不同病理分級胰腺神經內分泌腫瘤的影像特征分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 路濤 ,  蒲紅 , 陳光文

四川省醫學科學院·四川省人民醫院放射科（四川成都 610072）;

Corresponding?author：

蒲紅, Email: ph1726148853@qq.com

Keywords：

胰腺神經內分泌腫瘤; 病理分級; X線計算機; 磁共振成像; 體層攝影術

DOI：

10.7507/1007-9424.20160385

Video：

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目的初步探討不同病理分級的胰腺神經內分泌腫瘤的CT和MRI表現特點。方法回顧性分析2013年1月至2015年12月期間于筆者所在醫院經穿刺及手術病理學檢查證實的15例胰腺神經內分泌腫瘤患者的臨床及影像資料，根據2010年WHO第4版“神經內分泌腫瘤病理分類標準”分為G1、G2及G3級后進行分析。結果 15例患者中，8例有神經內分泌癥狀，5例主要癥狀為腹痛，2例無任何癥狀；G1、G2及G3級各5例。15例患者共檢出17個病灶（G1級5個，G2級5個，G3級7個），腫瘤主要位于胰體尾部（9個，其中G1級1個，G2級和G3級均為4個），其次為胰頭（7個，其中G1級3個，G2級1個，G3級3個）；1個病灶內有鈣化點（G2級），9個病灶內可見壞死（G1級2個，G2級4個，G3級3個）；10個病灶形態為類圓形（G1級3個，G2級3個，G3級4個），7個為不規則形（G1級2個，G2級2個，G3級3個）；10個病灶位于胰腺輪廓內（G1級4個，G2級3個，G3級3個），7個位于胰腺輪廓外（G1級1個，G2級2個，G3級4個）。CT平掃示17個病灶均為等或低密度，有壞死者密度不均。MRI檢查示：5個病灶T1WI為低信號，T2WI為高信號（G1級1個，G2級1個，G3級3個）；2個病灶T1WI為低信號，T2WI為等信號（G1級1個，G2級1個）；1個病灶T1WI及T2WI均為等信號（G1級）。病灶強化方式：1個病灶表現為動脈期明顯強化，門靜脈期強化密度降低（G1級）；8個病灶表現為動脈期和門靜脈期均明顯強化（G1級3個，G2級4個，G3級1個），8個病灶表現為動脈期輕度-較明顯強化，門靜脈期進一步明顯強化（G1級1個，G2級1個，G3級6個）。1例G1級及1例G2級病例發生肝臟轉移，1例G3級病例發生肝臟多發轉移及L2椎體骨轉移，另1例G3級病例有門腔間隙淋巴結腫大。結論各級別胰腺神經內分泌腫瘤的影像表現不具有特異性，尚需進一步大樣本研究。

Citation： 路濤, 蒲紅, 陳光文. 不同病理分級胰腺神經內分泌腫瘤的影像特征分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1525-1529. doi: 10.7507/1007-9424.20160385 Copy

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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, Akerstr?m 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, 王魯平, 等.消化系統腫瘤WHO分類.第4版.北京:診斷病理雜志社, 2012:580-581.
10.	要文青, 王威亞, 李甘地. 64例胰腺神經內分泌腫瘤的臨床病理特征.中華腫瘤雜志, 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.中國胃腸胰神經內分泌腫瘤臨床研究現狀分析.胃腸病學, 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.我國胃腸胰神經內分泌腫瘤臨床現狀分析.中國實用外科雜志, 2014, 34(6):490-492.
16.	葉正武, 金中高.胰腺不同級別神經內分泌腫瘤的CT、MRI特征分析.醫學影像學雜志, 2014, 24(12):2225-2228.
17.	王靜, 趙延濤, 趙念博, 等.胰腺神經內分泌腫瘤的MSCT表現.中國醫學計算機成像雜志, 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, 余永強, 錢銀鋒, 等.胰腺神經內分泌腫瘤MSCT表現及良惡性鑒別.臨床放射學雜志, 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.	司友嬌, 陳靜靜, 紀清連, 等.胰腺神經內分泌腫瘤CT表現及其與病理學分級的相關性.中國醫學影像技術, 2014, 30(4):544-547.
23.	何云飛, 張念如, 馮仕庭, 等.胃腸胰神經內分泌腫瘤的影像診斷進展.國際醫學放射學雜志, 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, Akerstr?m 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, 王魯平, 等.消化系統腫瘤WHO分類.第4版.北京:診斷病理雜志社, 2012:580-581.
10. 要文青, 王威亞, 李甘地. 64例胰腺神經內分泌腫瘤的臨床病理特征.中華腫瘤雜志, 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.中國胃腸胰神經內分泌腫瘤臨床研究現狀分析.胃腸病學, 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.我國胃腸胰神經內分泌腫瘤臨床現狀分析.中國實用外科雜志, 2014, 34(6):490-492.
16. 葉正武, 金中高.胰腺不同級別神經內分泌腫瘤的CT、MRI特征分析.醫學影像學雜志, 2014, 24(12):2225-2228.
17. 王靜, 趙延濤, 趙念博, 等.胰腺神經內分泌腫瘤的MSCT表現.中國醫學計算機成像雜志, 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, 余永強, 錢銀鋒, 等.胰腺神經內分泌腫瘤MSCT表現及良惡性鑒別.臨床放射學雜志, 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. 司友嬌, 陳靜靜, 紀清連, 等.胰腺神經內分泌腫瘤CT表現及其與病理學分級的相關性.中國醫學影像技術, 2014, 30(4):544-547.
23. 何云飛, 張念如, 馮仕庭, 等.胃腸胰神經內分泌腫瘤的影像診斷進展.國際醫學放射學雜志, 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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