肺神经内分泌肿瘤..docx

肺神经内分泌肿瘤
Pulmonary neuroendocrine tumc
复旦大学附属肿瘤医院内科
王惠杰
Incidence of Neuroendocrine Tumors
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Preinvasive lesions
Diffuse Idiopathic puImonary neuroendocrine cell hyperplasia (tXPNEC
Carcinoid tumor
Typical carcinoid (TC)
Atypical carcinoid (AC)
Small cell carcinoma
Combined small cell carcinoma
■ Large cell neuroendocrine carcinoma(LCNEC]
■・ Combined LCNEC
女性，50-70岁
可无症状

影像表现：磨玻璃影，双肺多发结节，细/支气管 增厚，闭塞性细支气管炎
可发展为TC/AC
皮质激素、a-，化疗
b・
a.
100 cases reviewed
Female 89%

诊断前症状持续3・30年
63%存在通气性障碍
55例随访，66%病情稳定，27%缓慢进展,
仆％非疾病相关死亡
SSA6例，SD
TC
AC
LNEC
SCL
NET Grade
Well G1
Well G2
Poor G3
Poor G3
Mitosis；10HP
<2
2-10
often 210
DO often 25(
KI-67%
<3%
3-20%
>20%
>20%
Clinical
Young/male or female/non-smoker
Young/male or female/non-smoker
Older/male/smoker
Older/nu
Lung location
Central
Peripheral
Midzone or perip heral
Central
Rate of regional metastasis
5-15%
25%
40%
90%
Small Cell Lung Cell
・ a forgotten disease In targeted cr
病理分类
WHO/IASLC肺上皮性肿瘤组织学分类
(Small cell carcinoma)
变异(Vaiimit)
1・3・2・(Combined small cell carcinoma)
SCLC混合任甸一种HSCLC成分,常見包括腺癌、11^癌和大细胞癌( LCNEC),较少见的梭形、巨细胞癌等
Ng
變
临床特点
■男性约占80%
■典型表现：肺门部原发肿瘤纵隔LN形成的大肿 块、远处转移
■中央型占80%
■空洞少见
■胸腔积液发生率与其他类型相近
■伴瘤综合征
0
4沃
3
A
受累器官组织
诊断％
尸检％
纵隔淋巴结
66-80
73-87
肝
21-27
69
骨
27-41
54
肾上»
5-31
35-65
骨《
15-30
NA
脑
10-14
28-50
腹膜后淋巴结
3-12
29-52
锁骨上淋巴结
17
42
胸腔枳液
16-20
30
对侧肺
1^12
8-27
软组织
5
19
SCLC-Stagi ng
History and physical examination
Routine hematologic and serum chemistry tests, LD
Chest + (upper) abdomen CT scan
Bone scan
CT with contrast or MRI of the brain
PET : i invasive procedures/better definition of irradiation field, possible future role for better pt staging
VALG： SCLC-Stagi