椎管内转移性神经内分泌癌1例  

Intraspinal metastatic neuroendocrine carcinoma:a case report

作　　者：李东 刘洪军[2] 漆建[2] 侯晓峰 LI Dong;LIU Hong-jun;QI Jian;HOU Xiong-feng(Department of Neurosurgery,The People's Hospital of Yubei District of Chongqing,Chongqing 401120,China;Department of Neurosurgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]重庆市渝北区人民医院神经外科,401120 [2]川北医学院附属医院神经外科,四川南充637000

出　　处：《中国临床神经外科杂志》2024年第11期696-697,699,共3页Chinese Journal of Clinical Neurosurgery

基　　金：2022年南充市校合作科研项目(22SXQT0035)。

摘　　要：神经内分泌肿瘤(NET)是一种罕见的异质性上皮肿瘤,以消化系统和肺部最常见,最常转移至肝、肺、淋巴结,椎管内转移罕见。本文报道1例椎管内转移性神经内分泌癌,为69岁男性,因剑突下疼痛3个月伴突发双下肢活动障碍20 h入院。胸椎MRI显示胸8椎体信号异常,伴椎管内硬脊膜外占位;腰椎CT示腰4椎体及双侧髂骨内斑片状稍高密度影。血清神经特异性烯醇化酶水平明显增高。在全麻下行T7~8椎管内硬脊膜外病变切除术。术中发现病变位于T7~8椎管内硬脊膜外,无明显包膜,实性,鱼肉状,位于硬脊膜囊腹侧,占据大部分椎管,并将硬脊膜囊推向后方。术后病理诊断转移性神经内分泌瘤3级。术后症状无改善,家属要求自动出院,2个月死亡。因此,对椎管内转移性肿瘤,原发病灶诊断困难时,建议PET-CT扫描。椎管内转移性NET预后非常差,手术能否改善病人预后有待进一步研究。Neuroendocrine tumors(NETs)are a kind of rare and highly heterogeneous epithelial tumors,mainly manifested in the digestive system and lungs.The most common metastatic sites are the liver,lungs and lymph nodes,while intraspinal metastasis is relatively rare.This paper presents a case of intraspinal metastatic neuroendocrine carcinoma in a 69-year-old male.The patient was admitted to the hospital due to substernal pain lasting for 3 months and sudden motor dysfunction of both lower extremities for 20 hours.Imaging examinations indicated abnormal signals in the T8 vertebra on thoracic spine MRI,accompanied by an extramedullary epidural space-occupying lesion in the spinal canal;and patchy slightly high-density shadows in the L4 vertebra and bilateral iliac bones on lumbar spine CT.Laboratory tests disclosed a significantly elevated level of serum neuron-specific enolase.Subsequently,an extramedullary epidural lesion resection within T7~T8 was conducted under general anesthesia.Intraoperative observations revealed that the lesion was located in the extramedullary epidural space of the T7~T8 spinal canal,without a distinct capsule,being solid and fish-like in shape,situated on the ventral side of the dural sac,occupying the majority of the spinal canal space and pushing the dural sac posteriorly.The postoperative pathological diagnosis was grade III metastatic neuroendocrine tumor.Despite the surgical treatment,the patient's symptoms did not improve.The family requested an automatic discharge and the patient died two months after the operation.In view of the difficulty in diagnosing the primary lesion of intraspinal metastatic tumors,it is suggested to consider using PET-CT scans in clinical practice for assistance in diagnosis.The prognosis of intraspinal metastatic NET is typically poor,and whether surgery can enhance the prognosis of patients remains to be further investigated.

关 键 词：椎管内转移性肿瘤 神经内分泌肿瘤 神经内分泌癌 显微手术 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]