浆膜腔积液中神经内分泌肿瘤临床病理特征分析  

Clinicopathological features of neuroendocrine neoplasms in serous cavity effusion

作　　者：钱文秀 董鑫鑫 徐海苗[3] Qian Wenxiu;Dong Xinxin;Xu Haimiao(Department of Pathology,the Second Affi liated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,China;Department of Nuclear Medicine,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine,Chinese Academy of Sciences,Hangzhou 310022,China;Department of Pathology,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine,Chinese Academy of Sciences,Hangzhou 310022,China)

机构地区：[1]浙江中医药大学附属第二医院病理科,浙江杭州310005 [2]浙江省肿瘤医院核医学科,中国科学院杭州医学研究所,浙江杭州310022 [3]浙江省肿瘤医院病理科,中国科学院杭州医学研究所,浙江杭州310022

出　　处：《实用肿瘤杂志》2025年第1期67-72,共6页Journal of Practical Oncology

摘　　要：目的探讨浆膜腔积液中神经内分泌肿瘤(neuroendocrine neoplasms,NENs)的临床特征、细胞病理学特征和免疫细胞化学染色特征,提高对浆膜腔积液中该类肿瘤的认识。方法通过电子病历系统回顾性收集浙江省肿瘤医院2016年1月至2022年4月确诊的69例NENs伴浆膜腔积液转移病例。通过简单随机抽样法抽取浙江省肿瘤医院同时期确诊的78例腺癌伴浆膜腔积液转移的病例作为对照组。调取其薄层液基细胞技术制片、细胞蜡块切片和免疫细胞化学染色切片再次阅片分析。结果69例NENs伴浆膜腔积液转移患者中,男性58例,女性11例;年龄37~81岁,平均年龄62.7岁;原发部位中肺60例,女性生殖系统4例,消化系统3例,其他部位2例。浆膜腔积液类型中,胸腔积液59例,腹腔积液7例,心包积液6例,其中3例同时出现胸腔积液和心包积液转移。NENs伴浆膜腔积液转移的薄层液基细胞制片中,肿瘤细胞以镶嵌状排列为主,绝大多数细胞显示椒盐样的核染色质,罕见核偏位和显著核仁,背景中间皮增生和坏死碎片多见。细胞蜡块中肿瘤细胞通常呈巢团状排列,类似于鳞状细胞癌的排列方式,而腺样或乳头状结构较少。免疫细胞化学染色中神经细胞黏附分子(neural cell adhesion molecule,CD56)、突触素(synaptophysin,SYN)和嗜铬素A(chromogranin A,CgA)阳性率分别为88.4%(38/43)、97.8%(45/46)和51.5%(17/33);肺来源病例中,甲状腺转录因子1(thyroid transcription factor-1,TTF-1)和NapsinA阳性率为90.0%(18/20)和0.0%(0/21)。结论NENs常出现在老年患者浆膜腔积液中,以肺来源为主,主要表现为胸腔积液。薄层液基细胞制片和细胞蜡块切片中有其独特的病理形态表现。NENs伴浆膜腔积液转移患者的免疫细胞化学染色中CD56和SYN阳性率高。Objective To investigate the clinical,cytopathological,and immunocytochemical characteristics of neuroendocrine neoplasms(NENs)in serous cavity effusion,in order to enhance the understanding of such tumors in serous cavity effusion.Methods The data of 69 cases of NENs diagnosed by serous cavity effusion exfoliated cell pathology at Zhejiang Cancer Hospital from January 2016 to April 2022 were collected from the electronic medical record system,and 78 cases of adenocarcinoma with serous cavity effusion selected by simple random sampling method from Zhejiang Cancer Hospital during the same time interval were used as control group.The liquid-based cytological specimen,cell blocks,and immunocytochemical sections of theses patients were obtained for analyses.Results The 69 NEN patients with serous cavity effusion were aged 37-81 years,with an average age of 62.7 years.Among these patients,58 were males and 11 were females.The primary sites were lung in 60 cases,female reproductive system in four cases,digestive system in three cases,and other sites in two cases.The types of serous effusions were pleural effusion in 59 cases,peritoneal effusion in 7 cases,and pericardial effusion in 6 cases.Three cases had both pleural effusion and pericardial effusion.In liquid-based cytological specimen,tumor cells were mainly arranged in mosaicism,most of the cells showed salt-like nuclear chromatin,nuclear offsets and prominent nucleoli were rare,and intermediate dermal hyperplasia and necrotic fragments were more common in the background.Tumor cells in cell blocks were usually arranged in nest-like clusters,similar to the arrangement of squamous cell carcinoma,with fewer adenoid or papillary structures.Immunocytochemical staining showed that the positive rates of neural cell adhesion molecule(CD56),synaptophysin(SYN),and chromogranin A(CgA)were 88.4%(38/43),97.8%(45/46),and 51.5%(17/33),and the positive rates of thyroid transcription factor-1(TTF-1)and NapsinA in lung-derived cases were 90.0%(18/20)and 0.0%(0/21).Conclusions NENs

关 键 词：神经内分泌肿瘤 浆膜腔积液 细胞病理学 免疫细胞化学 

分 类 号：R73[医药卫生—肿瘤]