【摘要】 胃神经内分泌瘤(gastric neuroendocrine tumor,g-NET)是一类起源于神经内分泌细胞的胃部肿瘤，其中梭形细胞g-NET是其罕见的亚型。2021年11月至2022年5月，西安市中医医院及西安交通大学第一附属医院收治了2例原发性梭形细胞g-NET病例，男女各1例，病变均位于胃体，无特异性临床表现。镜下可见肿瘤均呈浸润性生长，片状排列，不显示典型神经内分泌肿瘤(neuroendocrine neoplasm,NEN)的“器官样”结构；肿瘤细胞形态较一致，呈肥胖梭形，细胞质透亮可见细胞质内空泡，细胞核具有NEN特点。2例肿瘤均阳性表达嗜铬粒蛋白A(chromogranin A,CgA)、突触素(synaptophysin,Syn)等神经内分泌标志物，生长抑素受体2(somatostatin receptor 2,SSTR2)呈弥漫强阳性，Ki-67增殖指数分别为3%和1%,CD117、Dog-1、S100、平滑肌肌动蛋白(smooth muscle actin,SMA)、结蛋白(desmin)、CD34均阴性。2例患者随访时长分别为31个月、29个月，病情均稳定。梭形细胞g-NET极易误诊为间叶源性肿瘤，但其细胞形态较一致，呈肥胖梭形，联合细胞质内空泡具有一定诊断提示意义，结合典型NEN细胞核特征及免疫组织化学标志物检测结果可明确诊断。更多还原

【Abstract】 Gastric neuroendocrine tumor(g-NET) is a group of tumors arising from neuroendocrine cells of the stomach, among which spindle cell g-NET represents a rare subtype. Two cases of primary spindle cell g-NET were treated at the Xi’an Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Xi’an Jiaotong University from November 2021 to May 2022, one was male and the other female. Both lesions were located in the gastric body and presented with no specific clinical manifestations. Microscopically, both tumors exhibited infiltrative growth with sheet-like arrangement and lacked the typical “organoid” architecture of neuroendocrine neoplasms(NENs). The tumor cells were relatively uniform and appeared as plump spindle-shaped cells with clear cytoplasm and occasional intracytoplasmic vacuoles. The nuclei displayed characteristic features of NENs. Immunohistochemically, both tumors showed positive expression of neuroendocrine markers, including chromogranin A(CgA) and synaptophysin(Syn). Somatostatin receptor 2(SSTR2) showed diffuse strong positivity. The Ki-67 proliferation indices were 3% and 1%, respectively. Markers including CD117, Dog-1, S100, smooth muscle actin(SMA), desmin, and CD34 were all negative. The follow-up durations were 31 months and 29 months, respectively, and both patients remained clinically stable. Spindle cell g-NET is easily misdiagnosed as a mesenchymal tumor; however, its relatively uniform plump spindle cell morphology, together with intracytoplasmic vacuoles, may provide important diagnostic clues. Combined with the characteristic nuclear features of NENs and immunohistochemical findings, a definitive diagnosis can be achieved.更多还原