Haruna Kengo, Hata Taishi, Kawai Kenji, Kitahara Tomohiro, Hiraki Masayuki, Shinke Go, Katsuyama Shinsuke, Katsura Yoshiteru, Omura Yoshiaki, Masuzawa Toru, Takeno Atsushi, Takeda Yutaka, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2021 Dec;48(13):1996-1998.
We report the case of a patient who underwent additional surgical resection of a rectal neuroendocrine tumor(NET)G1 with a tumor diameter of 5 mm after endoscopic resection, and lymph node metastasis was observed. The patient was a 33- year-old woman. A lower gastrointestinal endoscopy was performed to examine the blood in the stool. A submucosal tumor of 5 mm in size was found in the rectum Ra, and endoscopic mucosal resection was performed. Pathological examination of the resected tissue revealed NET G1; HE staining revealed negative margins and no vascular invasion, but additional immunostaining revealed lymphatic invasion(Ly1a). Additional surgical resection was decided, and a laparoscopy-assisted low anterior resection D3 were performed. The surgical resection specimen showed no residual NET component in the rectum, but metastasis was found in one lymph node. The postoperative course of the patient has been uneventful, and the patient is currently undergoing without recurrence 6 months after the surgery. In the case of NET G1, it is important to search for detailed vascular invasion by immunostaining even in small lesions, and if vascular invasion is found, additional surgical resection should be considered.
我们报告了一例患者，该患者在内镜切除术后对直径5mm的直肠神经内分泌肿瘤（NET）G1进行了额外的手术切除，且观察到有淋巴结转移。患者为一名33岁女性。因便血行下消化道内镜检查。在直肠Ra发现一个大小为5mm的黏膜下肿瘤，并进行了内镜黏膜切除术。切除组织的病理检查显示为NET G1；苏木精-伊红（HE）染色显示切缘阴性且无血管侵犯，但进一步免疫染色显示有淋巴侵犯（Ly1a）。决定进行额外的手术切除，并实施了腹腔镜辅助下D3根治性低位前切除术。手术切除标本显示直肠内无残留的NET成分，但在一个淋巴结中发现了转移。患者术后恢复顺利，目前术后6个月无复发。对于NET G1病例，即使在小病变中也通过免疫染色仔细寻找血管侵犯很重要，如果发现血管侵犯，应考虑额外的手术切除。
