Clinicopathological Analysis Of Pulmonary And Gastrointestinal Neuroendocrine Tumors

Objective: to investigate the clinicopathological characteristics of neuroendocrine tumors of the pulmonary and gastrointestinal neurodocrine tumors,the commonness and difference of immunohistochemical expression,so as to provide new ideas for clinicopathological diagnosis of neuroendocrine tumors.Methods:(1)We collected 103 cases of lung neuroendocrine tumor.These cases were the department of pathology of the first affiliated hospital of bengbu medical college from January 1,2014 to january 1,2016.90 cases of small cell lung cancer,3cases of large cell lung cancer,6 cases of typical lung carcinoid and 4 cases of atypical lung carcinoid were included.There were 64 cases of gastrointestinal neuroendocrine tumor,including 7 cases of grade G1,3 cases of grade G2,23 cases of grade G3,and 31 cases of mixed adenoneuroendocrine carcinoma.Among them,27 cases were located in the stomach,and the remaining 4 cases were located in the intestinal tract.The clinical data,histological features and immunohistochemical expression were analyzed,and the prognosis and survival were followed up.(2)the expression of syn,Cg A,CD56,pax-5,ttf-1,SCGN and ki-67 in each subtype were detected by immunohistochemical Elivision assay in a total of 167 cases.Results:(1)A total of 103 cases of pulmonary neuroendocrine tumors were reported,including 66 males and 37 females,aged from 21 to 83 years old,with a median age of 61 years old.Tumor d>3cm in 39 patients,tumor <3cm in 64 patients.There were31 cases without lymph node metastasis and 72 cases with lymph node metastasis.There were 64 cases of gastrointestinal neuroendocrine tumors,including 50 males and 14 females,aged from 19 to 89 years old,with a median age of 60 years old.There were 7 cases of tumor with d<1cm,8 cases with 1cm<d<2cm,and 49 cases with d>2cm.There were 17 cases of distant metastasis and 47 cases of nonmetastasis.(2)Among the 103 cases of pulmonary neuroendocrine tumors,63 cases(61.2%) were syn positive.Among which the 2 cases(33.3%)of typical carcinoid were positive,3 cases(75.0%)of atypical carcinoid were positive,and 55 cases(61)of small cell lung carcinoid were positive.All three cases(100%)were positive for large cell neuroendocrine carcinoid.There were 39 cases(37.9%)positive for Cg A,including 4 cases(66.7%)positive of typical carcinoid,2 cases(50.0%)positive of atypical carcinoid,32 cases(35.6%)positive of small cell lung carcinoma,and 1 case(33.3%)positive for large cell neuroendocrine carcinoid.There were 79 cases(78.6%)with CD56 positive,including 4 cases(66.7%)positive of atypical carcinoid,1 case(25.0%)positive of atypical carcinoid,73 cases(81.1%)with positive small cell lung carcinoma,and 3 cases(100.0%)with positive large cell neuroendocrine carcinoid.TTF-1 was positive in 69 cases(67.0%),including 2 cases(33.3%)of typical carcinoid,1 case(25.0%)of atypical carcinoid,64 cases(71.1%)of small cell lung carcinoma,and 2 cases(66.7%)of large cell neuroendocrine carcinoid.The positive cases of pax-5 was 54(52.4%),1(16.7%),1(25.0%),51(56.7%)and 1(33.3%),respectively.There were 89 cases(86.4%)positive for SCGN,6 cases(100.0%)positive for typical carcinoid,4 cases(100.0%)positive for atypical carcinoid,77 cases(85.6%)positive for small cell lung carcinoma,and 2 cases(66.6%)positive for large cell neuroendocrine carcinoid.among the 64 cases of gastrointestinal neuroendocrine tumors,61(95.3%)were Syn positive,34(53.1%)were Cg A positive,58(71.9%)were CD56 positive,16(25.0%)were TTF-1 positive,18(28.1%)were Pax-5 positive,and 59(92.2%)were SCGN positive.(4)among the31 cases of mixed adenoneuroendocrine carcinoma,27 cases occurred in the stomach and the other 4 cases occurred in the intestinal tract,including 18 males and 13 females.The proportion of neuroendocrine under microscope was greater than that of adenocarcinoma in 21 cases.(5)follow-up: among the 103 patients with pulmonary neuroendocrine tumor,78 patients died,with a mortality rate as high as 75.7%,except for two patients who lost follow-up.Of the 90 patients with small cell lung cancer,74 died,with a mortality rate of 82.2%.Among the 64 cases of gastrointestinal neuroendocrine tumors,except for 4 patients who were lost to follow-up,25 cases died,with a mortality rate of 39.1%,including no deaths in G1 and G2,6 deaths in G3,and 19 deaths in MANEC patients,with a mortality rate as high as 61.3%Conclusions:(1)This study suggests that SCGN can be used in combination with traditional neuroendocrine tumor markers to help determine neuroendocrine tumors.(2)This study suggests that the combined application of SCGN,CD56 and ttf-1 may improve the detection rate of small cell lung cancer.(3)This study suggests that ttf-1 and pax-5 may be highly expressed in high-grade gastrointestinal neuroendocrine tumors.(4)Mixed adenoneuroendocrine carcinoma is prone to occur in the stomach and metastasis to the liver.(5)Survival time of MANEC patients with high ki-67 proliferation index and significant neuroendocrine carcinoma than those MANEC with low proliferation index and low proportion of neuroendocrine carcinoma.(6)In mixed adenocarcinoma,the survival time of MANEC with poorly differentiated adenocarcinoma components was significantly longer than that of MANEC with highly differentiated adenocarcinoma.