目的：探讨结直肠原发神经内分泌癌（NECs）的CT征象，以提高结直肠原发NECs的术前诊断。方法：回顾性分析经病理确诊的32例原发性结直肠NECs患者和46例结直肠腺癌患者的CT表现，比较两组患者发病年龄、性别、肿瘤发生部位、病变大小、肠壁增厚形式、平扫、增强CT值、肠周浸润情况、有无肠梗阻及其他器官转移等的差异。结果：与结直肠腺癌组比较，结直肠原发NECs组患者发病年龄小（t=3.634，P<0.001），两组在肠壁增厚形式、病灶大小、病灶强化程度等方面差异有统计学意义（P<0.05），在性别、病灶发生部位、有无肠梗阻、有无区域淋巴结转移、有远处转移等方面差异无统计学意义（P>0.05）。结论：结直肠NECs发病年龄较轻，其CT表现为息肉/肿块样病灶，密度均匀，增强动脉期表现为中度或显著强化，静脉期进一步强化时，应考虑到结直肠NECs的可能，并可出现显著强化的肝脏转移病灶。
Abstract
Objective: To explore the CT findings of primary colorectal neuroendocrine carcinomas(NECs), and to improve the imaging diagnosis of them. Methods: CT findings of 32 patients with primary colorectal NECs and 46 patients with colorectal adenocarcinoma confirmed by surgery and pathology were analyzed retrospectively. The differences of age, gender, tumor location, size of the lesion, the thickening pattern of the intestinal wall, the pattern of contrast-enhancement, the peri-intestinal invasion, the occurrence of intestinal obstruction and metastasis to other organs were compared between the two groups. Results: Compared with the colorectal adenocarcinoma group, patient of colorectal NECs group was younger(t=3.634, P<0.001). There were statistically significant differences of focal thickening, size of the lesion and contrast-enhancement(P<0.05). While in gender, lesion location, occurrence of intestinal obstruction, lymph node metastasis, or metastasis, there was no statistically significant difference(P>0.05). Conclusion: Primary colorectal NECs are often found in young patients. Their CT manifestations include a polypoid lesion and is characterized by significant contrast-enhancement. Significantly contrast-enhanced metastasis may occur in liver.
关键词
结直肠肿瘤；内分泌腺肿瘤；体层摄影术 /
螺旋计算机
Key words
Colorectal neoplasms /
Endocrine gland neoplasms /
Tomography, spiral computed
中图分类号：
Ｒ735.35
Ｒ735.37
Ｒ730.264
Ｒ814.42
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参考文献
[1]Kl?觟ppel G, Perren A, Heitz PU. The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification[J]. Ann N Y Acad Sci, 2004, 1014(1): 13-27.
[2]Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumours of the digestive system[M]. Lyon: Iarc Press, 2010: 60-65.
[3]廖波，魏少忠，黄小辉. 结直肠神经内分泌肿瘤25例临床分析[J]. 中华结直肠疾病电子杂志，2016，5（5）：440-443.
[4]Auernhammer CJ, G?觟ke B. Therapeutic strategies for advanced neuroendocrine carcinomas of lejunum/ileum and pancreatic origin[J]. Gut, 2011, 60(7): 1009-1021.
[5]Haeubl M, Schuerz S, Svejda B, et al. Asymmetrically substituted cationic indole- and fluorene porphyrins inhibit tumor proliferation in small intestinal neuroendocrine tumors and medullary thyroid carcinomas[J]. Eur J Med Chem, 2010, 45(2): 773-760.
[6]Fraenkel M, Kim MK, Faggiano A, et al. Epidemiology of gastroenteropancreatic neuroendocrine tumours[J]. Best Pract Res Clin Gastroenterol, 2012, 26(6): 691-703.
[7]Chang S, Choi D, Lee SJ, et al. Neuroendocrine neoplasms of the gastrointestinal tract: classification, pathologic basis, and imaging features[J]. Radiographics, 2007, 27(6): 1667-1679.
[8]蒋梦捷，胡涵光，郑树，等. 结直肠神经内分泌肿瘤诊治进展[J]. 中华结直肠疾病电子杂志，2014，3（5）：43-46.
[9]Cho MY, Kim JM, Jin HS, et al. Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors(GEP-NETs) in Korea 2000-2009: multicenter study[J]. Cancer Res Treat, 2012, 44(3): 65-157.
[10]Shafqat H, Ali S, Salhab M, et al. Survival of patients with neuroendocrine carcinoma of the colon and rectum: a population-based analysis[J]. Dis Colon Rectum, 2015, 58(3): 294-303.
[11]Schott M, Kl?觟ppel G, Raffel A, et al. Neuroendocrine neoplasms of the gastrointestinal tract[J]. Dtsch Arztebl Intern, 2011, 108(18): 305-312.
[12]Richards D, Davis D, Yan P, et al. Unusual case of small cell gastric carcinoma: case report and literature review[J]. Dig Dis Sci, 2011, 56(4): 951-957.
[13]Grabowski P, Sch?觟nfelder J, Ahnert-Hilger G, et al. Expression of neuroendocrine markers: a signature of human undifferentiated carcinoma of the colon and rectum[J]. Vrichows Arch, 2002, 441(3): 256-263.
[14]Vortmeyer AO, Lubensky IA, Merino MJ, et al. Concordance of genetic alterations in poorly differentiated colorectal neuroendocrine carcinomas and associated adenocarcinomas[J]. J Natl Cancer Inst, 1997, 89(19): 1448-1453.
[15]Wang D, Zhang GB, Yan L, et al. CT and Enhanced CT in diagnosis of gastrointestinal neuroendocrine carcinomas[J]. Abdom Imaging, 2012, 37(5): 738-745.
[16]李关宁，杨振淮. 结直肠神经内分泌癌15例临床诊治分析[J]. 消化肿瘤杂志：电子版，2016，8（1）：28-32.
[17]梁振威，蒋力明，李颖，等. 直肠神经内分泌肿瘤的影像学分析[J]. 中华肿瘤防治杂志，2015，22（11）：867-870.
[18]董锐增，师英强，叶延伟，等. 23例胃低分化神经内分泌癌的临床病理特点和预后分析[J]. 中华外科杂志，2010，13（8）：583-586.
[19]Kaltsas G, Rockall A, Papadogias D, et al. Recent advances in radiological and radionuclide imaging and therapy of neuroendocrine tumours[J]. Eur J Endocrinol, 2004, 151(1): 15-27.
[20]Cwikla JB, Nasierowska-guttmejer A, Jeziorski KG, et al. Diagnostic imaging approach to gastro-entero-pancreatic carcinomas of neuroendocrine origin-single net center experience in Poland[J]. Neuro Endocrinol Lett, 2007, 28(28): 789-800.
[21]Kim SY, Byun JH, Choi G, et al. A case of primary paraganglioma that arose in the pancreas: the color Doppler ultrasonography and dynamic CT features[J]. Korean J Radiol, 2008, 9(Suppl): 18-21.
[22]Badea R, Seicean A, Diaconu B, et al. Contrast-enhanced ultrasound of the pancreas—a method beyond its potential or a new diagnostic standard?[J]. J Gastrointestin Liver Dis, 2009, 18(2): 237-242.
[23]Suresh PK, Sahu KK, Pai RR, et al. The prognostic significance of neuroendocrine differentiation in colorectal carcinomas: our experience[J]. J Clin Diag Res, 2015, 9(12): 1-4.
基金
云南省科技厅-昆明医科大学应用基础研究联合专项基金（基金编号：2014FB062）。
