8例结直肠混合性腺神经内分泌癌临床病理分析  

Clinicopathological analysis of colorectal mixed adeno-neuroendocrine carcinoma:8 cases report

作　　者：张一鸣 李明昭 顾欣 Zhang Yiming;Li Mingzhao;Gu Xin(Department of Pathology,Tianjin Hospital of ITCWM(Nankai Hospital),Tianjin 300100,China;Department of Pathology,Tianjin Union Medical Center,Tianjin 300121,China;School of Biomedical Engineering and Technology,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津市中西医结合医院(南开医院)病理科,天津300100 [2]天津市人民医院病理科,天津300121 [3]天津医科大学生物医学工程与技术学院,天津300070

出　　处：《临床荟萃》2022年第10期921-926,共6页Clinical Focus

摘　　要：目的探讨结直肠混合性腺神经内分泌癌(mixed adeno-neuroendocrine carcinoma,MANEC)的临床病理特征。方法回顾性分析2016年8月-2020年12月于天津市中西医结合医院(南开医院)经手术切除的结直肠MANEC 8例患者的临床资料。结果8例患者中女性3例,男性5例,平均年龄63岁。临床表现无特异性。影像学表现为占位和淋巴结转移。肿瘤标记物检测示部分病例铁蛋白(2例)和癌胚抗原(2例)升高,所有病例甲胎蛋白和糖蛋白199均未见明显升高。6例行术前肠镜活检,诊断为腺癌5例,腺癌或MANEC 1例。肿瘤发生部位以结肠为主(6例)。溃疡型5例,隆起型3例,肿瘤最大径3~9 cm。光镜下:腺癌肿瘤细胞呈腺管样排列,2例伴有黏液腺癌;神经内分泌肿瘤细胞呈弥漫、巢团或器官样分布,小细胞型1例,大细胞型7例。淋巴结转移7例,肝转移1例。免疫组织化学示腺癌CK8/18、CK19和CEA不同程度阳性,神经内分泌肿瘤CgA、Syn和CD56不同程度阳性,Ki-67热点区40%~80%阳性。随访5例存活,中位生存时间17个月,2例死亡,平均生存时间8个月。结论结直肠MANEC发病率较低,缺乏临床特异性,易发生淋巴结转移,属于高度恶性肿瘤,诊断主要依赖免疫组织化学辅助的病理检查。Objective To explore the clinicopathological features of colorectal mixed adeno-neuroendocrine carcinoma(MANEC).Methods A retrospective analysis were porformed in 8 patients underwent MANEC eradication in Tianjin Hospital of ITCWM(Nankai Hospital)from August 2016 to December 2020.Results There were 3 female and 5 male,age averaged 63 years among these patients.Their clinical manifestations obviously had no-specificity,with the imaging showing space occupying and lymph node metastasis.The tumor marker detection verified 2 cases of significantly elevated ferritin,2 cases of significantly elevated carcinoembryonic antigen(CEA),and all cases of insignificantly elevated alpha-fetoprotein and carbohydrate antigen 199(CA199).The preoperative biopsy were conducted in 6 cases,5 cases of adenocarcinoma and 1 case of adenocarcinoma or MANEC,with main space occupying in colon.There were 5 cases for ulcer type,3 cases for protuberant type,with the maximum diameter of tumor for 3-9 cm.Under light microscope,the tumor cells of adenocarcinoma were arranged like glandular tubes,and 2 cases were accompanied with mucinous adenocarcinoma;neuroendocrine tumor cells showed diffuse,nest like or organ like distribution,including 1 case of small cell type and 7 cases of large cell type.Lymph node metastasis was found in 7 cases and liver metastasis in 1 case.Immunohistochemistry indicated that cytokeratin8/18(CK8/18),cytokeratin19(CK19)and CEA were positive to varying degrees in adenocarcinoma,chromogranin A(CgA),synaptophysin(Syn)and cluster of differentiation 56(CD56)were positive to varying degrees in neuroendocrine tumors,and 40%-80%of Ki-67 hot spots were positive.Five patients survived,the median survival time was 17 months,and two patients died,the average survival time was 8 months.Conclusion Colorectal MANEC is a highly malignant tumor characterized by lower morbidity,no-specificity,and incident lymph node metastasis,its diagnosis mainly depends on pathology with immunohistochemistry.

关 键 词：结直肠肿瘤 混合性腺神经内分泌癌 组织细胞学制备技术 免疫组织化学 

分 类 号：R735.3[医药卫生—肿瘤]