肺神经内分泌肿瘤..docxVIP

I I Yao. JC. et al J Clin Oncol 2008.26:2063 3072. Yao. JC. et al J Clin Oncol 2008.26:2063 3072. 肺神经内分泌肿瘤 Pulmonary neuroendocrine turn 复旦大学附属肿瘤医院内科 王惠杰 Incidence of Neuroendocrine Tumors MO 8二Ks冬；― bTMlI IH?—? Cseum—? I 4 ?B i-igo o o oYear MO 8二Ks冬； ― bTMlI IH? —? Cseum —? I 4 ? B i-ig o o o o Year Preinvasive lesions Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNEC 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 慢性干咳、呼吸困难 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-IFN.生长抑素，化疗 100 cases reviewed Female 89% ■诊断平均年龄57.8 ■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, 廿％非疾病相关死亡 I SSA6例.SD TC AC LNEC SCL NET Grade Well G1 Well G2 Poor G3 Poor G3 Mitosis/10HP 2 2-10 10 often ^10 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/mi Lung location Central Peripheral Midzone or peripheral Central Rate of regional metastasis 5-15% 25% 40% 90% Small Cell Lung Cell ? a forgotten disease in targeted er 病理分类 WHO/IASLC肺上皮性肿瘤组织学分类 WHO/IASLC肺上皮性肿瘤组织学分类 I 1.3.2.小细胞癌(Small cell carcinoma) 变异(Variant) 13.2.1.混合性小细胞癌(Combined small cell carcinoma) ■ SCLC混合任何一种NSCLC成分,常见包括腺癌、鳞癌和大细胞癌( LCNEC),较少见的梭形、巨细胞癌等 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 诊断％ 尸检％ 纵隔淋巴结 66-80 73-87 肝 21-27 69 骨 27-41 54 肾上腺 5-31 35-65 骨制 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 胸腔积液 16-20 30 对侧肺 1-12 8-27 软组织 5 19 SCLC-Staging History and physical examination Routine hematologic and serum chemistry tests, LD Chest + (upper) abdomen CT scan Bone scan i CT with contrast or MRI of the brain i PET : X invasive procedures/better definition of irradiation field, possible future role for better pt staging VALG： SCLC-Staging ■? limited-stage disease : ContnCon?tumor confined to one hemithorax with or without homolate