胃混合性神经内分泌-非神经内分泌肿瘤CT表现及病理分析  

Gastric mixed neuroendocrine-non-neuroendocrine neoplasms:CT imaging and pathological correlation

作　　者：王雨璐 梁盼[1] 李爱云 吕东博 高剑波[1] WANG Yu-lu;LIANG Pan;LI Ai-yun(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射科,郑州450052

出　　处：《放射学实践》2021年第5期617-620,共4页Radiologic Practice

摘　　要：目的:探讨胃混合性神经内分泌-非神经内分泌肿瘤(MiNEN)的CT特征及临床病理表现。方法:回顾性分析17例经病理证实的胃MiNEN患者的影像学及临床病理资料。所有患者术前均行CT平扫及增强扫描。结果:17例胃MiNEN患者的中位年龄为62岁,男女比例2.4:1;病灶位于贲门胃底12例,胃体2例,胃窦3例;13例病灶表现为胃壁增厚,其中10例胃壁呈节段性不规则增厚,3例呈局限性胃壁增厚,4例病灶表现为溃疡性肿物,12例病灶表面有溃疡形成;病灶最大范围34.6~91.8 mm,平均66.7 mm;CT平扫病灶密度均匀,增强扫描4例呈轻中度强化,13例呈明显强化;12例强化不均匀,5例强化均匀;10例呈持续性强化,7例呈渐进性强化。11例胃周脂肪间隙模糊,9例浆膜面不规则呈结节状,15例胃周有肿大淋巴结,2例肝内见环形强化的转移灶。17例胃MiNEN均由腺癌及神经内分泌癌组成,两种成分均占比30%以上,免疫组化检查显示CK、Syn、CD56均为阳性,CgA14阳性率82.4%。结论:胃MiNEN常发生于中老年男性,贲门胃底最为多见,典型CT表现为节段性或局灶性胃壁增厚,表面多伴溃疡形成,增强扫描呈明显不均匀持续性或渐进性强化。胃MiNEN侵袭性强,预后不良,CT检查可提供病灶浸润范围及转移情况等有价值信息,最终确诊需依靠病理及免疫组化检查。Objective:To investigate CT manifestations and clinicopathological characteristics of gastric mixed neuroendocrine-non-neuroendocrine neoplasms(MiNEN).Methods:Clinicopathological and imaging features of 17 patients with pathologically proven gastric MiNEN were retrospectively reviewed.All patients underwent preoperative unenhanced and dynamic contrast enhanced CT examination.Results:The patients had median age of 62 years old,with a male:female radio of 2.4:1.The tumor size ranged from 34.6mm to 91.8mm(mean 66.7mm),which located in cardia and fundus(n=12),body(n=2),and antrum(n=3).13 cases showed segmental irregular(n=10)or focal(n=3)gastric wall thickening.4 cases showed ulcerative mass lesions.12 lesions had mural surface ulceration.The tumor showed homogeneous attenuation with mild to moderate(n=4)or markedly(n=13)enhancement,and homogeneous(n=5)or heterogeneous(n=12)enhancement,and consistent(n=10)or progressive delayed(n=7)enhancement.There were perigastric fat strand in 11,irregular nodular margin of gastric wall in 9,perigastric lymph nodes enlargement in 15,liver metastasis in 2.Pathologically,the tumor were composed of adenocarcinoma and neuroendocrine carcinoma,both of the components accounted for more than 30%.Immunohistochemical staining showed positive staining for CK,Syn and CD56 in all patients,and CgA(82.4%).Conclusion:Gastric MiNEN usually occurs in the middle-to elderly males with predominance of gastric cardia and fundus location.On CT,gastric MiNEN appeared as segmental or localized gastric wall thickening,mural ulceration,markedly heterogeneous continuous or progressive enhancement.CT can also provide valuable informations for local invasion and distant metastasis.

关 键 词：胃肿瘤 混合性神经内分泌-非神经内分泌肿瘤 神经内分泌肿瘤 体层摄影术 X线计算机 病理学 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]