摘要/Abstract

摘要： 目的 ·探讨直肠神经内分泌肿瘤 (rectal neuroendocrine neoplasms，R-NENs)的临床病理特征、诊断要点和预后。方法 ·回顾性分析 2008年 1月至 2017年 6月上海交通大学医学院附属仁济医院 113例 R-NENs患者的临床资料，进行临床病理特征及预后分析。取患者的 R-NENs组织标本，行苏木精 –伊红染色，并通过免疫组织化学法检测突触素（ synapsin，Syn）、神经细胞黏附分子（ neural cell adhesion molecule，CD56）、嗜铬粒蛋白 A（chromogranin A，CgA）的表达。结果 ·在 113例 R-NENs患者中，男性 59例，女性 54例；年龄 25～ 83（52.3±13.3）岁。 R-NENs 的临床表现不明显，主要为排便习惯改变（ 21.3%）、腹痛（ 8.9%）和肛门症状（ 6.2%），其中 63.7%的临床表现在常规体检时发现。病理学分级为 G1、G2、G3级的患者分别占 79.6%、11.5%、8.8%。免疫组织化学染色结果显示， Syn的阳性率为 94.7%，CD56的阳性率为 80.9%，CgA的阳性率为 48.6%。截至 2017年 11月，患者中位生存时间为 33.10（0.40～ 114.67）个月； 1年、3年和 5年生存率分别为 93.8%、90.0%和 85.9%。患者的病理学分级、肿瘤浸润深度、有无淋巴结转移或远处转移、肿瘤大小及年龄均与预后相关。结论 ·大部分 R-NENs为低度恶性肿瘤，临床表现缺乏特异性，总体预后良好。
关键词: 神经内分泌肿瘤, 直肠, 病理特征, 预后
Abstract:
Objective · To investigate the clinicopathological features, diagnosis and prognosis of rectal neuroendocrine neoplasms (R-NENs). Methods · The clinical data of 113 cases of R-NENs, January 2008 to June 2017, were collected in Renji Hospital, Shanghai Jiao Tong University School of Medicine, and the clinicopathological features and prognostic factors were retrospectively analyzed. The of synapsin (Syn), neural cell adhesion molecule (CD56), and chromogranin A (CgA) were observedimmunohistochemistry in the R-NENs specimens. The specimens were also observed after hematoxylin-eosin staining. Results · In 113 cases of R-NENs, there were 59 males and 54 females, and their ages ranged 25 to 83 with an average age of (52.3±13.3) years old. All the patients had no obvious clinical manifestations. The main symptoms included changes in bowel habits (21.3%), abdominal pain (8.9%) and anal symptoms (6.2 %), and 63.7% of cases were found in routine medical examinations. The R-NENs were diagnosed as G1 (79.6%), G2 (11.5%), and G3 (8.8%). Immunohistochemistry results demonstrated that 94.7% of tumors were positive for Syn, 80.9% for CD56, and 48.6% for CgA. Till November 2017, the median survival time was 33.10 months (0.40–114.67 months), with 1-year, 3-year, and 5-year survival rates of 93.8%, 90.0%, and 85.9%, respectively. The pathological grade, depth of tumor invasion, lymph node metastasis or distant metastasis, tumor size, and age were all associated with prognosis of patients with R-NENs. Conclusion · Most of R-NENs are low-grade malignant tumors with good overall prognosis and have a lack of specificity in clinical manifestations.
Key words: neuroendocrine neoplasms, rectum, pathological feature, prognosis


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