核素示踪技术分子功能影像在肿瘤诊治中应用及进展

核素示踪技术的功能影像在肿瘤诊治中的广泛应用进一步提高了诊治水平，主要技术有受体显像、代谢显像、乏氧显像、人源化的基因工程重组单抗片段放射免疫显像、标记反义探针基因显像和RNA干扰显像。全文综述核素示踪技术分子功能影像在肿瘤核医学应用研究热点。     

核素显像与肿瘤治疗

综述了当前用于监测肿瘤治疗疗效的各种核素显像技术如普通显像、免疫显像、分子核医学显像、代谢显像等,并对各种技术的特点和应用进行了评价。     

消化道肿瘤骨转移患者297例放射性骨显像分析

[目的]探讨核素骨显像对消化道肿瘤骨转移的临床诊断价值.[方法]分析605例消化道肿瘤患者中骨转移患者的全身骨显像结果.[结果] 605例肿瘤患者中,297例(49.09％)发生骨转移.多发骨转移(88.22％)多于单发骨转移(11.78％).转移灶的分布多为邻近转移,且躯干骨多于四肢骨和颅骨.69.36％患者有骨痛症状.[结论]核素骨显像对消化道肿瘤骨转移诊断具有诊断价值.消化道肿瘤患者在随访中应常规行核素骨显像.     

核素显像与肿瘤治疗

综述了当前用于监测肿瘤治疗疗效的各种核素显像技术如普通显像、免疫显像、分子核医学显像、代谢显像等,并对各种技术的特点和应用进行了评价.     

核素骨显像对骨转移癌诊断价值探讨

作者总结30例临床怀疑骨转移的肿瘤病人核素骨平面显像结果，与临床症状、骨X线平片对照分析。结果显示：核素骨显像对于有骨病症状及无骨癌症状病例核素异常浓聚阳性检出率为88．2％及46．2％，明显高于X线平片溶骨性改变检出率（52．9％及7．7％），P＜0．01，对于X线平片无改变病例骨显像为55％阳性检出率，X线平片有溶骨性改变病例骨显像阳性检出率为100％，且显示病灶数较X线平片增多。核素骨显像对检测肿瘤骨转移，阳性率高，特异性较强，能起早期诊断作用。     

放射性核素标记Exendin-4类似物用于胰岛素瘤显像的研究进展

胰岛素瘤是常见的胰腺内分泌肿瘤,常规方法难以检测。核素显像如单光子断层扫描（SPECT）和正电子断层扫描（PET）具有无创、敏感度高、特异性好等优势,为胰岛素瘤的诊断提供了新技术。胰高血糖素样肽-1受体（GLP-1R）在胰岛素瘤中高表达,是潜在的肿瘤靶点。Exendin-4作为GLP-1R激动剂,可与受体特异性结合。本文介绍放射性核素标记GLP-1R激动剂（Exendin-4）类似物的进展及在胰岛素瘤显像研究中的应用。     

120例乳腺癌术后核素骨显像分析

目的 对１２０例乳癌术后患者行全身核素骨显像,诊断有无骨转移灶。方法 用＾９９ｍＴｃ－ＭＤＰ静注后２－３小时显像。结果 有７７例核业像阳性,占６４．１％,其中５６例与Ｘ线检查相对照,核素骨显像阳性４６５例,占８２．１％,Ｘ线阳性１７例,占３０．３％。结论核素骨显像明显优于Ｘ线检查。乳腺癌术后应定期行全身核素骨显像,对早期发现病灶,进行及时治疗,具有一定     

核医学新型分子探针在神经内分泌肿瘤临床应用中的研究进展

摘 要：神经内分泌肿瘤（neuroendocrine neoplasm,NEN）是一种罕见的肿瘤,源于肽能神经元和神经内分泌细胞,具有神经内分泌分化并表达神经内分泌标志物。近年来,核医学诊疗一体化分子探针在NEN的诊断和治疗方面取得了显著的临床进展,为该病的管理提供了新的视角。放射性核素标记分子探针在NEN的诊断中展现了全身特异性显像的优势,可用于早期诊断、临床分期、复发转移监测以及随访评估,有助于为患者制定更精准的治疗方案。同时,治疗放射性核素标记的分子探针在NEN的治疗中也展现了显著的临床疗效,为患者带来了新的治疗选择。全文综述各种新型核医学分子探针在NEN的诊断和治疗中的应用和研究进展。     

超声与超声联合核素显像诊断甲状腺结节的对比研究

目的评价超声显像和超声联合核素显像对甲状腺结节良恶性的诊断价值和意义.方法将110例手术切除的甲状腺结节患者的超声诊断和超声联合核素显像诊断分别与病理诊断结果进行回顾性分析.结果单纯超声诊断甲状腺结节的符合率为87.3%,超声联合核素显像的诊断符合率为90.9%.无论对良性结节或恶性结节,单纯超声诊断与超声联合核素显像诊断相比,两者差异无显著性(P＞0.05).结论对甲状腺结节的良恶性判断,超声联合核素显像与单纯超声诊断相比,并不能明显提高诊断符合率,超声检查仍应作为首选筛检方法.     

超声与超声联合核素显像诊断甲状腺结节的对比研究

目的：评价超声显像和超声联合核素显像对甲状腺结节良恶性的诊断价值和意义。方法：将110例手术切除的甲状腺结节患的超声诊断和超声联合核素显像诊断与病理诊断结果进行回顾性分析。结果：单纯超声诊断甲状腺结节的符合率为87．3％, 超声联核素显像的诊断符合率为90．9％,无论对良性结节或恶性结节,单纯超声诊断与超声联合核素显像诊断相比,两差异无显性（P＞0．05）。结论：对甲状腺结节的良恶性判断,超声联合核素显像与单纯超声诊断相比,并不能明显提高诊断符合率,超声检查仍应作为首选筛检方法。     

Neuron-specific enolase as a new tumor marker

Enolase is a glycolytic enzyme widely distributed in each mammalian tissue and consists of three distinct subunits alpha, beta, and gamma. In the brain enolase exhibits three dimetric isozymic forms: alpha alpha, alpha gamma and gamma gamma. The gamma protein subunit has recently been found to be identical with the nervous system-specific and species-nonspecific protein, 14-3-2; therefore, alpha gamma and gamma gamma types of enolase were characterized as neuron-specific enolase (NSE). NSE has been also detected in the pituitary gland, thyroid gland, adrenal medulla and pancreas, all of which contain neuroendocrine cells. Recently NSE was observed by immunostaining or radioimmunoassay in neuroendocrine tumor such as glucagonomas, insulinomas, gut carcinoids, medullary thyroid carcinomas or neuroblastomas. Furthermore, small cell carcinoma of the lung which has been known to frequently exhibit neuroendocrine properties was found to produce NSE. In this paper NSE as a tumor marker in various cancers was evaluated by immunostaining or enzyme immunoassay which was developed by a co-worker Kato. The data revealed that serum NSE was clinically useful as a tumor marker, especially a monitoring marker of disease extent. NSE productions were also observed in adenocarcinoma of the colon or the lung and large cell carcinoma of the lung as well as small cell carcinoma of the lung and the esophagus, all of which were considered to share the biochemical features of neuroendocrine tumor. The evidence challenges a speculation that small cell carcinoma of the lung has an origin separated from the other histological types of lung carcinoma. In this meaning NSE is an important tumor marker for both clinical medicine and basic research.     

神经内分泌肿瘤中西医结合治疗的思路和体会

神经内分泌肿瘤是一组散见于全身各处、异质性强的少见肿瘤，但常见于消化道和胰腺；其中分化良好的神经内分泌肿瘤可表现出较好的生存预后，而部分肿瘤则具有较恶的生物学行为导致较高的死亡率，总体治疗效果不尽人意。笔者多年来专注于神经内分泌肿瘤诊疗领域，紧跟国内外研究前沿。同时，在神经内分泌肿瘤不同部位及分化良差等多个切入点进行了中西医结合治疗的探索。笔者认为，“益气健脾和胃”应贯穿于神经内分泌肿瘤治疗的始终，同时还需注重疏肝理气，强调“肝脾同调”。另外，还要结合某些原发部位的特殊性，采用“辨证”加“辨病”的方式，进行个体化诊治，在临床上取得了良好的效果。     

肺支气管神经内分泌肿瘤的研究现状

支气管肺神经内分泌肿瘤约占所有肺恶性肿瘤的20%,可分为典型类癌、不典型类癌、大细胞神经内分泌癌和小细胞肺癌,其中小细胞肺癌为支气管肺神经内分泌肿瘤最常见的类型。支气管肺神经内分泌肿瘤的诊断主要依靠细胞神经内分泌形态及神经内分泌标志物。现就其临床病理特点、分子特征和研究现状进行综述。     

胸腺神经内分泌肿瘤临床病理学亚型和诊治进展

胸腺神经内分泌肿瘤（neuroendocrine tumors of the thymus,NETT）是一种临床上罕见的位于前上纵隔的胸腺恶性肿瘤。它是一种主要或完全由神经内分泌细胞构成的上皮性肿瘤,需与含有散在的和成团的神经内分泌细胞的胸腺癌相鉴别。该病临床表现复杂多变且具有高度侵袭性。文章重点对NETT临床病理学亚型和诊治进展作一综述。     

Primary neuroendocrine tumor of the breast

Adult neuroendocrine tumors may present with a wide range of clinical symptoms that share specific ultrastructural and biochemical features. A 63-year-old post-menopausal female patient was admitted to the hospital with a mass in her right breast and the diagnosis was primary neuroendocrine tumor of the breast. Although neuroendocrine tumors can originate in various parts of the body and breast carcinoma with neuroendocrine differentiation has been described, primary neuroendocrine tumor of the breast is very unusual. This case is now presented and the current literature is reviewed.     

Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report

BACKGROUNDLiver tumors with dual differentiations [combined hepatocellular carcinoma (HCC) and cholangiocarcinoma] are common. However, liver tumors that exhibit hepatocellular, biliary, and neuroendocrine differentiation are exceedingly rare, with only three previous case reports in the literature. CASE SUMMARYA 65-year-old female with a previous history of hepatitis C and a distant history of low grade, well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging. Serum alpha-fetoprotein and chromogranin A were elevated. Biopsy of the larger lesion in segment 4 revealed a high-grade tumor, with morphologic and immunohistochemical features of a neuroendocrine tumor. Given the previous history of rectal neuroendocrine tumor, imaging investigation, serologic markers, and biopsy findings, metastatic neuroendocrine tumor was considered. Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation. Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes. The patient eventually expired due to complications of chemotherapy.CONCLUSIONHCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare, posing a diagnostic challenge for clinicians and pathologists.     

Gastrointestinal neuroendocrine tumors in 2020

Gastrointestinal neuroendocrine tumors are rare slow-growing tumors with distinct histological, biological, and clinical characteristics that have increased in incidence and prevalence within the last few decades. They contain chromogranin A, synaptophysin and neuron-specific enolase which are necessary for making a diagnosis of neuroendocrine tumor. Ki-67 index and mitotic index correlate with cellular proliferation. Serum chromogranin A is the most commonly used biomarker to assess the bulk of disease and monitor treatment and is raised in both functioning and non-functioning neuroendocrine tumors. Most of the gastrointestinal neuroendocrine tumors are non-functional. World Health Organization updated the classification of neuroendocrine tumors in 2017 and renamed mixed adenoneuroendocrine carcinoma into mixed neuroendocrine neoplasm. Gastric neuroendocrine tumors arise from enterochromaffin like cells. They are classified into 4 types. Only type I and type II are gastrin dependent. Small intestinal neuroendocrine tumor is the most common small bowel malignancy. More than two-third of them occur in the terminal ileum within 60 cm of ileocecal valve. Patients with small intestinal neuroendrocrine tumors frequently show clinical symptoms and develop distant metastases more often than those with neuroendocrine tumors of other organs. Duodenal and jejuno-ileal neuroendocrine tumors are distinct biologically and clinically. Carcinoid syndrome generally occurs when jejuno-ileal neuroendocrine tumors metastasize to the liver. Appendiceal neuroendocrine tumors are generally detected after appendectomy. Colonic neuroendocrine tumors generally present as a large tumor with local or distant metastasis at the time of diagnosis. Rectal neuroendocrine tumors are increasingly being diagnosed since the implementation of screening colonoscopy in 2000. Gastrointestinal neuroendocrine tumors are diagnosed and staged by endoscopy with biopsy, endoscopic ultrasound, serology of biomarkers, imaging studies and functional somatostatin scans. Various treatment options are available for curative and palliative treatment of gastrointestinal neuroendocrine tumors.     

Klassifikation und Pathologie der neuroendokrinen Tumoren des Magen-Darm-Trakts und Pankreas

Although well established in medical terminology, the term carcinoid is no longer adequate to cover the entire morphological and biological spectrum of neoplasms of the disseminated neuroendocrine cell system. Instead of “carcinoid,” the WHO classification published in 2000 therefore uses the general terms “neuroendocrine tumor” and “neuroendocrine carcinoma.” In relation to the localization and based on various morphological and biological criteria, benign neuroendocrine tumors are distinguished from tumors with uncertain malignant potential and tumors showing low-grade and high-grade malignancy. The tumor entities on which the new WHO classification is based are briefly discussed and the basic diagnostic pathways described.     

Nephroblastoma with neuroendocrine differentiation

A nephroblastoma (Wilms' tumor) with morphological, histochemical, immunohistochemical and ultrastructural evidence of neuroendocrine differentiation is described. Whereas areas of neural differentiation and occasional argyrophilic cells in cases of Wilms' tumor have been previously reported, the unique characteristic in this case was the extent of the neuroendocrine differentiation, as shown by a strong Grimelius stain of over 90% of the blastematous cells. Immunoperoxidase studies employing antibodies to neuron-specific enolase and ultrastructural data were also in favor of the neuroendocrine differentiation and suggested the existence, in addition to the already reported variant of Wilms' tumor with neural differentiation, of a neuroendocrine variant which may be part of the histologic spectrum of this neoplasm.     

胃神经内分泌肿瘤预后相关因素的临床分析（附71例）

目的:分析71例胃神经内分泌肿瘤（G-NEN）的临床特征及预后相关因素。方法:回顾性分析2009年7月至2018年10月西京医院收治的71例G-NEN患者的临床病理资料及随访资料,分析其临床病理学特征及预后相关因素。结果:单因素生存分析结果显示:5年生存率与年龄、肿瘤分级、TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）;3年生存率与肿瘤分级、TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）;1年生存率与TNM分期、肿瘤转移方面差异具有统计学意义（P<0.05）。多因素 Cox风险生存模型统计结果表明TNM分期和复发转移是影响胃神经内分泌癌预后的独立因素（P<0.05）,性别、年龄、肿瘤直径、肿瘤分类、肿瘤分级、化疗与否、手术方式等与其预后无关（P>0.05）。复发转移在性别、年龄、肿瘤直径、肿瘤分级、肿瘤分类、脉管/神经侵犯、淋巴结转移数目、淋巴结转移、手术方式、辅助化疗上均不存在显著差异（P>0.05）;是否复发转移在TNM分期上存在显著差异（P<0.05）。结论:年龄、肿瘤分级、肿瘤分期、是否复发转移是影响胃神经内分泌癌患者术后生存时间的因素,肿瘤分期、是否复发转移是影响患者预后的独立危险因素。