Kamisawa T, Fukayama M, Tabata I, Isawa T, Tsuruta K, Okamoto A
Department of Medicine, Tokyo Metropolitan Komagome Hospital, Japan.
Pathol Res Pract. 1996 Sep;192(9):901-8. doi: 10.1016/S0344-0338(96)80071-9.
To evaluate the significance of neuroendocrine differentiation in duct carcinoma of the pancreas, we investigated 79 pancreatic carcinomas, applying histochemistry and immunohistochemistry (chromogranin A, Leu-7, synaptophysin and neuron-specific enolase (NSE), and correlated the morphologic differentiation pattern with clinicopathological characteristics. There were two types of neuroendocrine differentiation: scattered (n = 23) and diffuse (n = 3). The scattered type of pancreatic duct carcinoma contained scattered endocrine cells amounting to less than 10% of the neoplastic cells and was seen more frequently in well-differentiated carcinomas. There was no characteristic clinical feature found in the scattered type when compared with the tumors devoid of endocrine cells (n = 53). In contrast, the diffuse type showed diffuse immunostaining with NSE and synaptophysin in tumor cells and dense core granules ultrastructurally. These tumors showed a greater hypervascularity in angiography (p < 0.01) and the patients had relatively longer survival (33.3 months, p < 0.05) than unresectable cases of other histological types of pancreatic cancer. Two types of neuroendocrine differentiation (scattered and diffuse) existed in pancreatic ductal carcinoma. The diffuse type (Duct-Endocrine Cell Carcinoma of the Pancreas) showed synchronous duct and endocrine differentiation and particular clinical features.
为评估神经内分泌分化在胰腺导管癌中的意义，我们应用组织化学和免疫组织化学方法（嗜铬粒蛋白A、Leu-7、突触素和神经元特异性烯醇化酶（NSE））对79例胰腺癌进行了研究，并将形态学分化模式与临床病理特征相关联。存在两种类型的神经内分泌分化：散在型（n = 23）和弥漫型（n = 3）。散在型胰腺导管癌含有散在的内分泌细胞，其数量少于肿瘤细胞的10%，在高分化癌中更常见。与无内分泌细胞的肿瘤（n = 53）相比，散在型未发现特征性临床特征。相反，弥漫型肿瘤细胞中NSE和突触素呈弥漫性免疫染色，超微结构可见致密核心颗粒。这些肿瘤在血管造影中显示出更大的血管密度（p < 0.01），并且与其他组织学类型的不可切除胰腺癌患者相比，生存期相对较长（33.3个月，p < 0.05）。胰腺导管癌中存在两种神经内分泌分化类型（散在型和弥漫型）。弥漫型（胰腺导管-内分泌细胞癌）表现为导管和内分泌的同步分化及特殊的临床特征。
