Kim Sang Hyung, Yang Dong-Hoon, Lee Jung Su, Park Soyoung, Lee Ho-Su, Lee Hyojeong, Park Sang Hyoung, Kim Kyung-Jo, Ye Byong Duk, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Kim Jin-Ho, Kim Chan Wook, Kim Jihun
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Intest Res. 2015 Apr;13(2):175-9. doi: 10.5217/ir.2015.13.2.175. Epub 2015 Apr 27.
Lymph node metastasis is rare in small (i.e., <10 mm) rectal neuroendocrine tumors (NETs). In addition to tumor size, pathological features such as the mitotic or Ki-67 proliferation index are associated with lymph node metastasis in rectal NETs. We recently treated a patient who underwent endoscopic treatment of a small, grade 1 rectal NET that recurred in the form of perirectal lymph node metastasis 7 years later. A 7-mm-sized perirectal lymph node was noted at the time of the initial endoscopic treatment. The same lymph node was found to be slightly enlarged on follow-up and finally confirmed as a metastatic NET. Therefore, the perirectal lymph node metastasis might have been present at the time of the initial diagnosis. However, the growth rate of the lymph node was extremely low, and it took 7 years to increase in size from 7 to 10 mm. NETs with low Ki-67 proliferation index and without mitotic activity may grow extremely slowly even if they are metastatic.
在小的（即<10毫米）直肠神经内分泌肿瘤（NETs）中，淋巴结转移很少见。除肿瘤大小外，有丝分裂或Ki-67增殖指数等病理特征与直肠NETs的淋巴结转移有关。我们最近治疗了一名患者，该患者接受了内镜下治疗的小的1级直肠NET，7年后以直肠周围淋巴结转移的形式复发。初次内镜治疗时发现一个7毫米大小的直肠周围淋巴结。随访时发现同一个淋巴结略有增大，最终确诊为转移性NET。因此，直肠周围淋巴结转移可能在初次诊断时就已存在。然而，该淋巴结的生长速度极慢，从7毫米增大到10毫米花了7年时间。Ki-67增殖指数低且无有丝分裂活性的NETs即使发生转移，生长速度也可能极慢。
