胰腺神经内分泌肿瘤转移至肝细胞腺瘤的临床病理观察
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摘要
目的探讨胰腺神经内分泌肿瘤(pNEN)作为供体肿瘤转移至受体肿瘤的临床病理学特征。方法分析1例胰腺神经内分泌瘤转移到肝细胞腺瘤(HCA)的临床病理特征及免疫表型,并复习文献。结果患者女性,49岁。发作性心悸、出汗伴饥饿感2年,常于不及时进餐发作,进餐后缓解。生长抑素受体断层显像、胰腺增强CT加灌注及胰腺高分辨率MRI检查均提示胰腺尾部占位,考虑为胰岛素瘤;肝VIII段疑似转移病变。故行剖腹探查、胰岛素瘤切除及肝肿物切除术。术后病理诊断为①胰腺神经内分泌瘤(G1);②肝细胞腺瘤(2灶,未分类型),其中1个病灶内见转移性神经内分泌瘤。结论瘤对瘤转移很少见,胰腺神经内分泌肿瘤可作为供体肿瘤转移到良性或低度恶性肿瘤内,也可作为受体肿瘤被转移;临床特点及影像学表现类似转移瘤。
Objective To evaluate the clinicopathological characteristics of tumor-to-tumor metastasis in which pancreatic neuroendocrine neoplasm(pNEN) was the recipient or the donor. Methods A case of a pNET metastasizing to a hepatocellular adenoma was studied by light microscopy and immunohistochemistry and the literature regarding tumor-to-tumor metastasis with pNEN were reviewed. Results A 49-year-old woman presented paroxysmal palpitations with sweating and hunger which often relieved after meals. Somatostatin receptor tomography, contrast-enhanced computed tomography(CT) with pancreas perfusion imaging and magnetic resonance imaging(MRI) of pancreas all showed that a nodular mass in the tail of pancreas, which was considered to be insulinoma, and the imaging also indicated suspected hepatic metastatic lesions in segment VIII. The patient underwent laparotomy, insulinoma resection and hepatectomy. Postoperative pathological examination showed a pancreatic neuroendocrine tumor and a metastatic neuroendocrine tumor within the hepatocellular adenoma(2 lesions, unclassified). Conclusions Tumor-to-tumor metastasis is rare. pNET as the donor tumors can metastasize to benign or low-grade malignant tumors, and also can be recipients. The clinical features and imaging are similar to those of metastasis.
Objective To evaluate the clinicopathological characteristics of tumor-to-tumor metastasis in which pancreatic neuroendocrine neoplasm(pNEN) was the recipient or the donor. Methods A case of a pNET metastasizing to a hepatocellular adenoma was studied by light microscopy and immunohistochemistry and the literature regarding tumor-to-tumor metastasis with pNEN were reviewed. Results A 49-year-old woman presented paroxysmal palpitations with sweating and hunger which often relieved after meals. Somatostatin receptor tomography, contrast-enhanced computed tomography(CT) with pancreas perfusion imaging and magnetic resonance imaging(MRI) of pancreas all showed that a nodular mass in the tail of pancreas, which was considered to be insulinoma, and the imaging also indicated suspected hepatic metastatic lesions in segment VIII. The patient underwent laparotomy, insulinoma resection and hepatectomy. Postoperative pathological examination showed a pancreatic neuroendocrine tumor and a metastatic neuroendocrine tumor within the hepatocellular adenoma(2 lesions, unclassified). Conclusions Tumor-to-tumor metastasis is rare. pNET as the donor tumors can metastasize to benign or low-grade malignant tumors, and also can be recipients. The clinical features and imaging are similar to those of metastasis.
引文
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[24] Cohen J, Meunier R, Jamshed S, et al. Metastatic renal cell carcinoma in a hepatic hemangioma: a case report and review of the literature[J]. Int J Surg Pathol, 2016, 24(6): 552-555.
[25] Pintea B, Di Tommaso L, Destro A, et al. Combined hepatocellular carcinoma-cholangiocarcinoma harboring a metastasis of colon adenocarcinoma[J]. J Gastrointestin Liver Dis,2013, 22(3): 341-343.
[2] Berent W. Seltene Metastasenbildung[J]. Zentralbl Allg Pathol, 1902, 13:406-410.
[3] Baloch ZW, Livolsi VA. Tumor-to-tumor metastasis to follicular variant of papillary carcinoma of thyroid[J]. Arch Pathol Lab Med, 1999, 123(8):703-706.
[4] Jarrell ST, Vortmeyer AO, Linehan WM, et al. Metastases to hemangioblastomas in von Hippel-Lindau disease[J]. J Neurosurg, 2006, 105(2):256-263.
[5] Reynolds MR, Crilly SM, Sweeney KJ, et al. Metastatic pancreatic neuroendocrine tumor to the central nervous system in a patient with von Hippel-Lindau disease: a case report and literature review[J]. Br J Neurosurg, 2015, 29(2): 291-293.
[6] Ricketts R, Tamboli P, Czerniak B, et al. Tumor-to-tumor metastasis: report of 2 cases of metastatic carcinoma to angiomyolipoma of the kidney[J]. Arch Pathol Lab Med, 2008,132(6):1016-1020.
[7] Bednarek-Rajewska K, Zalewski P, Breborowicz D, et al. Renal cell carcinoma metastasizing to pancreatic neuroendocrine neoplasm the second case described in the word literature[J]. Pol J Pathol, 2017, 68(1): 82-85.
[8] Matsukuma S, Kono T, Takeo H, et al. Tumor-to-tumor metastasis from lung cancer: a clinicopathological postmortem study[J]. Virchows Arch, 2013, 463(4): 525-534.
[9] Cenkowski M, Gibson IW, Lategan B, et al. Tumor-to-tumor metastasis: report of a case of renal cell carcinoma metastasizing to a pancreatic endocrine neoplasm[J]. J Clin Oncol, 2011, 29(11): e303-304.
[10] Dobbing J. Cancer to cancer[J]. Guy Hosp Rep, 1958,107(1):60-65.
[11] Campbell LV, Gilbert E, Chamberlain CR, et al. Metastases of cancer to cancer[J]. Cancer, 1968, 22(3):635-643.
[12] Petraki C, Vaslamatzis M, Argyrakos T, et al. Tumor to tumor metastasis: report of two cases and review of the literature[J]. Int J Surg Pathol, 2003,11(2):127-135.
[13] Sumit S, Naviot C, Lee-Cyn A, et al. Papillary thyroid carcinoma metastasizing to anaplastic meningioma: an unusual case of tumor-to-tumor metastasis[J]. Brain Tumor Pathol, 2017, 34(3):130-134.
[14] Radu EC, Saizu AI, Grigorescu RR,et al. Metastatic neuroendocrine pancreatic tumor: Case report[J]. J Med Life, 2018, 11(1):57-61.
[15] Modlin IM, Lye KD, Kidd M, et al. A 5-decade analysis of 13,715 carcinoid tumors[J]. Cancer, 2003, 97(4):934-959.
[16] Song JS, Taylor SM, Trites J, et al. Tumor-to-tumor metastases: papillary thyroid carcinoma into a clear cell renal cell carcinoma[J]. J Otolaryngol-Head Neck Surg, 2017,46(1):17.
[17] Ryska A, Cáp J. Tumor-to-tumor metastasis of renal cell carcinoma into oncocytic carcinoma of the thyroid[J]. Pathology, 2003,199(2): 101-106.
[18] Minn AJ, Gupta GP, Siegel PM, et al. Genes that mediate breast cancer metastasis to lung[J]. Nature, 2005, 436(7050): 518-524.
[19] Modlin IM, Kidd M, Pfragner R, et al. The functional characterization of normal and neoplastic human enterochromaffin cells[J]. J CIin Endocrinol Metab, 2006, 9l(6): 2340-2348.
[20] Rha SE, Jung SE, Lee KH, et al. CT and MR imaging findings of endocrine tumor of the pancreas according to WHO classification[J]. Eur J Radiol, 2007,62(3): 371-377.
[21] Dromain C, de Baere T, Baudin E, et al. MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques[J]. Am J Roentgenol, 2003, 180(1):121-128.
[22] Rebouissou S, Bioulac-Sage P, Zucman-Rossi J, et al. Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma[J]. J Hepatol, 2008, 48(1): 163-170.
[23] Bioulac-Sage P, Laumonier H, Couchy G, et al. Hepatocellular adenoma management and phenotypic classification: the bordeaux experience[J]. Hepatology, 2009, 50(2): 481-489.
[24] Cohen J, Meunier R, Jamshed S, et al. Metastatic renal cell carcinoma in a hepatic hemangioma: a case report and review of the literature[J]. Int J Surg Pathol, 2016, 24(6): 552-555.
[25] Pintea B, Di Tommaso L, Destro A, et al. Combined hepatocellular carcinoma-cholangiocarcinoma harboring a metastasis of colon adenocarcinoma[J]. J Gastrointestin Liver Dis,2013, 22(3): 341-343.