原发性椎管内神经内分泌肿瘤1例报告

神经内分泌肿瘤(neuroendocrine tumor,NET)是起源于弥散神经内分泌系统的一组异质性肿瘤群[1,2].椎管内NET少见,多为其他系统原发NET转移而来,而原发性椎管内NET更少见.我们收治1例原发性椎管内NET患者,报告如下. 患者女性,59岁,主因"腰骶部疼痛4个月"于2013年3月1日入住我院.4个月前无明显诱因出现腰骶部疼痛,针刺样,阵发性发作,程度剧烈,每次持续约数分钟,并向双臀、双股外侧放射,体力活动、咳嗽、劳累后容易出现,偶有夜间疼痛导致睡眠障碍,卧床休息能好转,无双下肢麻木、无力和活动障碍.曾行针灸治疗,疼痛有所缓解,但反复发作,程度和频率逐渐加重.患病以来,精神食欲可,大便略费力,稍干燥,1～2天排便1次,小便正常,体重无明显变化既往无腰骶部外伤和手术史,无腰部剧烈活动史,无家族性肿瘤病史神经系统查体:自主体位,正常步态;L4～S1棘突及椎旁有压痛及叩击痛;肛门周围针刺觉和触觉减退,余感觉检查正常;肛门括约肌张力和主动收缩力降低;四肢肌力对称,约5级,肌张力正常,无肌萎缩;双侧肛门反射减弱,双下肢腱反射正常,阵挛及病理反射未引出;共济运动检查正常.     

原发性胆囊小细胞神经内分泌癌1例报告

正1病例资料患者,男性,65岁,因"反复右上腹疼痛半月"入院。患者无明显诱因出现右上腹阵发性疼痛半个月,为阵发性绞痛,多于夜间发作,持续1～2小时后可自行缓解,无伴畏寒发热、黄疸、腹胀、恶心呕吐、呼吸困难等症状。行B超可见胆囊结石,结石大小约59 mm×15 mm。为求治疗,于2018年3月21日入院。既往史无特殊,个人史无特殊。入院查体:皮肤、巩膜无黄染,腹平软,右上腹压痛,无反跳痛,Murphy征(+),移动性浊音(-)。肿瘤标志物CA199:336.49 U/mL(正常值0～35 U/mL)、     

肾脏原发性神经内分泌癌一例报告

肾脏原发性神经内分泌癌临床罕见 ,我院收治 1例 ,报告如下。患者 ,男 ,71岁。因Ｂ超发现右肾囊实性占位 3个月于 2 0 0 0年 12月 8日入院。患者 11年前体检Ｂ超发现双肾多发囊肿 ,无症状。 3个月前因肝硬化腹水就诊 ,复查Ｂ超发现右肾囊实性占位 ,ＣＴ、ＭＲＩ检查均提示双肾多发囊肿 ,右肾囊实性占位。全身骨扫描无异常。查体 :双肾区无包块及异常隆起 ,无明显叩击痛 ,沿双侧输尿管径路无压痛。入院诊断 :双肾多发囊肿 ,右肾囊实性占位(肾癌 ?) ,肝硬化。因肾功能不全 ,于同年 12月 2 6日全麻下行保存肾单位之右肾肿瘤切除术。术中探及右…     

肾脏原发性神经内分泌癌一例报告

患者,男,60岁.因体检B超发现右肾占位2d于2006年12月18日入院.无腰背酸痛及肉眼血尿,高血压病史10年.查体:肾区无隆起无叩击痛,全身浅表淋巴结无肿大.血尿常规、肝肾功能、胸部X线片未见异常,电子胃镜及肠镜检查未见异常.B超检查:右肾内实质低回声团块,大小4 cm×4 cm,圆形,边界尚清楚,内部回声不均匀,后方回声衰减,周围血管结构受压,并弯曲移位,内部可见彩色血流信号;输尿管及膀胱未见异常.CT检查见右肾实质内5 cm×4 cm类圆形实质占位灶,密度较均匀,平扫CT值40 HU,增强后不均匀强化,CT值85 HU;双侧肾盂未见扩张,肾血管无特殊,后腹膜未见肿大淋巴结.考虑右肾恶性肿瘤.     

肾原发性神经内分泌癌一例报告

患者,男,55岁.因右腰部酸痛1周入院.B超检查示右肾失去正常形态,右肾下极7.9 cm×8.2 cm中低回声区.CT检查示右肾下极见直径9.0 cm类圆形实质占位灶,密度较均匀,平扫CT值39 HU,增强后不均匀强化,CT值84HU,双侧肾盂未见扩张,肾血管无特殊,后腹膜未见肿大的淋巴结,考虑右肾癌.全麻下行右肾癌根治术.     

乳腺神经内分泌癌1例报告

1 病例 患者,女,60岁,因发现左侧乳腺肿块半年入院,当时查体:双侧乳头无内陷,无溢液或脱屑,左侧乳腺外卜象限可触及1个约3 cm×4 cm大小肿物,质硬、无触痛、边界清、活动度差.右侧乳腺未触及异常,双侧腋窝及双侧锁骨上区未触及肿大淋巴结.胸部X线片及肝胆彩超无阳性发现.完善各项检察后,先在局麻下行病灶切除活检,冰冻病理检查示:左侧乳腺浸润性癌,具体病理类型待常规石蜡及免疫组化诊断.     

肾脏原发性神经内分泌癌1例报告并文献复习

神经内分泌癌(neuroendocrine carcinoma,NEC)是指广泛分布于机体内许多器官和内分泌腺中神经内分泌细胞所发生的恶性肿瘤,可发生于全身各处,发病率低,最常见部位为消化道(75%)和肺部(10%),发生于泌尿系者较为少见[1],发生于肾脏更是罕见.2010 年 11 月 23 日广东省人民医院收治肾脏原发性 NEC 1 例,现报告如下.     

睾丸原发性神经内分泌癌1例报告并文献复习

目的：探讨睾丸原发性神经内分泌癌的起源、诊断要点和治疗方法,提高对该疾病的认识。方法：回顾性分析我院收治的1例睾丸原发性神经内分泌癌患者的资料,并复习有关文献。结果：患者左侧睾丸有一无痛肿块,质硬。彩超扫描证实左侧睾丸内存在一2．7cmX2．3crux3．1cm低回声实性团块,包膜完整,界限清楚,肿块内血流信号丰富;腹膜后、腹股沟彩超检查未见肿大淋巴结。血清肿瘤标记物pHCG、CEA和AFP未见异常。手术完整切除肿瘤,术后病检提示为睾丸神经内分泌癌。病变组织起源于神经内分泌细胞,癌细胞类圆形,胞质伊红染,核圆形,颗粒状,癌细胞呈巢状或岛状排列。癌细胞弥漫性表达突触素、嗜铬颗粒A和细胞角蛋白。结论：睾丸原发性神经内分泌癌罕见,临床表现缺乏特异性,组织学特点和免疫组化标记物是诊断该病的主要依据,需与转移性类癌和混合性类癌相鉴别。早期诊断并手术效果良好,术后应密切随访预防复发和转移。     

输尿管镜检后原发性输尿管神经内分泌癌1例报告

正(1.天津南开天孕医院,天津300110;2.北京大学人民医院泌尿外科,北京100044)     

Intracranial invasion of neuroendocrine carcinoma: a case report

A rare case of neuroendocrine carcinoma arising from the nasal cavity is reported. A 57-year-old female, who had been complaining of anosmia for 8 years, was admitted to the otolaryngological department because an intranasal tumor was found. Then, removal of the tumor and radiotherapy was carried out. After these procedures, the patient suffered from a high fever and CSF rhinorrhea. At this stage, our neurosurgical department was consulted. CT scan revealed a partially calcified low density mass with a slight enhancement effect at the left frontal base. Under the diagnosis of intracranial invasion by intranasal neuroendocrine carcinoma, the patient was operated on. Through bifrontal craniotomy and a combination of extra- and intradural approach, the tumor was excised. After that, the dura and the skull base were reconstructed. On histological examination, the tumor was found to consist of NSE positive cells forming some glandular structures. Electron microscopic study disclosed neurosecretory granules in the cytoplasmic process. These findings are typical of neuroendocrine carcinoma and compatible to those of the intranasal tumor previously removed. Neuroendocrine carcinoma is rare in itself and there have been reported only two cases of its invasion of the skull base. The clinical features, diagnostic procedures, pathological findings, and treatment of this tumor are discussed in this report.     

Prostatic neuroendocrine carcinoma with priapism : a case report

An 84-year-old man presented with priapism in May, 2009. At 79 years old, he was diagnosed with stage C prostate cancer and then, was treated with hormonal therapy. The serum level of prostate-specific antigen (PSA) was within the normal range (0.02 ng/ml). Penile caverno-dorsal vein shunt (Barry shunt) and caverno-spongiosum shunt (Quackels shunt) were performed for the purpose of managing local symptoms. Following operation, the penile pain was mitigated. Postoperative computed tomography (CT) revealed the enlarged prostate and multiple metastases to lungs and multiple bone metastases. Histological examination of the prostatic needle biopsy revealed poorly differentiated neuroendocrine carcinoma of the prostate.     

Thymic large cell neuroendocrine carcinoma: report of a resected case - a case report

Thymic large cell neuroendocrine carcinomas (LCNECs) are very rare. We here describe a case in which the tumor could be completely resected. A 55-year-old male was admitted to our hospital for treatment of an anterior mediastinal tumor found at a regular health check-up. The patient underwent an extended thymectomy of an invasive thymoma of Masaoka's stage II that had been suspected preoperatively. The tumor was located in the right lobe of the thymus and was completely resected. Final pathological diagnosis of the surgical specimen was thymic LCNEC. The patient underwent adjuvant chemotherapy with irinotecan and cisplatin in accordance with the diagnosis of a lung LCNEC, and is alive without recurrence or metastasis 16 months after surgery.     

Double primary lung carcinoma consisting of large cell neuroendocrine carcinoma and squamous cell carcinoma: report of a case.

We report a rare case of double primary lung carcinoma including large cell neuroendocrine carcinoma (LCNEC). A 67-year-old man underwent an annual medical checkup in 2000, pulmonary carcinoma was strongly suspected by sputum cytology and radiological images. Preoperative diagnosis was double primary lung carcinoma with a squamous cell carcinoma in the right lower lobe and non-small cell carcinoma in the right upper lobe. The histological carcinoma type in the right upper lobe could not be determined preoperatively. The patient underwent a right lower lobectomy and wedge resection of the right upper lobe. Histologically, the tumor in the right upper lobe was LCNEC and the tumor in the right lower lobe was a moderately differentiated squamous cell carcinoma. The patient had right supraclavicular lymph node metastases of LCNEC and died of multiple pulmonary metastases 10 months after the operation.     

胆管小细胞神经内分泌癌一例报道

病例：女,53岁,因“中上腹胀痛伴皮肤巩膜黄染1周”入院。体检示,皮肤、巩膜黄染,右上腹有轻压痛,未及异常肿块。磁共振胰胆管成像（MRCP）显示,胆总管下端狭窄,局部管壁略增厚,胆道扩张、胆囊积液（见图1）;逆行胰胆管造影（ERCP）发现,胆总管远段明显狭窄．近端胆管明显扩张（见图2）。肝功能指标如下,白蛋白34．7g／L。血清丙氨酸氨基转移酶（ALT）311．0IU／L,     

A case report of primary neuroendocrine carcinoma of the perihilar bile duct

We investigated the patterns and predictors of recurrence and survival in cryptogenic non-B, non-C, non-alcoholic hepatocellular carcinoma (CR-HCC). We compared the findings with those hepatitis virus B (B) and hepatitis virus C (C)-HCC. CR-HCC does not include HCC developed on NASH. From 1990 to 2011, of 676 patients who underwent primary curative liver resection as initial therapy for HCC at our institution, 167 had B-HCC, 401 had C-HCC, and 62 had CR-HCC. Differences between three groups were analyzed using the Chi-squared test. Cumulative overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method, prognostic factors involved in OS/DFS were evaluated by univariate analysis using the log-rank test, and stepwise Cox regression analysis. Liver function was better in CR-HCC than in B/C-HCC, and mean tumor size was larger in CR-HCC than in B/C-HCC. In CR-HCC, OS was equivalent to that of B/C-HCC, and DFS was equivalent to that of B-HCC. Both tumor-related factors and background liver function appeared to be prognostic factors for three groups. Our findings indicate that the probability of survival of advanced CR-HCC was not longer than that of B/C-HCC. Given our findings, a postoperative follow-up protocol for CR-HCC should be established alongside that for B/C-HCC.     

Urothelial carcinoma of ureter with neuroendocrine differentiation: a case report

A 73-year-old woman complained of gross hematuria. Urine cytology showed small cell carcinoma (SmCC) cells mixed with urothelial carcinoma (UC) cells. Cystoscopy revealed a bladder tumor around the right ureteral orifice. Abdominal CT demonstrated severe right hydronephrosis. Pelvic MRI showed a mass (approximately phi5 cm) in the urinary bladder wall that protruded into the lumen. TUR biopsy of the bladder tumor was SmCC. With laparoscopic nephrectomy/open ureterectomy, distal end (approximately 10 cm) of the right ureter was tumorous and obstructed. The tumor invaded into the urinary bladder/peritoneum and was unresectable. The tumor of lower-end of ureter tumor was SmCC, showing neuroendocrine differentiation such as pseudo-rosette, positive Grimelius stain, and chromogranin A/NCAM/synaptophysin immunostaining. Proximal to this tumor, non-invasive UC spread superficially over entire length of the ureter to the renal pelvis. Abrupt transition from invasive SmCC to non-invasive UC was observed in the middle of the ureter. Post-operative adjuvant chemotherapy was discouraged due to senile dementia of the patient. The patient died nine months after the operation because of systemic progression of cancer.     

Right hepatectomy for combined primary neuroendocrine and hepatocellular carcinoma. A case report

INTRODUCTION

Cases of primary neuroendocrine tumors in the liver combined with hepatocellular carcinoma are scarce. Such cases could present either as combined-type tumor or collision type.

PRESENTATION OF CASE

A 51-year-old man presented with a mass in the right hemiliver. Serum level of alpha-fetoprotein was slightly elevated (2.3 ng/ml), with normal CA19-9 and CA125. The patient underwent right hepatectomy. The resected specimen showed a well-defined and heterogeneous gray-white to brown friable tumor, 20 cm in diameter. Microscopically, the tumor consisted predominantly of monotonous small- to medium-sized neoplastic cells arranged in trabeculea separated by sinusoidal spaces. Immunohistochemically, the tumor cells were strongly positive for synaptophysin and focally positive for chromogranin-A. Interestingly, the tumor cells showed patchy positive coarse granular staining of HerPar-1 involving about 1% of the tumor cells. Glypican-3 staining was negative. These immunohistochemical findings supported the diagnosis of combined high grade neuroendocrine carcinoma and hepatocellular carcinoma.

DISCUSSION

Cases of primary neuroendocrine tumors in the liver combined 82 with hepatocellular carcinoma are scarce. The uniqueness of this case lies in the fact that the neuroendocrine carcinoma component comprised more than 99% of the tumor area, and the minor hepatocellular carcinoma component was detected only by the immunohistochemical staining for HepPar-1.

CONCLUSION

To the best of our knowledge, this is the first case of combined neuroendocrine carcinoma and hepatocellular carcinoma in Egypt.