直肠神经内分泌肿瘤的诊治
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摘要
目的探讨直肠神经内分泌肿瘤的临床表现、内镜特点、病理及内镜下治疗。方法对解放军总医院2012年12月至2017年2月经临床及病理诊断为直肠神经内分泌肿瘤的22例患者进行回顾性分析。结果全部患者行内镜检查,内镜下均表现为表面光滑的直肠黏膜下隆起,色泽黄或者微黄。16例患者行微探头超声内镜检查,1例未探测到,余15例均起源于黏膜下层,14例表现为低回声改变。全部病例均行内镜下治疗,钳除5例,电凝电切1例,内镜下黏膜剥离(endoscopic submucosal dissection,ESD) 12例,内镜下黏膜切除(endoscopic mucosal resection,EMR) 3例,1例行外科手术切除。全部病例均行病理检查,21例行免疫组化,G1级11例,G2级10例,G3级0例。结论常规内镜、超声内镜对诊断直肠神经内分泌肿瘤有重要价值,包含EMR、ESD的内镜下治疗对直肠神经内分泌肿瘤安全、有效。
Objective To investigate the clinical manifestations,features of endoscopy,pathology and endoscopic treatment of rectal neuroendocrine neoplasm( RNEN). Methods The clinical data of 22 patients with RNEN diagnosed by clinic and pathology were retrospectively analyzed. Results All patients underwent colonoscopy,and all the surface of RNEN were smooth. A total of 16 patients underwent endoscopic ultrasonography( EUS). Among them,1 case could not be detected,and the remaining 15 cases originated from submucosa,and 14 cases were manifested as lesions with low level echoes. All the RNEN were removed by endoscopic therapy,including removing by biopsy for 1 case,electroresction for 1 case,endoscopic submucosal dissection( ESD) for 12 cases,endoscopic mucosal resection( EMR) for 3 cases and surgical operation for 1 case. All the cases of specimen were pathologically confirmed,and 21 cases were underwent immunohistochemical examination. Eleven cases were classified as grade G1,10 cases as grade G2,and 0 case as grade G3. Conclusion The colonoscopy and EUS are very important to diagnose RNEN. The efficacy and safety of endoscopic therapy have been verified,which include EMR and ESD.
Objective To investigate the clinical manifestations,features of endoscopy,pathology and endoscopic treatment of rectal neuroendocrine neoplasm( RNEN). Methods The clinical data of 22 patients with RNEN diagnosed by clinic and pathology were retrospectively analyzed. Results All patients underwent colonoscopy,and all the surface of RNEN were smooth. A total of 16 patients underwent endoscopic ultrasonography( EUS). Among them,1 case could not be detected,and the remaining 15 cases originated from submucosa,and 14 cases were manifested as lesions with low level echoes. All the RNEN were removed by endoscopic therapy,including removing by biopsy for 1 case,electroresction for 1 case,endoscopic submucosal dissection( ESD) for 12 cases,endoscopic mucosal resection( EMR) for 3 cases and surgical operation for 1 case. All the cases of specimen were pathologically confirmed,and 21 cases were underwent immunohistochemical examination. Eleven cases were classified as grade G1,10 cases as grade G2,and 0 case as grade G3. Conclusion The colonoscopy and EUS are very important to diagnose RNEN. The efficacy and safety of endoscopic therapy have been verified,which include EMR and ESD.
引文
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9郭旭,王向东,令狐恩强,等.小探头超声内镜在直肠光滑隆起型病变诊疗中的价值[J].胃肠病学与肝病学杂志,2014,23(4):471-473.
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11 Kim J,Kim JH,Lee JY,et al.Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor[J].BMCGastroenterol,2018,8(1):77.
12 Palacios Salas F,Guzmán Calderón E,Liza Baca E,et al.Endoscopic treatment of rectal neuroendocrine tumors:multicentre study in Peru[J].Rev Gastroenterol Peru,2018,38(1):32-39.
13 Tsikitis VL,Wertheim BC,Guerrero MA.Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States:a seer analysis[J].J Cancer,2012,3:292-302.
14洪娜,王进.直肠神经内分泌肿瘤的临床病理特征及预后[J].世界华人消化杂志,2016,24(33):4526-4530.
15韦耿周,王玮,冯兴宇,等.直肠神经内分泌肿瘤的临床病理特征及预后分析[J].中华普通外科杂志,2017,32(10):828-831.
16吴凡,李鹏,赵宏,等.手术治疗直肠神经内分泌肿瘤的预后因素分析[J].中华医学杂志,2014,94(16):1237-1240.
17 Nam SJ,Chae GB,Lee S,et al.A small,well-differentiated rectal neuroendocrine tumor with multiple lymph node metastases:A case report[J].Oncol Lett,2018,15(5):7139-7143.
18 Xu G,Wang P,Xiao Y,et al.Local resection of rectal neuroendocrine tumor with first clinical manifestation of giant liver metastasis by transanal endoscopic microsurgery:A case report[J].Medicine(Baltimore),2017,96(50):e9153.
2 Modlin IM,Kidd M,Latich I,et al.Current status of gastrointestinal carcinoids[J].Gastroenterology,2005,128(6):1717-1751.
3 Ni SJ,Sheng WQ,Du X.Pathologic research update of colorectal neuroendocrine tumors[J].World J Gastroenterol,2010,16(14):1713-1719.
4 Yao JC,Hassan M,Phan A,et al.One hundred years after"carcinoid":epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States[J].J Clin Oncol,2008,26(18):3063-3072.
5 Godwin JD 2nd.Carcinoid tumors.An analysis of 2,837 cases[J].Cancer,1975,36(2):560-569.
6 Naunheim KS,Zeitels J,Kaplan EL,et al.Rectal carcinoid tumors--treatment and prognosis[J].Surgery,1983,94(4):670-676.
7 Zhang W,Tong Q,Chen Z,et al.The usefulness of endoscopic ultrasound in the differential diagnosis between benign and malignant gastric ulcer[J].Scand J Gastroenterol,2010,45(9):1093-1096.
8 Chen HT,Xu GQ,Teng XD,et al.Diagnostic accuracy of endoscopic ultrasonography for rectal neuroendocrine neoplasms[J].World JGastroenterol,2014,20(30):10470-10477.
9郭旭,王向东,令狐恩强,等.小探头超声内镜在直肠光滑隆起型病变诊疗中的价值[J].胃肠病学与肝病学杂志,2014,23(4):471-473.
10马玲玲,孔文洁,黄晓玲,等.经内镜微探头超声检查对直肠黏膜下肿物的诊断意义[J].中华消化内镜杂志,2015,32(11):758-759.
11 Kim J,Kim JH,Lee JY,et al.Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor[J].BMCGastroenterol,2018,8(1):77.
12 Palacios Salas F,Guzmán Calderón E,Liza Baca E,et al.Endoscopic treatment of rectal neuroendocrine tumors:multicentre study in Peru[J].Rev Gastroenterol Peru,2018,38(1):32-39.
13 Tsikitis VL,Wertheim BC,Guerrero MA.Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States:a seer analysis[J].J Cancer,2012,3:292-302.
14洪娜,王进.直肠神经内分泌肿瘤的临床病理特征及预后[J].世界华人消化杂志,2016,24(33):4526-4530.
15韦耿周,王玮,冯兴宇,等.直肠神经内分泌肿瘤的临床病理特征及预后分析[J].中华普通外科杂志,2017,32(10):828-831.
16吴凡,李鹏,赵宏,等.手术治疗直肠神经内分泌肿瘤的预后因素分析[J].中华医学杂志,2014,94(16):1237-1240.
17 Nam SJ,Chae GB,Lee S,et al.A small,well-differentiated rectal neuroendocrine tumor with multiple lymph node metastases:A case report[J].Oncol Lett,2018,15(5):7139-7143.
18 Xu G,Wang P,Xiao Y,et al.Local resection of rectal neuroendocrine tumor with first clinical manifestation of giant liver metastasis by transanal endoscopic microsurgery:A case report[J].Medicine(Baltimore),2017,96(50):e9153.