摘要目的 探讨胃混合性腺神经内分泌癌(MANEC)临床病理学特点.方法 收集福建省立医院病理科2011年1月到2018年12月期间36例胃MANEC临床和病理资料,行光镜观察,免疫组织化学EnVision法检测,并与同时期40例胃神经内分泌癌进行比较.结果 男性29例,女性7例;发病年龄43~87岁(平均年龄66岁);肿瘤直径1.0~9.0 cm(平均5.0 cm);临床分期T1+T2分期4例,T3+T4分期32例;临床表现主要为上腹部闷痛、腹胀、吞咽困难;20例患者获得完整随访资料,其中健在11例,死亡9例.病理学观察所有肿瘤均由神经内分泌癌和腺癌两种不同成分构成,且均大于30%;免疫组织化学显示腺癌成分表达细胞角蛋白,神经内分泌癌成分主要表达CD56和突触素;胃MANEC和胃神经内分泌癌在年龄、性别、T分期以及预后方面未见明显差异(P>0.05),胃神经内分泌癌好发于食管胃交界和胃体部,而胃窦部发生率较低;胃MANEC好发于食管胃交界和胃窦部,而胃体部发生率较低,胃MANEC比胃神经内分泌癌更容易发生淋巴结转移(P<0.05).结论 胃MANEC多为中老年男性,好发于胃食管交界和胃窦部,发现时大都分期较高,多数患者发生淋巴结转移且预后较差.

abstractsObjective To investigate the clinicopathological characteristics of gastric mixed adenoneuroendocrine carcinoma (MANEC). Methods The clinical and pathologic data of 36 cases of gastric MANEC collected from January 2011 to December 2018 in the Department of Pathology, Fujian Provincial Hospital were retrospectively analyzed. Light microscopy and EnVision immunohistochemical (IHC) staining were used in the study. The results were compared with 40 cases of gastric neuroendocrine carcinoma collected within the same period. Results The 36 cases were collected, there were 29 males and 7 females. The patients′age ranged from 43 to 87 years (mean 66 years). The tumor diameter ranged from 1.0 to 9.0 cm (mean 5.0 cm). Clinical staging showed that four cases were at T1+T2 stages and 32 cases were at T3+T4 stages. The main clinical manifestations were upper abdominal pain, abdominal distension and dysphagia. Complete follow?up data were obtained in 20 (eleven living and nine dead) patients. Pathologic analysis showed that all tumors were composed of neuroendocrine carcinoma and adenocarcinoma and each of the components was more than 30%. IHC staining showed that CK was expressed in adenocarcinoma; whereas the neuroendocrine carcinoma mainly expressed CD56 and Syn. There was no significant difference in age, sex, T stage and prognosis between gastric MANEC and gastric neuroendocrine carcinoma(P>0.05). Gastric neuroendocrine carcinoma predominantly occurred in the esophagogastric junction and the gastric body but only rarely in the gastric antrum; gastric MANEC mainly occurred in the esophagogastric junction and the gastric antrum but rarely in the gastric body. Gastric MANEC was more prone to lymph node metastasis than gastric neuroendocrine cancer(P<0.05). Conclusions Most of the gastric MANEC patients are middle?aged and elderly males, and the tumors predominantly occur in the esophagogastric junction and the gastric antrum. Most of the patients are found to have higher stages, and most of them have lymph node metastases and poor prognosis.