不同病理分级胰腺神经内分泌肿瘤的影像特征分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 路涛 ,  蒲红 , 陈光文

四川省医学科学院·四川省人民医院放射科（四川成都 610072）;

Corresponding author：

蒲红, Email: ph1726148853@qq.com

Keywords：

胰腺神经内分泌肿瘤; 病理分级; X线计算机; 磁共振成像; 体层摄影术

DOI：

10.7507/1007-9424.20160385

Video：

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目的初步探讨不同病理分级的胰腺神经内分泌肿瘤的CT和MRI表现特点。方法回顾性分析2013年1月至2015年12月期间于笔者所在医院经穿刺及手术病理学检查证实的15例胰腺神经内分泌肿瘤患者的临床及影像资料，根据2010年WHO第4版“神经内分泌肿瘤病理分类标准”分为G1、G2及G3级后进行分析。结果 15例患者中，8例有神经内分泌症状，5例主要症状为腹痛，2例无任何症状；G1、G2及G3级各5例。15例患者共检出17个病灶（G1级5个，G2级5个，G3级7个），肿瘤主要位于胰体尾部（9个，其中G1级1个，G2级和G3级均为4个），其次为胰头（7个，其中G1级3个，G2级1个，G3级3个）；1个病灶内有钙化点（G2级），9个病灶内可见坏死（G1级2个，G2级4个，G3级3个）；10个病灶形态为类圆形（G1级3个，G2级3个，G3级4个），7个为不规则形（G1级2个，G2级2个，G3级3个）；10个病灶位于胰腺轮廓内（G1级4个，G2级3个，G3级3个），7个位于胰腺轮廓外（G1级1个，G2级2个，G3级4个）。CT平扫示17个病灶均为等或低密度，有坏死者密度不均。MRI检查示：5个病灶T1WI为低信号，T2WI为高信号（G1级1个，G2级1个，G3级3个）；2个病灶T1WI为低信号，T2WI为等信号（G1级1个，G2级1个）；1个病灶T1WI及T2WI均为等信号（G1级）。病灶强化方式：1个病灶表现为动脉期明显强化，门静脉期强化密度降低（G1级）；8个病灶表现为动脉期和门静脉期均明显强化（G1级3个，G2级4个，G3级1个），8个病灶表现为动脉期轻度-较明显强化，门静脉期进一步明显强化（G1级1个，G2级1个，G3级6个）。1例G1级及1例G2级病例发生肝脏转移，1例G3级病例发生肝脏多发转移及L2椎体骨转移，另1例G3级病例有门腔间隙淋巴结肿大。结论各级别胰腺神经内分泌肿瘤的影像表现不具有特异性，尚需进一步大样本研究。

Citation： 路涛, 蒲红, 陈光文. 不同病理分级胰腺神经内分泌肿瘤的影像特征分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1525-1529. doi: 10.7507/1007-9424.20160385 Copy

1.	Lawrence B, Gustafsson BI, Chan A, et al. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am, 2011, 40(1):1-18.
2.	Tan EH, Tan CH. Imaging of gastroenteropancreatic neuroendo-crine tomors. World J Clin Oncol, 2011, 2(1):28-43.
3.	O'Grady H, Conlon K. Pancreatic neuroendocrine tumors. Eur J Surg Oncol, 2008, 34(3):324-332.
4.	Bosman F, Carneiro F, Hruban R, et al, WHO classification of tumors of the digestive system. Lyon:IARC Press, 2010:100-155.
5.	Modlin IM, Champaneria MC, Bornschein J, et al. Evolution of the diffuse neuroendocrine system-clear cells and cloudy origins. Neuroendocrinology, 2006, 84(2):69-82.
6.	Yao JC, Hassan M, Phan A, et al. One hundred years after 'carcinoid':epidemiology of and prognostic factors for neuroendocrine tumors in 35825 cases in the United States. J Clin Oncol, 2008, 26(18):3063-3072.
7.	Oberg K, Akerström G, Rindi G, et al. Neuroendocrine gastroentero-pancreatic tumours:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5:v223-v227.
8.	Sahani DV, Bonaffini PA, Fernández-Del Castillo C, et al. Gastroen-teropancreatic neuroendocrine tumors:role of imaging in diagnosis and management. Radiology, 2013, 266(1):38-61.
9.	崔全才, 孟宇宏, 王鲁平, 等.消化系统肿瘤WHO分类.第4版.北京:诊断病理杂志社, 2012:580-581.
10.	要文青, 王威亚, 李甘地. 64例胰腺神经内分泌肿瘤的临床病理特征.中华肿瘤杂志, 2014, 36(4):287-293.
11.	Ho HC, Eloubeidi MA, Siddiqui UD, et al. Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours:a multicentre case series. Dig Liver Dis, 2013, 45(9):750-753.
12.	Sa ML, Yeo CJ. Neurodocrine tumors of the pancreas. Curr Opin Oncol, 2012, 24(1):46-55.
13.	郭林杰, 唐承薇.中国胃肠胰神经内分泌肿瘤临床研究现状分析.胃肠病学, 2012, 17(5):178-276.
14.	Wang YH, Lin Y, Xue L, et al. Relationship between clinical characteristics and survival of gastroenteropancreatic neuroendocrine neoplasms:a single-institution analysis (1995-2012) in South China. BMC Endocr Disord, 2012, 12:30.
15.	唐承薇, 郭林杰.我国胃肠胰神经内分泌肿瘤临床现状分析.中国实用外科杂志, 2014, 34(6):490-492.
16.	叶正武, 金中高.胰腺不同级别神经内分泌肿瘤的CT、MRI特征分析.医学影像学杂志, 2014, 24(12):2225-2228.
17.	王静, 赵延涛, 赵念博, 等.胰腺神经内分泌肿瘤的MSCT表现.中国医学计算机成像杂志, 2014, 20(4):339-343.
18.	Kim DW, Kim HJ, Kim KW, et al. Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT:comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour. Eur Radiol, 2015, 25(5):1375-1383.
19.	Osawa A, Sumiyama Y, Watanabe M, et al. Single case of renal cell carcinoma and endocrine pancreatic head cancer occurring with von Hippel-Lindau disease. J Hepatobiliary Pancreat Surg, 2006, 13(2):174-180.
20.	章婷婷, 余永强, 钱银锋, 等.胰腺神经内分泌肿瘤MSCT表现及良恶性鉴别.临床放射学杂志, 2014, 33(5):722-726.
21.	Takumi K, Fukukura Y, Higashi M, et al. Pancreatic neuroendocrine tumors:correlation between the contrast-enhanced computed tomography features and the pathological tumor grade. Eur J Radiol, 2015, 84(8):1436-1443.
22.	司友娇, 陈静静, 纪清连, 等.胰腺神经内分泌肿瘤CT表现及其与病理学分级的相关性.中国医学影像技术, 2014, 30(4):544-547.
23.	何云飞, 张念如, 冯仕庭, 等.胃肠胰神经内分泌肿瘤的影像诊断进展.国际医学放射学杂志, 2012, 35(1):53-58.
24.	Elsayes KM, Menias CO, Bowerson M, et al. Imaging of carcinoid tumors:spectrum of findings with pathologic and clinical correlation. J Comput Assist Tomogr, 2011, 35(1):72-80.
25.	Heller MT, Shah AB. Imaging of neuroendocrine tumors. Radiol Clin North Am, 2011, 49(3):529-548.

1. Lawrence B, Gustafsson BI, Chan A, et al. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am, 2011, 40(1):1-18.
2. Tan EH, Tan CH. Imaging of gastroenteropancreatic neuroendo-crine tomors. World J Clin Oncol, 2011, 2(1):28-43.
3. O'Grady H, Conlon K. Pancreatic neuroendocrine tumors. Eur J Surg Oncol, 2008, 34(3):324-332.
4. Bosman F, Carneiro F, Hruban R, et al, WHO classification of tumors of the digestive system. Lyon:IARC Press, 2010:100-155.
5. Modlin IM, Champaneria MC, Bornschein J, et al. Evolution of the diffuse neuroendocrine system-clear cells and cloudy origins. Neuroendocrinology, 2006, 84(2):69-82.
6. Yao JC, Hassan M, Phan A, et al. One hundred years after 'carcinoid':epidemiology of and prognostic factors for neuroendocrine tumors in 35825 cases in the United States. J Clin Oncol, 2008, 26(18):3063-3072.
7. Oberg K, Akerström G, Rindi G, et al. Neuroendocrine gastroentero-pancreatic tumours:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2010, 21 Suppl 5:v223-v227.
8. Sahani DV, Bonaffini PA, Fernández-Del Castillo C, et al. Gastroen-teropancreatic neuroendocrine tumors:role of imaging in diagnosis and management. Radiology, 2013, 266(1):38-61.
9. 崔全才, 孟宇宏, 王鲁平, 等.消化系统肿瘤WHO分类.第4版.北京:诊断病理杂志社, 2012:580-581.
10. 要文青, 王威亚, 李甘地. 64例胰腺神经内分泌肿瘤的临床病理特征.中华肿瘤杂志, 2014, 36(4):287-293.
11. Ho HC, Eloubeidi MA, Siddiqui UD, et al. Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours:a multicentre case series. Dig Liver Dis, 2013, 45(9):750-753.
12. Sa ML, Yeo CJ. Neurodocrine tumors of the pancreas. Curr Opin Oncol, 2012, 24(1):46-55.
13. 郭林杰, 唐承薇.中国胃肠胰神经内分泌肿瘤临床研究现状分析.胃肠病学, 2012, 17(5):178-276.
14. Wang YH, Lin Y, Xue L, et al. Relationship between clinical characteristics and survival of gastroenteropancreatic neuroendocrine neoplasms:a single-institution analysis (1995-2012) in South China. BMC Endocr Disord, 2012, 12:30.
15. 唐承薇, 郭林杰.我国胃肠胰神经内分泌肿瘤临床现状分析.中国实用外科杂志, 2014, 34(6):490-492.
16. 叶正武, 金中高.胰腺不同级别神经内分泌肿瘤的CT、MRI特征分析.医学影像学杂志, 2014, 24(12):2225-2228.
17. 王静, 赵延涛, 赵念博, 等.胰腺神经内分泌肿瘤的MSCT表现.中国医学计算机成像杂志, 2014, 20(4):339-343.
18. Kim DW, Kim HJ, Kim KW, et al. Neuroendocrine neoplasms of the pancreas at dynamic enhanced CT:comparison between grade 3 neuroendocrine carcinoma and grade 1/2 neuroendocrine tumour. Eur Radiol, 2015, 25(5):1375-1383.
19. Osawa A, Sumiyama Y, Watanabe M, et al. Single case of renal cell carcinoma and endocrine pancreatic head cancer occurring with von Hippel-Lindau disease. J Hepatobiliary Pancreat Surg, 2006, 13(2):174-180.
20. 章婷婷, 余永强, 钱银锋, 等.胰腺神经内分泌肿瘤MSCT表现及良恶性鉴别.临床放射学杂志, 2014, 33(5):722-726.
21. Takumi K, Fukukura Y, Higashi M, et al. Pancreatic neuroendocrine tumors:correlation between the contrast-enhanced computed tomography features and the pathological tumor grade. Eur J Radiol, 2015, 84(8):1436-1443.
22. 司友娇, 陈静静, 纪清连, 等.胰腺神经内分泌肿瘤CT表现及其与病理学分级的相关性.中国医学影像技术, 2014, 30(4):544-547.
23. 何云飞, 张念如, 冯仕庭, 等.胃肠胰神经内分泌肿瘤的影像诊断进展.国际医学放射学杂志, 2012, 35(1):53-58.
24. Elsayes KM, Menias CO, Bowerson M, et al. Imaging of carcinoid tumors:spectrum of findings with pathologic and clinical correlation. J Comput Assist Tomogr, 2011, 35(1):72-80.
25. Heller MT, Shah AB. Imaging of neuroendocrine tumors. Radiol Clin North Am, 2011, 49(3):529-548.

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不同病理分级胰腺神经内分泌肿瘤的影像特征分析

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