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Gastric Carcinoid Tumors: Distinction Among Types, and Why Evaluation of the Background Gastric Mucosa Really Matters

机译:胃类癌肿瘤:类型之间的区别,以及为什么对背景胃粘膜的评估确实很重要

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摘要

The incidence of endocrine tumors of the stomach is increasing. Most gastric endocrine tumors are well-differentiated neoplasms of enterochromaffin-like cells, the major endocrine cell type of the gastric body and fundus. These gastric carcinoids (GCs) show relatively uniform cells with a low (<2/10 high-power fields) mitotic rate and no necrosis. Poorly-differentiated neuroendocrine carcinomas (large and small cell) are much less common and are characterized by high (>10/10 high-power fields) mitotic rate, frequent necrosis, and poor prognosis as compared with both GCs and to conventional gastric adenocarcinomas. GCs are subdivided into 3 major types with different clinical associations, management, and prognosis. Type I (autoimmune gastritis-associated) are the most common; they tend to be small, lack muscularis propria invasion, have low rates of lymph node and distant metastases, and only rarely are lethal. Type II (Zollinger-Ellison syndrome-associated, especially as part of multiple endocrine type-1) are the least common; their mean size, depth of invasion, and metastatic rate are intermediate between type I and type III GCs, yet even metastatic tumors do not usually result in death. Both types I and II arise in a background of enterochromaffin-like cell hyperplasia-dysplasia due to the trophic effects of hypergastrinemia, and therefore, are frequently multifocal and confined to the gastric body and fundus. Type III (sporadic) GCs are independent of gastrin and are therefore solitary tumors that can arise throughout the stomach. They are frequently large, deeply invasive, have high rates of lymph node and liver metastases, and approximately one-fourth are lethal. A fourth type of GC may exist in patients with hypergastrinemia because of congenital or acquired defects in acid secretion from parietal cells. Separation of sporadic GCs from other types is important because the former are treated surgically with a cancer operation, whereas the latter are generally managed more conservatively.
机译:胃内分泌肿瘤的发生率正在增加。多数胃内分泌肿瘤是肠嗜铬细胞样细胞的分化良好的肿瘤,是胃体和眼底的主要内分泌细胞类型。这些胃类癌(GC)显示相对均匀的细胞,有丝分裂率低(<2/10高倍视野),且无坏死。与GC和常规胃腺癌相比,分化较差的神经内分泌癌(大细胞和小细胞)少见,其特征是有丝分裂率高(> 10/10高倍视野),频繁坏死且预后较差。 GC分为3种主要类型,具有不同的临床关联,管理和预后。 I型(自身免疫性胃炎相关)是最常见的。它们往往很小,缺乏固有肌层浸润,淋巴结转移率低且远处转移,而且很少致命。 II型(与Zollinger-Ellison综合征相关,尤其是作为1型多发性内分泌的一部分)是最不常见的;它们的平均大小,浸润深度和转移率介于I型和III型GC之间,但即使是转移性肿瘤也通常不会导致死亡。由于高胃泌素血症的营养作用,I型和II型都出现在肠嗜铬细胞样细胞增生-增生的背景下,因此通常多灶并局限于胃体和眼底。 III型(散发)GC独立于胃泌素,因此是可能在整个胃部出现的孤立性肿瘤。它们通常很大,具有很强的侵袭性,具有很高的淋巴结转移和肝转移,大约四分之一是致命的。高胃泌素血症患者可能存在第四种类型的GC,因为先天性或后天性壁细胞酸分泌缺陷。将散发性GC与其他类型的GC分开很重要,因为前者通过外科手术进行癌症手术治疗,而后者通常采用更为保守的方式进行管理。

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