Department of Surgical Pathology, Uludag University Medical Faculty, Bursa, Turkey.
Department of General Surgery, Uludag University Medical Faculty, Bursa, Turkey.
Tumori. 2021 Feb;107(1):80-85. doi: 10.1177/0300891620941921. Epub 2020 Jul 24.
Pancreatic neuroendocrine neoplasms (NENs) are tumors with histopathologic and prognostic heterogeneity that pose difficulties in establishing standards for diagnosis, classification, and treatment. Among NENs, well-differentiated neuroendocrine tumors (NETs) have been classified as grade 1, 2, and 3 in the most recently released World Health Organization classification. Although well-differentiated NETs are associated with relatively better prognosis, they have a potential for malignant behavior such as extrapancreatic spread, metastasis, or recurrence. The present study aimed to evaluate clinical and histomorphologic findings of patients with well-differentiated pancreatic NETs and to identify histopathologic findings effective in predicting nodal metastatic progression.
The study group consisted of 54 patients diagnosed with well-differentiated NET. All preparations and blocks of the patients were examined for the following histopathologic parameters: tumor diameter, microscopic tumor growth pattern (solid, trabecular, acinar, and mixed), cellular features (clear, eosinophilic, oncocytic, peliotic, and pseudopapillary), stromal changes (calcification, lymphocytic infiltration, and stromal hyalinization), presence of necrosis, perineural invasion, lymphovascular invasion, mitotic activity, and Ki67 proliferative index.
Lymph node metastasis was present in 7 patients. Lymph node metastasis was significantly associated with tumor diameter of >2 cm ( = 0.012), Ki67 proliferative index of >20% ( = 0.022), grade 3 tumors ( = 0.002), presence of dense stromal hyalinization ( = 0.034), and mild lymphocytic infiltration ( = 0.041).
The present study revealed that the new findings such as presence of dense stromal hyalinization and absence of remarkable lymphocytic infiltration could be predictive morphologic findings for the development of lymph node metastasis.
胰腺神经内分泌肿瘤（NENs）是一种具有组织病理学和预后异质性的肿瘤，在建立诊断、分类和治疗标准方面存在困难。在 NENs 中，分化良好的神经内分泌肿瘤（NETs）在最近发布的世界卫生组织分类中被分为 1 级、2 级和 3 级。虽然分化良好的 NETs 预后相对较好，但它们具有恶性行为的潜力，如胰腺外扩散、转移或复发。本研究旨在评估分化良好的胰腺 NET 患者的临床和组织形态学发现，并确定有助于预测淋巴结转移进展的组织病理学发现。
研究组包括 54 例经诊断为分化良好的 NET 患者。对所有患者的标本和切片进行了以下组织病理学参数的检查：肿瘤直径、显微镜下肿瘤生长模式（实性、小梁状、腺泡状和混合性）、细胞特征（透明细胞、嗜酸性粒细胞、嗜酸细胞、Peliosis 和假乳头）、间质变化（钙化、淋巴细胞浸润和间质玻璃样变）、坏死、神经周围侵犯、血管侵犯、有丝分裂活性和 Ki67 增殖指数。
7 例患者发生淋巴结转移。淋巴结转移与肿瘤直径>2cm（=0.012）、Ki67 增殖指数>20%（=0.022）、3 级肿瘤（=0.002）、致密间质玻璃样变（=0.034）和轻度淋巴细胞浸润（=0.041）显著相关。
本研究表明，存在致密的间质玻璃样变和缺乏明显的淋巴细胞浸润等新发现可能是预测淋巴结转移发生的形态学发现。
