Tanaka Hiroki, Matsusaki Shimpei, Baba Youichirou, Isono Yoshiaki, Kumazawa Hiroaki, Sase Tomohiro, Okano Hiroshi, Saito Tomonori, Mukai Katsumi, Kaneko Hiroshi
Department of Gastroenterology, Suzuka General Hospital, Mie, Japan.
Department of Pathology, Suzuka General Hospital, Mie, Japan.
Clin J Gastroenterol. 2015 Dec;8(6):414-20. doi: 10.1007/s12328-015-0609-4. Epub 2015 Oct 6.
A 68-year-old man was referred to our hospital because of left upper quadrant pain. Contrast enhanced computed tomography showed a low density mass with delayed contrast effects as well as para-aortic node swelling with homogenous contrast effects. Histological examination of specimens obtained by endoscopic ultrasound fine needle aspiration revealed a pancreatic neuroendocrine tumor (NET) G2, according to the World Health Organization 2010 classification, and lymph node metastasis. Distal pancreatectomy and lymph node dissection were performed. On histological examination, the tumor showed well-differentiated morphology with an organoid pattern. The Ki67 labeling index was 21.6 %, and the mitotic count was 25/10 high power fields. As mentioned above, we made a final diagnosis of the lesion as "NET G3," because the tumor presented with well-differentiated morphology. Chemotherapy with Everolimus was administered. Liver metastasis occurred 11 months after the first operation, and a partial hepatectomy was performed. Histological findings were similar to those of the first operation. Herein we present a case of pancreatic well-differentiated neuroendocrine tumor with a high proliferative rate referred to as "NET G3," and review the relevant literature.
一名68岁男性因左上腹疼痛转诊至我院。增强计算机断层扫描显示一个低密度肿块，有延迟强化效应，以及主动脉旁淋巴结肿大，呈均匀强化效应。根据世界卫生组织2010年分类标准，经内镜超声细针穿刺获取的标本组织学检查显示为胰腺神经内分泌肿瘤（NET）G2，并伴有淋巴结转移。遂行胰体尾切除术及淋巴结清扫术。组织学检查显示，肿瘤呈分化良好的形态，具有类器官模式。Ki67标记指数为21.6%，有丝分裂计数为25/高倍视野。如上所述，由于肿瘤表现为分化良好的形态，我们最终将该病变诊断为“NET G3”。给予依维莫司化疗。首次手术后11个月发生肝转移，遂行部分肝切除术。组织学结果与首次手术相似。在此，我们报告一例具有高增殖率的胰腺高分化神经内分泌肿瘤，称为“NET G3”，并复习相关文献。
