目的 探讨消化道类癌的诊断和治疗。方法 对我院1992年10月至2002年12月收治的23例消化道类癌患者的临床资料进行回顾性分析。结果 23例消化道类癌中3例胃类癌，1例十二指肠类癌，4例阑尾类癌，3例结肠类癌，12例直肠类癌。术前9例（39%）经活检确诊； 术后经病检23例中11例（47.8%）浸润程度超过肌层； 4例（17.4%）有区域淋巴结转移； 8例经神经元特异性烯醇酶（NSE）检查（此酶为神经内分泌肿瘤的重要标志物，具有诊断价值）有6例阳性表达，表达阳性率为75%。结论 病变部位、浸润深度、淋巴结转移是决定消化道类癌预后的关键因素，手术是有效的治疗方式。
Pulmonary carcinoid (PC) is a rare low-grade malignant neuroendocrine tumor. Unlike other neuroendocrine tumors of the digestive tract, PC seldom causes hormone-related neuroendocrine symptoms, and the diagnosis mainly depends on the biopsy of the lesion. Besides, the immunohistochemical staining technique is an important supplement and a grading standard for pathological diagnosis. Surgery is the first choice for the treatment of early PC. However, the therapy of advanced PC which is the main problem perplexing most of clinicians is controversial and still facing severe challenges. Therefore, we will discuss the current progress of the diagnosis and therapy of advanced PC.
Objective To investigate the clinicopathological characteristics and factors influencing the prognosis of rectal carcinoid. Methods Clinical data of 31 cases with rectal careinoid, which identified diagnosis through operation and pathologic examination from January 2003 to March 2010 were retrospectively reviewed. Primary tumors were classified by size （≤1.0 cm， 1.0-2.0 cm， and ＞2.0 cm）and muscularis invasion respectively, compared therapeutic effect of different groups. Results Median age of 31 cases was 49 years (22-83 years). Median follow-up time was 36 months (15-86 months), follow-up rate was 80.6% （25 /31）. During the follow-up period, there were no cases with recurrence among the 15 patients with tumor size≤l.0 cm, 1 case recurred in the 7 patients with turmor size between 1.0 cm to 2.0 cm, and 2 cases died from postoperative liver metastasis among the 3 patients with tumor size＞2.0 cm.There were relations between the tumor size, invasion depth, and metastasis （P＜0.05）. Metastasis and invasion depth of tumor were possibility increment to follow the aggrandizement of the diameter of rectal carcinoid. Conclusion The diameter of rectal carcinoid and muscularis invasion may be important factors affecting survival, which may be an important basis for the choice of operative mode.
目的：总结胸腺类癌的临床表现、病理特征、CT表现及其临床价值。方法：对本院收治的2例胸腺类癌进行分析并结合文献复习。结果：胸腺类癌发病率低，大部分早期患者无临床症状，经胸部X线、CT检查时发现；中晚期始出现症状。病理检查出类癌后，电镜可见神经内分泌颗粒，免疫组化显示神经特异性烯醇化酶、肿瘤嗜铬蛋白A、促皮质素阳性。胸部CT表现特征为起于前上纵隔肿块，常位于心底部大血管和心包周围，肿块内密度不均，可见钙化，增强后轻中度强化，易发生胸内外转移。结论：胸腺类癌是一罕见的前纵隔肿瘤，根据CT特征，结合临床可有助诊断、指导手术、推测预后，因此CT在临床诊治中有非常重要的价值。
To investigate the pathological characteristics, diagnosis and treatment of rectal carcinoid tumors, 26 cases, which had been diagnosed and treated in our hospital from 1987 to 1997, were retrospectively analysed. The rectoscopic examination were taken in all 26 patients and final diagnosis were made by pathological examination, among them, 19 cases were treated with local resection or expensively local resection, 7 cases with radical operation because the diameter of tumor was beyond 2 cm. These patiests were followed up 1-10 years with 5 patients died. The authors consider that rectoscopic examination and biopsy are important method to diagnose rectal carcinoid tumors preoperatively, in addition, for suspicious case, argentation and immunohistochemistry staining should be further made besides routine HE staining. The operative treatment is the best therapy to this kind of disease, the choice of operative mode must be made according to the size, infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.
Objective To summary the pathogenic site, clinical manifestations, endoscopic and radiographic features, pathologic characteristics, diagnosis, treatment, and prognosis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN). Methods Clinical data of 70 cases of GEP-NEN who were treated in Nanjing Drum Tower Hospital from Jan. 2003 to Dec. 2012 were collected and retrospectively analyzed. Results Of the 70 cases, 35 cases(50.0%) were in pancreas, 18 cases(25.7%) were in rectum, 10 cases(14.3%) were in stomach, and 7 cases(10.0%) were in appendix; 55 cases(78.6%) were nonfunctional tumors, while 15 cases(21.4%) were functional; 50 cases(71.4%) were neuroendocrine tumor, 15 cases(21.4%) were neuroendocrine carcinoma, and 5 cases(7.2%) were mixed adenoendocrine carcinoma; 43 cases(61.4%) were in grade 1, 7 cases(10.0%) were in grade 2, and 20 cases(28.6%) were in grade 3 respectively. The detection rate of endoscopy, type-B ultrasonic, CT, and MRI were 90.0%(27/30), 67.9% (19/28), 86.0%(43/50), and 70.0%(7/10) respectively. A total of 67 patients(95.7%) were underwent surgery, including endoscopic resection, and 3 cases (4.3%) didn't receive surgery. Forty cases were followed-up for 6 months to 9 years(the median survival time was 3 years), and the 1-, 3-, and 5-year survival rates were 82.5%(33/40), 47.5%(19/40), and 35.0%(14/40) respectively. Conclusion GEP-NEN occurs mainly in pancreas, and the clinical manifestations are variable. Endoscopy and radiographic examination methods play an important role in diagnosis of GEP-NEN, but final diagnosis is mainly based on pathological detection. Surgery is the main treatment method for it.
Objective To investigate the clinical features, diagnosis, treatment and prognosis of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by bronchopulmonary carcinoid. Methods Twenty patients (13 males and 7 females) with ectopic ACTH syndrome caused by bronchopulmonary carcinoid confirmed by surgical pathology were selected from March 2007 to May 2016 in our hospital. We collected and arranged the important clinical data of 20 patients and analyzed carefully. Results The mean age of 20 patients including 14 patients of typical carcinoid and 6 patients of atypical carcinoid was 38.85±15.31 years ranged 13-70 years. All patients had the typical clinical manifestation of Cushing's syndrome. All the thoracic lesions were located by thoracic computed tomography (CT) eventually. The concentration of serum cortisol and ACTH significantly decreased after surgery. Postoperative complications in 3 patients (15.00%) were severe pulmonary infection. Eighteen patients including 13 patients of typical carcinoid and 5 patients of atypical carcinoid were followed up. The median time of follow-up was 31.5 (12-122) months. There were 7 patients of stage Ⅰa, 1 patient of stage Ⅰb, 2 patients of stage Ⅱa and 8 patients of stage Ⅲa in the patients followed up. One patient underwent postoperative radiotherapy, and 4 patients with postoperative chemotherapy. During the follow-up period, one patient relapsed and there was no death. Conclusion Ectopic ACTH syndrome caused by bronchopulmonary carcinoid is a very rare disease. It is every difficult for clinicians to make early diagnosis and draw up plans of treatment without multidisciplinary collaboration. Chest CT is an important method of finding lesions and assessing the viability of surgery. Surgical treatment in early stage will be effective for this disease. And almost all of patients can achieve long-term survival after complete resection of tumors early.
Objective To summarize the application and advancement of liver transplantation for hepatic metastasis from neuroendocrine tumor. Methods Domestic and overseas publications on the study of liver transplantation for hepatic metastasis from neuroendocrine tumor in recent years were collected and reviewed. Results Liver transplantation can offer good relief of symptoms, long disease-free intervals, and potential cure in individual patients with hepatic metastatic tumor. Important selection criteria are well-differentiated tumors and a low proliferation rate (Ki67＜10%). Conclusion In carefully selected patients with metastatic neuroendocrine tumors, liver transplantation is an appropriate option.