A Clinicopathological Study Of Gastro-entero-pancreatic Neuroendocrine Tumor

Background Neuroendocrine neoplasms(neuroendocrine neoplasms,NENs)are a class of tumors that originate from neuroendocrine cells and produce bioactive amines or polypeptide hormones,accounting for 2% of all malignant tumors.They can occur in various parts of the body,such as the lungs.Mammary gland,thyroid,gastrointestinal tract,pancreas and other organs.In China,gastrointestinal tract and pancreas are common sites of NENs,and rectum is one of the best sites of gastrointestinal and pancreatic neuroendocrine tumors(Gastro-entero-pancreatic neuroendocrine neoplasms,GEP-NENs).Rectal neuroendocrine neoplasms(rectal neuroendocrine tumor,R-NEN)account for about 1.1 to 1.3 percent of all rectal tumors,but due to the rarity of typical clinical symptoms,they are often misdiagnosed as polyps,and pathology is the final diagnostic criterion for R-NEN.Previous studies have shown that R-NEN is a relatively rare tumor with low incidence.However,with the wide application of endoscopy therapy and the increasing of people’s health awareness,the detection rate of R-NEN has increased significantly.We should pay more attention to the diagnosis,treatment and prognosis of R-NEN.GEP-NENs metastases are not uncommon,especially in NENs of pancreas or jejunum,even well-differentiated NENs is no exception.It has been reported that 67% of well-differentiated neuroendocrine tumors(WDNET)can have a distant metastasis rate of 20%.Different chemotherapeutic and targeted drug therapy protocols and surgical resection of primary lesions are necessary to relieve complications.Therefore,correct pathological diagnosis is of great significance for the surgeon to choose the treatment correctly and to improve the survival rate of the patients.Foreign studies have shown that SATB2(Special AT-rich sequence-binding protein 2,)and CDX-2(Caudal-type homeobox protein 2,are expressed differently in primary gastrointestinal and pancreatic WDNET.However,these two antibodies are mainly used in the differential diagnosis of gastrointestinal epithelial tumors in China.However,they have not been widely used in the diagnosis of gastrointestinal and pancreatic WDNET.To prove the value of these two antibodies to gastrointestinal and pancreatic WDNET,to provide reference for the selection and judgement of immunohistochemical antibodies for differential diagnosis of gastrointestinal pancreatic WDNET,will be very helpful to the pathological differential diagnosis of metastatic WDNET and reduce the misdiagnosis rate.To improve the understanding and diagnosis level of GEP-NENs in gastrointestinal and pancreatic neuroendocrine tumors.Objective To investigate the clinicopathological features,diagnosis,differential diagnosis and the prognosis of neuroendocrine neoplasms(neuroendocrine neoplasms,NENs)helps to improve the ability of cognitive diseases.At the same time,the expression of SATB2 and CDX-2 antibodies in WDNET originating from stomach,pancreas,small intestine and rectum was studied to improve the understanding of GEP-NENs in gastrointestinal and pancreatic neuroendocrine tumors the level and ability of diagnosis and treatment.Methods 1.The data of 113 cases of rectal neuroendocrine tumors(R-NENs),from January 2008 to June 2017,were collected in Renji Hospital of Shanghai Jiaotong University School of Medicine,and retrospectively analyzed.HE staining,immunohistochemistry,clinicopathological features and Prognostic analysis were carried out.55 cases of WDNET located in stomach,pancreas(foregut),small intestine(midgut)and rectum(hindgut)were detected by SATB2 and CDX-2 immunoassay.Results 1.113 cases of R-NENs,59 males and 54 females,age ranges from 25 to 83 with an average age of 52.3±13.3 years old.R-NENs clinical manifestations were not obvious,main symptoms include changes in bowel habits 21.24%,abdominal pain 8.85% and anal symptoms 6.19 %,of which 63.72% were found in routine medical examinations.Pathological grading showed G1 grade 79.6%,G2 grade 11.5%,G3 grade 8.8%.Immunohistochemistry results demonstrated that Syn positive rate was 94.7%,CD56 positive rate was 80.91%,and CgA positive rate was 48.62%.Till November 2017,the median survival time was 33 months(0.4-114.7),with 1-,3-,and 5-year survival rates of 93.8%,90.0%,and 85.9%,respectively,pathological grade,depth of tumor invasion,lymph nodes,or distant Metastasis,tumor size,and age were all associated with prognosis.2.The positive expression rate of SATB2 in rectum,stomach,pancreas and small intestine was significantly different(P < 0.001).The positive expression rate of SATB2 in foregut(stomach and pancreas),midgut(small intestine)and hindgut(rectum)was significantly different(P < 0.001).Compared with midgut group,hindgut group had a significantly higher positive expression rate(P=0.002)and foregut group(P < 0.001).3 The positive expression rate of CDX-2 in rectum,stomach,pancreas and small intestine was significantly different(P < 0.001).The positive rate of CDX-2 in the foregut(stomach and pancreas),midgut(small intestine)and hindgut(rectum)was significantly different(P < 0.001),and the positive rate of CDX-2 in midgut group was significantly higher than that in hindgut group(P < 0.001).The positive expression rate of CDX-2 in the foregut group was significantly higher than that in the hindgut group(P=0.003),but there was no significant difference in the positive expression rate of CDX-2 between the foregut group and the midgut group(P0.105).Conclusion 1.R-NENs is a low-grade malignant tumor with lack of specificity in clinical manifestations and good overall prognosis.2.In gastrointestinal and pancreatic WDNETs,the specificity and sensitivity of SATB2 antibody was higher in the hindgut,but it was not expressed in the foregut.CDX2 was expressed in the WDNET of the foregut and midgut origin,but not in the hindgut.