Burke A P, Federspiel B H, Sobin L H, Shekitka K M, Helwig E B
Department of Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000.
Am J Surg Pathol. 1989 Oct;13(10):828-37. doi: 10.1097/00000478-198910000-00002.
The light-microscopic and immunohistochemical characteristics of 65 duodenal carcinoids are presented. Most tumors showed a mixture of cribriform, insular, glandular, solid, and trabecular growth patterns. Eighty-five percent of the tumors were argyrophil and 15% argentaffin. The nonspecific neuroendocrine markers chromogranin, Leu-7, and neuron-specific enolase were positive in 97, 91, and 83% of tumors, respectively. Immunoreactivity for specific hormones/amines were as follows (percent positive tumors): somatostatin, 47%; N-gastrin, 56%; serotonin, 39%; calcitonin, 19%; insulin, 5%; pancreatic polypeptide, 3%; adrenal corticotropic hormone, 0%; glucagon, 0%. Sixty-eight percent had gastrin/cholecystokinin-like reactivity. Ten psammomatous tumors were located near the ampulla; eight were somatostatin positive, including two in patients with neurofibromatosis. One additional tumor in a patient with neurofibromatosis lacked psammoma bodies but elaborated somatostatin. Eight additional tumors in nonneurofibromatosis patients produced solely somatostatin. Duodenal carcinoids often elaborate more than one polypeptide hormone; those in the ampulla often elaborate somatostatin and have psammoma bodies.
本文介绍了65例十二指肠类癌的光镜和免疫组化特征。大多数肿瘤呈现筛状、岛状、腺管状、实性和小梁状生长模式的混合。85%的肿瘤嗜银，15%亲银。非特异性神经内分泌标志物嗜铬粒蛋白、Leu-7和神经元特异性烯醇化酶分别在97%、91%和83%的肿瘤中呈阳性。特定激素/胺的免疫反应性如下（阳性肿瘤百分比）：生长抑素，47%；N-胃泌素，56%；5-羟色胺，39%；降钙素，19%；胰岛素，5%；胰多肽，3%；促肾上腺皮质激素，0%；胰高血糖素，0%。68%具有胃泌素/胆囊收缩素样反应性。10例砂粒体性肿瘤位于壶腹附近；8例生长抑素阳性，其中2例患者患有神经纤维瘤病。1例患有神经纤维瘤病的患者的另一肿瘤缺乏砂粒体，但分泌生长抑素。非神经纤维瘤病患者的另外8例肿瘤仅分泌生长抑素。十二指肠类癌常分泌不止一种多肽激素；壶腹部的类癌常分泌生长抑素并具有砂粒体。
