The Clinical Analysis Of Neuroendocrine Neoplasms In Upper Digestive Tract

BackgroundsGastrointestinal neuroendocrine neoplasms(GI-NENs) constitute a heterogeneous group of tumors, with specific clinical progression and ways to diagnosis and treatment. They were thought to be rare,but the incidence has significantly increased over the last few years,including NENs in upper gastrointestinal tract.Materials and MethodsCases are patients who were diagnosed as upper GI-NENs by pathology between March2009and December2013in the first affiliated hospital of Zhejiang University.A follow-up study was made to analyze the clinicopathologic characteristics,diagnosis and treatment of this disease.Results1. In this study,57cases were diagnosed as upper GI-NENs,19.30%in esophagus,54.39%in stomach,26.32%in duodenum and1both in stomach and duodenum.47are males(82.5%) and10are females(17.5%). Most patients are60-70years old, the median age is58.56±12.025, ranging from26to86. The average age of men is larger than women.2. The average size is(2.95±2.12)*(2.19±1.60)cm, ranging from10*8cm to0.3*0.3cm. NENs in duodenum are smaller than those in esophagus and stomach. Gl、G2、G3and M account35.1%、10.5%、45.6%and8.8%respectively. NENs in esophagus have high grades. NENs in duodenum have low gredes. Tumors with higher grades have larger sizes. And tumors in older patients have higher grades.48.9%cases have lymph metastasis, while less have distant invasion, which are with higher grades.3. Most patients have no specific clinical manifestations. Radiological examination can provide some information. Gastroendoscopy has high detection rate of neoplasms in upper GI, but only30.8%have confirmed diagnosis of NEN simply by biopsy, unless with immunohistochemistry. It is worth mentioning that CgA and Syn show high value in immunohistochemistry. EUS can tell us the origin of tumors, which were almost consistent with the pathological results.88.9%cases show hypoechoic lesion.4.59.6%patients were given surgical treatment, while just1had severe complication.7patients with NEN in stomach and5with NEN in duodenum were given endoscopic therapy. The complete resection rate of endoscopic therapy is83.3%. The operation of1duodenum NEN cannot be finished, thus changing to surgery. Other endoscopic therapy cases were all treated successfully with no bleeding and perforation during and after treatment.Conclusions1. NENs in upper GI are getting more and more common currently. Men have higher risks than women, especially for age in sixties. This kind of tumors in older patients has higher grades. NENs in esophagus are more malignant. NENs in duodenum have low gredes, and are often small. 2. Gastroendoscopy and EUS have high diagnostic value, and can help make treatment choices. Immunohistochemistry is important in pathological diagnosis. CgA and Syn are useful in diagnosing NENs.3. For small upper-GI NENs without regional and distant metastasis, endoscopic therapy is considered an effective and safe option.