Sarsfield P, Anthony P P
Area Department of Pathology, Royal Devon & Exeter Hospital, University of Exeter, UK.
Histopathology. 1990 Apr;16(4):357-63. doi: 10.1111/j.1365-2559.1990.tb01139.x.
Three patients are described who presented with a large colonic adenoma in which a solid, undifferentiated carcinomatous component was found on microscopic examination. Despite small size (1.0 and 1.5 cm) and submucosal location in two cases, the tumours had metastasized to regional lymph nodes and the liver and death ensued at 4, 11 and 18 weeks after surgery. Immunocytochemistry was positive for carcino-embryonic antigen, low molecular weight cytokeratins and neuron specific enolase in all three cases and scanty dense core granules of neurosecretory type were found in one of two examined by electron microscopy. These 'neuroendocrine' carcinomas are compared with 'pure' adenomas and 'ordinary' poorly differentiated adenocarcinomas of the colon from which they differ, mainly by lack of glandular differentiation and mucus secretion, although two adenocarcinomas also showed patchy reactivity for neuron specific enolase. The term 'neuroendocrine' may be disputed but is now well established to describe a tumour that runs a uniquely aggressive course and for which radical surgery alone cannot provide a cure.
本文描述了3例患者，他们均患有大的结肠腺瘤，显微镜检查发现其中存在实性、未分化的癌性成分。尽管其中2例肿瘤体积较小（分别为1.0 cm和1.5 cm）且位于黏膜下层，但肿瘤已转移至区域淋巴结和肝脏，术后4周、11周和18周死亡。所有3例免疫细胞化学检测癌胚抗原、低分子量细胞角蛋白和神经元特异性烯醇化酶均呈阳性，在接受电子显微镜检查的2例中的1例发现了少量神经分泌型致密核心颗粒。这些“神经内分泌”癌与“纯”腺瘤以及结肠“普通”低分化腺癌进行了比较，它们的主要区别在于缺乏腺管分化和黏液分泌，尽管有2例腺癌对神经元特异性烯醇化酶也呈散在反应。“神经内分泌”这个术语可能存在争议，但现在已被广泛用于描述一种病程独特且侵袭性强、仅靠根治性手术无法治愈的肿瘤。
