2 772例肠肿瘤临床病理特征分析
| 作者: |
1王海艳,
1许春伟,
1吴永芳,
1邵云,
1邰艳红,
1李晓兵,
2徐建明,
3吴世凯,
4李虎城,
4尉承泽
1 军事医学科学院附属医院病理科，北京 100071 2 军事医学科学院附属医院消化道肿瘤科，北京 100071 3 军事医学科学院附属医院放疗科，北京 100071 4 军事医学科学院附属医院普外科，北京 100071 |
| 通讯: |
邵云
Email: shysep@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.08.020 |
摘要
目的：按照WHO第四版(2010年)消化系统肿瘤中肠肿瘤分类标准，探讨分析军事医学科学院附属医院肠肿瘤的临床病理类型及其分布特点。方法：收集2010年11月至2015年3月军事医学科学院附属医院诊治的2 772例肠肿瘤，并复习其临床资料、HE及免疫组织化学切片，按WHO第四版分类标准进行病理诊断及分类。结果：2 772例肠肿瘤中，小肠病例201例(7.25%)，其中良性上皮源性肿瘤/病变(腺瘤和息肉)58例(2.09%)，癌前病变30例(1.08%)，腺癌52例(1.88%)，神经内分泌肿瘤8例(0.29%)，间叶性肿瘤37例(1.33%)，淋巴造血系统肿瘤4例(0.14%)，转移瘤12例(0.43%)，男女总体发病率接近1∶1；结直肠病例2 571例(92.75%)，其中良性上皮源性肿瘤/病变(腺瘤和息肉)1 353例(48.81%)，癌前病变146例(5.27%)，肠癌1 001例(36.11%)，神经内分泌肿瘤27例(0.97%)，混合性腺神经内分泌癌2例(0.07%)，间叶性肿瘤15例(0.54%)，淋巴瘤6例(0.22%)，转移瘤17例(0.61%)，异位起源性肿瘤4例(0.14%)，男女总体发病率接近3∶2。结直肠癌分子亚型分类KRAS基因突变率34.62%(126/364)，BRAF基因突变率2.20%(8/364)和NRAS基因突变率3.96%(4/101)。结论：肠道肿瘤种类繁多，小肠恶性肿瘤中以间质瘤及腺癌发病率占明显优势，结直肠恶性肿瘤中以管状腺癌占较高比例。结直肠癌患者中KRAS基因存在较高的突变率，尤其为G12D、G12V和G13D，KRAS、BRAF和NRAS基因检测能指导利妥昔单抗或帕尼单抗的靶向治疗。
关键词：
管状腺癌
间质瘤
神经内分泌肿瘤
2 772 cases of clinicopathological characteristics analysis of intestine neoplasm
CorrespondingAuthor: SHAO Yun Email: shysep@163.com
DOI: 10.3978/j.issn.2095-6959.2016.08.020
Abstract
Objective: To analyze clinicopathological features and observe the pathological types and distribution among intestine neoplasms of digestive system tumors in Affiliated Hospital of Academy of Military Medical Sciences, according to the World Health Organization criteria (2010). Methods: Retrospective analysed 2 772 cases of intestine neoplasms, which was diagnosed in Affiliated Hospital of Academy of Military Medical Science from November 2010 to March 2015. All the histopathological slides including HE slides and immunohistochemistry slides were re-examined and the medical records were reviewed. Results: Among the 2 772 cases, there were 201 cases of the small intestine neoplasms (7.25%), which include 58 benign tumors deriving epithelium (adenomas and polyps) (2.09%), 30 precancerous lesions (1.08%), 52 adenocarcinomas of the small intestine (1.88%), 8 neuroendocrine tumors (0.29%), 37 mesenchymal tumors (1.33%), 4 cases were lymphomas (0.14%) and 12 secondary tumors (0.43%). There was no obviously difference of incidence between males and females. There were 2 571 cases of colon and rectum lesions (92.75%), including 1 353 benign tumors deriving epithelium (adenomas and polyps) (48.81%), 146 precancerous lesions (5.27%), 1 001 carcinomas of the colon and rectum (36.11%), 27 neuroendocrine tumors (0.97%), 2 mixed adenoneuroendocrine cancers (0.07%), 15 mesenchymal tumors (0.54%), 6 lymphomas (0.22%), 17 secondary tumors (0.61%) and 4 tumours of ectopic origin (0.14%), the ratio between males and females were 3:2. KRAS gene mutation rate was 34.62% (126/364), BRAF gene mutation rate was 2.20% (8/364) and NRAS gene mutation rate was 3.96% (4/101). Conclusion: There were many kinds of tumors in intestine, most of the malignant small intestines were interstitial tumors and adenocarcinomas, and most of the malignant colon and rectum were tubular adenocarcinomas. The mutation rate of KRAS gene is high in colorectal cancer and these mutations predominantly occur in G12D, G12V and G13D. KRAS, BRAF and NRAS mutation can guide the rituximab or panitumumab target for therapy.