医学研究生学报
醫學研究生學報
의학연구생학보
Journal of Medical Postgraduates
2015年
10期
1057-1060
,共4页
纵隔%神经内分泌癌%CT%病理
縱隔%神經內分泌癌%CT%病理
종격%신경내분비암%CT%병리
Mediastinum%Neuroendocrine carcinoma%CT%Pathology
目的 纵隔原发性小细胞神经内分泌癌是一种好发于中老年男性的少见高度恶性肿瘤,其组织学来源尚未明确,影像学表现无明显特征性,误诊率高. 文中通过对该病CT表现及病理特征的探讨,以期为提高该病的认知及诊断水平提供依据. 方法 回顾性分析2009年1月至2015年6月期间南方医院收治经病理证实的4例纵隔原发性小细胞神经内分泌癌患者的影像及临床病理资料,并复习相关文献. 结果 4例肿瘤中2例位于前中上纵隔,1例位于前上纵隔,1例位于中上纵隔;除1例外,余3例形态不规则,边界不清,密度不均匀,内见低密度囊变坏死区,其中2例见散在斑点状钙化;增强后3例呈中度不均匀强化,1例呈环形强化. 病理示肿瘤细胞异型性明显,体积较小,细胞质少,染色质淡染,核仁少或无,核分裂象多见;免疫组化分析示4例嗜铬蛋白A(CgA)、突触蛋白(Syn)及细胞角蛋白(CK)均呈阳性,3例神经元特异性烯醇化酶(neuron-specific enolase, NSE)、细胞表面分化抗原CD56及细胞核增殖指数(Ki-67)及1例上皮膜抗原(epithelial membrane an-tigen, EMA)呈阳性. 结论 位于前中纵隔的肿块内见散在斑点状钙化,压迫或侵犯邻近纵隔结构,应怀疑小细胞神经内分泌癌. 但确诊仍需结合病理及免疫组织化学检查.
目的 縱隔原髮性小細胞神經內分泌癌是一種好髮于中老年男性的少見高度噁性腫瘤,其組織學來源尚未明確,影像學錶現無明顯特徵性,誤診率高. 文中通過對該病CT錶現及病理特徵的探討,以期為提高該病的認知及診斷水平提供依據. 方法 迴顧性分析2009年1月至2015年6月期間南方醫院收治經病理證實的4例縱隔原髮性小細胞神經內分泌癌患者的影像及臨床病理資料,併複習相關文獻. 結果 4例腫瘤中2例位于前中上縱隔,1例位于前上縱隔,1例位于中上縱隔;除1例外,餘3例形態不規則,邊界不清,密度不均勻,內見低密度囊變壞死區,其中2例見散在斑點狀鈣化;增彊後3例呈中度不均勻彊化,1例呈環形彊化. 病理示腫瘤細胞異型性明顯,體積較小,細胞質少,染色質淡染,覈仁少或無,覈分裂象多見;免疫組化分析示4例嗜鉻蛋白A(CgA)、突觸蛋白(Syn)及細胞角蛋白(CK)均呈暘性,3例神經元特異性烯醇化酶(neuron-specific enolase, NSE)、細胞錶麵分化抗原CD56及細胞覈增殖指數(Ki-67)及1例上皮膜抗原(epithelial membrane an-tigen, EMA)呈暘性. 結論 位于前中縱隔的腫塊內見散在斑點狀鈣化,壓迫或侵犯鄰近縱隔結構,應懷疑小細胞神經內分泌癌. 但確診仍需結閤病理及免疫組織化學檢查.
목적 종격원발성소세포신경내분비암시일충호발우중노년남성적소견고도악성종류,기조직학래원상미명학,영상학표현무명현특정성,오진솔고. 문중통과대해병CT표현급병리특정적탐토,이기위제고해병적인지급진단수평제공의거. 방법 회고성분석2009년1월지2015년6월기간남방의원수치경병리증실적4례종격원발성소세포신경내분비암환자적영상급림상병리자료,병복습상관문헌. 결과 4례종류중2례위우전중상종격,1례위우전상종격,1례위우중상종격;제1예외,여3례형태불규칙,변계불청,밀도불균균,내견저밀도낭변배사구,기중2례견산재반점상개화;증강후3례정중도불균균강화,1례정배형강화. 병리시종류세포이형성명현,체적교소,세포질소,염색질담염,핵인소혹무,핵분렬상다견;면역조화분석시4례기락단백A(CgA)、돌촉단백(Syn)급세포각단백(CK)균정양성,3례신경원특이성희순화매(neuron-specific enolase, NSE)、세포표면분화항원CD56급세포핵증식지수(Ki-67)급1례상피막항원(epithelial membrane an-tigen, EMA)정양성. 결론 위우전중종격적종괴내견산재반점상개화,압박혹침범린근종격결구,응부의소세포신경내분비암. 단학진잉수결합병리급면역조직화학검사.
Objective Mediastinal primary small cell neuroendocrine carcinoma ( MPSCNC) is a rare neoplasm of high ma-lignant potential mostly affecting elderly and middle-aged males, which has a high rate of misdiagnosis because of its unidentified histo-genesis and lack of obvious characteristic imaging findings .This study was to investigate the CT findings and pathologic features of MP-SCNC, so as to improve the recognition and diagnostic accuracy of the disease . Methods We retrospectively analyzed the imaging and clinicopathologic data about 4 cases of pathologically confirmed MPSCNC and reviewed relevant literature . Results Of the 4 tumors, 2 were located in the anterior-middle-superior mediastinum , 1 in the anterior-superior mediastinum , and the other in the mid-dle-superior mediastinum .Three of them exhibited irregular shape , unclear boundary , and inhomogeneous density , with low-density cyst degeneration and necrosis , of which two had scattered punctate calcifications .Enhanced scanning revealed moderate uneven en-hancement in 3 cases and ring-shaped enhancement the other .Pathological findings showed small tumor cells with marked pleomor-phism, little cytoplasm, pale chromatin, inconspicuous or absent nucleoli , and obvious mitotic figures.Immunochemistry manifested positive CgA, Syn, and CK in all the 4 cases, positive NSE, CD56, and Ki-67 in 3 cases, and positive epithelial membrane antigen in 1. Conclusion A tumor located in the anterior-middle mediastinum with scattered punctate calcifications and compressing or inva-ding the adjacent mediastinal structures should be suspected as a small cell neuroendocrine carcinoma . However , definite diagnosis should be based on histopathologic and immunohistochemical exami-nations .
