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同步性肝神经内分泌癌和直肠腺癌伴脑桥转移：诊断难题

Synchronous Hepatic Neuroendocrine Carcinoma and Rectal Adenocarcinoma With Pontine Metastasis: A Diagnostic Dilemma.

作者信息

Said Ebram, Gerais Yasmin, Boshnaf Mohamed, Mahmoud Anas, Elbenawi Hossam, Salem Ahmed, OLeary Michelle, Hamad Sammy, Hamad Bachar

机构信息

Internal Medicine, Ascension St. Joseph Hospital, Chicago, USA.

Gastroenterology, Saint Joseph Medical Center, Joliet, USA.

出版信息

Cureus. 2025 Jun 15;17(6):e86100. doi: 10.7759/cureus.86100. eCollection 2025 Jun.

DOI:10.7759/cureus.86100
PMID:40671972
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12264442/
Abstract

We present a complex case of a 53-year-old male with stage IV large-cell neuroendocrine carcinoma (NEC) of unconfirmed primary origin, manifesting with a pontine brain mass, multiple hepatic lesions, lymphadenopathy, and a synchronous rectal adenocarcinoma. Imaging and pathology revealed distinct morphologic and immunohistochemical profiles: hepatic biopsy confirmed large-cell NEC positive for synaptophysin and CD56, whereas rectal biopsy showed adenocarcinoma with intestinal markers and no neuroendocrine differentiation. Differential diagnoses included two independent primary malignancies, mixed adenoneuroendocrine carcinoma (MANEC), or colorectal adenocarcinoma with neuroendocrine differentiation in the liver. Although molecular profiling or clonal comparison was considered to clarify the primary origin, it was not performed due to clinical constraints. This report underscores the diagnostic challenges in distinguishing synchronous multiple primaries from metastatic or mixed tumors, with significant implications for staging and treatment.

摘要

我们报告了一例复杂病例，患者为53岁男性，患有原发灶不明的IV期大细胞神经内分泌癌（NEC），表现为桥脑脑肿块、多发肝损害、淋巴结病以及同步发生的直肠腺癌。影像学和病理学检查显示出不同的形态学和免疫组化特征：肝活检证实为大细胞NEC，突触素和CD56呈阳性，而直肠活检显示为具有肠道标志物的腺癌，无神经内分泌分化。鉴别诊断包括两种独立的原发性恶性肿瘤、混合性腺神经内分泌癌（MANEC）或伴有肝脏神经内分泌分化的结直肠癌。尽管考虑进行分子谱分析或克隆比较以明确原发灶，但由于临床限制未实施。本报告强调了区分同步性多发原发性肿瘤与转移性或混合性肿瘤时的诊断挑战，这对分期和治疗具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/de6fff24911b/cureus-0017-00000086100-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/764987da0bfe/cureus-0017-00000086100-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/b03a60de6899/cureus-0017-00000086100-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/063c6269c690/cureus-0017-00000086100-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/d3c57e5e4ccd/cureus-0017-00000086100-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/de6fff24911b/cureus-0017-00000086100-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/764987da0bfe/cureus-0017-00000086100-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/b03a60de6899/cureus-0017-00000086100-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/063c6269c690/cureus-0017-00000086100-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/d3c57e5e4ccd/cureus-0017-00000086100-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3bf0/12264442/de6fff24911b/cureus-0017-00000086100-i05.jpg

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