例行根治性手术,1例仅行穿刺活检术,术后病理均证实为GB-NECs。术后病理及免疫组化:2例由腺癌和神经内分泌肿瘤(neuroendocrine tumours,NETs)两种成分组成,1例NETs呈弥漫片状生长。免疫组化:Syn、CgA联合阳性率100%,Ki-67阳性指数为75%~85%。3例GB-NECs均为G3级,且恶性程度较高。2例行根治性手术患者未行进一步辅助化疗,1例行穿刺活检术患者仅行进一步姑息化疗。3例患者生存时间分别为8个月、大于10个月、3个月。结论GBNECs的确诊主要是通过术后病理及免疫组化。手术是主要的治疗手段,手术治疗能明显延长患者生存期。Objective To investigate the clinicopathological features and prognosis and treatment of gallbladder-neuroendocrine carcinomas(GB-NECs).Methods Three cases of GB-NECs cases received treatment from May 2015 to May 2019 in Hunan Provincial People’s Hospital and cofirmed by postoperative pathological examination were collected.The medical history,laboratory examination,imaging examination and treatment program were analyzed,and the postoperative pathological features and prognosis were discussed.Results There were 3 cases with GB-NECs(1 male,2 females),aged from 52 to 68 years.Two patients underwent radical operation,and one received needle biopsy.All the 3 patients were confimed GB-NECs by postoperative pathology.Postoperative pathology and immunohistochemistry showed that tumors in 2 cases were composed of adenocarcinoma and neuroendocrine tumours(NETs),and neuroendocrine tumor in 1 case exhibited a diffuse patchy growth.Immunohistochemistry showed that the positive rate of Syn and CgA was 100%,and the positive index of ki-67 was 75%~85%.All the 3 cases of GB-NECs were in grade G3,and the malignant degree was high.Two cases who underwent radical operation refused further adjuvant chemotherapy,and one case who underwent needle biopsy received only palliative chemotherapy.The survival time of the 3 patients were 8 months,over 10 months and 3 months,respectively.Conclusion The diagnosis of GB-NECs is mainly by postoperative pathology and immunohistochemistry.Surgical treatment is the main approach,which can significantly prolong the survival of GB-NECs.

关 键 词：胆囊癌 神经内分泌肿瘤 临床病理特征 

分 类 号：R735.8[医药卫生—肿瘤]