Clinicopathological analysis of colorectal mixed adeno-neuroendocrine carcinoma: 8 cases report

doi:10.3969/j.issn.1004-583X.2022.10.007

Abstract

Abstract:

Objective To explore the clinicopathological features of colorectal mixed adeno-neuroendocrine carcinoma (MANEC). Methods A retrospective analysis were porformed in 8 patients underwent MANEC eradication in Tianjin Hospital of ITCWM (Nankai Hospital) from August 2016 to December 2020. Results There were 3 female and 5 male, age averaged 63 years among these patients. Their clinical manifestations obviously had no-specificity, with the imaging showing space occupying and lymph node metastasis.The tumor marker detection verified 2 cases of significantly elevated ferritin, 2 cases of significantly elevated carcinoembryonic antigen (CEA), and all cases of insignificantly elevated alpha-fetoprotein and carbohydrate antigen 199 (CA199). The preoperative biopsy were conducted in 6 cases, 5 cases of adenocarcinoma and 1 case of adenocarcinoma or MANEC, with main space occupying in colon. There were 5 cases for ulcer type, 3 cases for protuberant type, with the maximum diameter of tumor for 3-9 cm. Under light microscope, the tumor cells of adenocarcinoma were arranged like glandular tubes, and 2 cases were accompanied with mucinous adenocarcinoma; neuroendocrine tumor cells showed diffuse, nest like or organ like distribution, including 1 case of small cell type and 7 cases of large cell type. Lymph node metastasis was found in 7 cases and liver metastasis in 1 case. Immunohistochemistry indicated that cytokeratin8/18 (CK8/18), cytokeratin19 (CK19) and CEA were positive to varying degrees in adenocarcinoma, chromogranin A (CgA), synaptophysin (Syn) and cluster of differentiation 56 (CD56) were positive to varying degrees in neuroendocrine tumors, and 40%-80% of Ki-67 hot spots were positive. Five patients survived, the median survival time was 17 months, and two patients died, the average survival time was 8 months. Conclusion Colorectal MANEC is a highly malignant tumor characterized by lower morbidity, no-specificity, and incident lymph node metastasis, its diagnosis mainly depends on pathology with immunohistochemistry.

Key words: colorectal neoplasms, mixed adeno-neuroendocrine carcinoma, histocytological preparation techniques, immunohistochemistry

CLC Number:

R735.3

Zhang Yiming, Li Mingzhao, Gu Xin. Clinicopathological analysis of colorectal mixed adeno-neuroendocrine carcinoma: 8 cases report[J]. Clinical Focus, 2022, 37(10): 921-926.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.10.007

https://huicui.hebmu.edu.cn/EN/Y2022/V37/I10/921

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References 21

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病例	性别	年龄(岁)	临床表现
1	男	59	腹痛腹泻伴排气排便不畅
2	女	62	腹痛
3	男	53	腹痛
4	女	54	腹部不适伴便血
5	女	70	腹痛
6	男	51	腹痛伴血便
7	男	67	腹泻伴黏液脓血便
8	男	87	腹痛

病例	性别	年龄(岁)	临床表现
1	男	59	腹痛腹泻伴排气排便不畅
2	女	62	腹痛
3	男	53	腹痛
4	女	54	腹部不适伴便血
5	女	70	腹痛
6	男	51	腹痛伴血便
7	男	67	腹泻伴黏液脓血便
8	男	87	腹痛

编号	部位	大体类型	最大径(cm)	病理分级	分期	腺癌比例及分化	NEC比例及类型	淋巴结转移(腺癌/NEC/腺癌+NEC*)	Syn	CgA	CD56	Ki-67指数(腺癌百分比/NEC百分比)
1	乙状结肠	溃疡	5	T3N2bM0	ⅢC	50%,中分化	50%,大细胞	5/3/3	+	-	-	60/80
2	乙状结肠	溃疡	6	T3N1aM1a	ⅣA	30%,中-低分化	70%,大细胞	0/2/0	+	+	-	60/80
3	升结肠	隆起	5	T3N2bM0	ⅢC	70%,中-低分化(伴黏液腺癌)	30%,大细胞	10/2/0	+	-	+	80/60
4	横结肠	溃疡	9	T3N0M0	ⅡA	70%,中-低分化(伴黏液腺癌)	30%,大细胞	0/0/0	部分+	-	+	50/70
5	升结肠	溃疡	4	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	8/0/0	+	弱+	弱+	50/60
6	直肠	隆起	3	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	0/7/0	部分+	部分+	局灶+	40/60
7	直肠	溃疡	6	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	1/1/0	部分+	部分+	-	50/70
8	乙状结肠	隆起	5	T3N2bM0	ⅢC	30%,高-中分化	70%,小细胞	3/13/3	+	-	零星+	50/60

编号	部位	大体类型	最大径(cm)	病理分级	分期	腺癌比例及分化	NEC比例及类型	淋巴结转移(腺癌/NEC/腺癌+NEC*)	Syn	CgA	CD56	Ki-67指数(腺癌百分比/NEC百分比)
1	乙状结肠	溃疡	5	T3N2bM0	ⅢC	50%,中分化	50%,大细胞	5/3/3	+	-	-	60/80
2	乙状结肠	溃疡	6	T3N1aM1a	ⅣA	30%,中-低分化	70%,大细胞	0/2/0	+	+	-	60/80
3	升结肠	隆起	5	T3N2bM0	ⅢC	70%,中-低分化(伴黏液腺癌)	30%,大细胞	10/2/0	+	-	+	80/60
4	横结肠	溃疡	9	T3N0M0	ⅡA	70%,中-低分化(伴黏液腺癌)	30%,大细胞	0/0/0	部分+	-	+	50/70
5	升结肠	溃疡	4	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	8/0/0	+	弱+	弱+	50/60
6	直肠	隆起	3	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	0/7/0	部分+	部分+	局灶+	40/60
7	直肠	溃疡	6	T3N2bM0	ⅢC	30%,高-中分化	70%,大细胞	1/1/0	部分+	部分+	-	50/70
8	乙状结肠	隆起	5	T3N2bM0	ⅢC	30%,高-中分化	70%,小细胞	3/13/3	+	-	零星+	50/60