Reumkens Ankie, Sastrowijoto Prapto, Grabsch Heike I, Goudkade Danny, le Clercq Chantal, Bakker Minke, Keulen Eric, de Ridder Rogier, de Herder Wouter W, Winkens Bjorn, Sanduleanu Silvia, de Vos-Geelen Judith, Masclee Ad
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
NUTRIM, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
Endosc Int Open. 2022 Jul 15;10(7):E940-E951. doi: 10.1055/a-1793-9057. eCollection 2022 Jul.
Neuroendocrine neoplasms (NEN) account for a small number of colorectal neoplasms. Endoscopic detection is essential for diagnosis, treatment and follow-up. Little is known about incidence of NENs in colonoscopy populations or the relationship between clinical, endoscopic and histopathologic features. We evaluated epidemiology, endoscopic and clinical characteristics of colorectal NENs in a population-based cohort. Medical records of NEN cases were cross-linked with the national pathology database from January 2001 to December 2015, in South Limburg County, the Netherlands, covering four endoscopy units. Senior pathologists reviewed and classified NENs using World Health Organization 5th edition (2019) guidelines. The number of colorectal NEN diagnoses was stable over time with 0.6 NEN per 1,000 patients. A total of NENs were detected in 85 patients: 65 neuroendocrine tumors (NETs) and 20 poorly differentiated neuroendocrine carcinomas (NECs). Rectal NETs were usually small sessile/submucosal lesions with yellowish (lipoma-like) color. Colonic NETs were larger sessile/submucosal lesions with darker color compared to background. Colorectal NECs presented as large, dark-colored lesions with ulcerated/necrotizing areas. Our population-based data point to a stable and low incidence of 0.6 NEN per 1,000 patients in the Netherlands. Rectal NETs mainly present as small sessile yellowish lesions. Colonic NETs present as larger and darker lesions than background mucosa and NECs as darker lesions than background with ulceration/necrosis. Standardized endoscopic characterization of colorectal NENs is necessary to improve recognition of these lesions and provide a basis for evidence-based treatment and surveillance recommendations.
神经内分泌肿瘤（NEN）在结直肠肿瘤中占比很小。内镜检测对于诊断、治疗及随访至关重要。关于结肠镜检查人群中NEN的发病率或临床、内镜及组织病理学特征之间的关系，我们知之甚少。我们在一个基于人群的队列中评估了结直肠NEN的流行病学、内镜及临床特征。2001年1月至2015年12月期间，荷兰南林堡县四个内镜检查单位的NEN病例医疗记录与国家病理数据库进行了交叉比对。资深病理学家根据世界卫生组织第5版（2019年）指南对NEN进行了审查和分类。结直肠NEN的诊断数量随时间保持稳定，每1000名患者中有0.6例NEN。共在85例患者中检测到NEN：65例神经内分泌瘤（NET）和20例低分化神经内分泌癌（NEC）。直肠NET通常为小的无蒂/黏膜下病变，呈淡黄色（脂肪瘤样）。结肠NET为较大的无蒂/黏膜下病变，与周围组织相比颜色更深。结直肠NEC表现为大的深色病变，伴有溃疡/坏死区域。我们基于人群的数据表明，在荷兰，NEN的发病率稳定且较低，每1000名患者中有0.6例。直肠NET主要表现为小的无蒂淡黄色病变。结肠NET表现为比周围黏膜更大、颜色更深的病变，而NEC表现为比周围组织颜色更深且伴有溃疡/坏死的病变。对结直肠NEN进行标准化的内镜特征描述对于提高对这些病变的识别以及为循证治疗和监测建议提供依据是必要的。
