胰腺实性假乳头状瘤35例临床诊疗体会
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摘要
目的探讨胰腺实性假乳头状瘤(SPT)诊断与治疗的方法及特点,以提高临床医师对胰腺SPT的诊治水平。方法回顾性分析35例胰腺SPT患者的临床资料,分析患者的实验室检查结果、肿瘤标志物水平、影像学特征、手术相关情况和病理学检查结果,观察并记录患者的术后并发症发生情况和随访情况,探讨临床对胰腺SPT的诊治特点和体会。结果肿瘤标志物检测结果显示,有8例胰腺SPT患者的血清癌胚抗原(CEA)水平升高,10例胰腺SPT患者的糖类抗原19-9(CA19-9)水平升高。计算机断层扫描(CT)检查结果显示,所有病例均为单发。35例胰腺SPT患者中,共13例胰腺SPT患者行磁共振成像(MRI)检查,其中,8例患者被诊断为胰腺SPT。35例胰腺SPT患者中,囊实性胰腺SPT患者10例,囊性胰腺SPT患者15例,实性胰腺SPT患者10例。术后出现胰瘘11例,出血1例,胸腔积液1例,切口感染2例,胃排空障碍1例,其他19例患者未出现术后并发症。以上术后并发症经对症治疗后患者均痊愈,无死亡患者。随访期间,1例患者于术后2年出现了肝转移,行肝转移灶切除术后好转;1例患者于术后6个月出现了高血糖,经相关治疗后情况稳定。结论胰腺SPT是一种罕见的低度恶性肿瘤,临床表现缺乏特异性,CT和MRI是其主要的影像学检查方法,手术是其有效的治疗手段,预后良好。在临床治疗中,需要根据患者的具体情况选择合适的手术方式和诊疗手段。
Objective To investigate the diagnosis and treatment of solid pseudopapillary tumor(SPT) of the pancreas, aiming to improve the level of diagnosis and treatment of SPT of the pancreas by clinicians. Method A retrospective analysis was performed to analyze the clinical data of 35 cases of SPT of the pancreas, of which the laboratory results, level of tumor markers, imaging findings, surgical conditions, and pathological examinations were evaluated, besides, the postoperative complications and follow-up data were recorded and analyzed to discuss the clinical experiences regarding the diagnosisof SPT of the pancreas. Result In regard to level of tumor markers, 8 cases of SPT of the pancreas had elevated carcinoembryonic antigen(CEA) level, 10 cases were with increased carbohydrate antigen 19-9(CA19-9). As to computed tomography(CT) findings, all cases were with single lesion. There were 13 cases who had magnetic resonance imaging(MRI) examination, among which, 8 cases were confirmed as SPT of the pancreas. In the 35 cases of SPT of the pancreas, 10 were with cystic and solid lesions, 15 were with cystic lesions, and there were 10 cases of solid lesions. After surgery, there were 11 cases of pancreatic fistula, 1 case of hemorrhage, 1 case of pleural effusion, 2 cases of wound infection, 1 case of gastric emptying disorder, and the remaining 19 cases did not develop any complications after surgery.All patients were cured after symptomatic treatment, and there was no death in this cohort. During follow-up, 1 case developed hepatic metastasis in 2 years after surgery, and was healed after surgical resection; another 1 case had hyperglycemia in 6 months after surgery, and was well controlled after specific treatment. Conclusion Solid pseudopapillary tumor of the pancreas is a rare tumor lacking specific clinical characteristics, which can be confirmed by CT and MRI and may be effectively treated through surgical resection, with good prognosis. In clinical treatment, specific surgical mode and diagnostic instrument should be determined based on individual conditions.
Objective To investigate the diagnosis and treatment of solid pseudopapillary tumor(SPT) of the pancreas, aiming to improve the level of diagnosis and treatment of SPT of the pancreas by clinicians. Method A retrospective analysis was performed to analyze the clinical data of 35 cases of SPT of the pancreas, of which the laboratory results, level of tumor markers, imaging findings, surgical conditions, and pathological examinations were evaluated, besides, the postoperative complications and follow-up data were recorded and analyzed to discuss the clinical experiences regarding the diagnosisof SPT of the pancreas. Result In regard to level of tumor markers, 8 cases of SPT of the pancreas had elevated carcinoembryonic antigen(CEA) level, 10 cases were with increased carbohydrate antigen 19-9(CA19-9). As to computed tomography(CT) findings, all cases were with single lesion. There were 13 cases who had magnetic resonance imaging(MRI) examination, among which, 8 cases were confirmed as SPT of the pancreas. In the 35 cases of SPT of the pancreas, 10 were with cystic and solid lesions, 15 were with cystic lesions, and there were 10 cases of solid lesions. After surgery, there were 11 cases of pancreatic fistula, 1 case of hemorrhage, 1 case of pleural effusion, 2 cases of wound infection, 1 case of gastric emptying disorder, and the remaining 19 cases did not develop any complications after surgery.All patients were cured after symptomatic treatment, and there was no death in this cohort. During follow-up, 1 case developed hepatic metastasis in 2 years after surgery, and was healed after surgical resection; another 1 case had hyperglycemia in 6 months after surgery, and was well controlled after specific treatment. Conclusion Solid pseudopapillary tumor of the pancreas is a rare tumor lacking specific clinical characteristics, which can be confirmed by CT and MRI and may be effectively treated through surgical resection, with good prognosis. In clinical treatment, specific surgical mode and diagnostic instrument should be determined based on individual conditions.
引文
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[17]宋禾,董明,周建平,等.胰腺实性假乳头状瘤临床诊治分析[J].中华普通外科杂志,2016,31(1):1-3.
[18]Guimar?es LS,de Melo AM,Ruiz MR,et al.Solid pseudopapillary tumor of the pancreatic:evaluation of clinical,radiological and surgical profiles[J].Rev Col Bras Cir,2013,40(5):398-403.
[19]Murhekar K,Ramakrishnan AS,Ramani B,et al.Solid pseudo-papillary tumor of pancreas:A rare case report and review of Indian literature[J].J Cancer Res Ther,2013,9(3):507-510.
[20]Machado MC,Machado MA,Bacchella T,et al.Solid pseudopapillary neoplasm of the pancreas:distinct patterns of onset,diagnosis,and prognosis for male versus female patients[J].Surgery,2008,143(1):29-34.
[21]Buetow PC,Buck JL,Pantongrag-Brown L,et al.Solid and papillary epithelial neoplasm of the pancreas:imagingpathologic correlation on 56 cases[J].J Radiology,1996,199:707-711.
[22]张锴,马超,丁月超,等.胰腺实性假乳头状瘤69例手术体会[J].中国现代医学杂志,2017,27(5):135-137.
[23]Guermehe Y,Soyer P,Dohan A,et al.Solid-pseudopapillary tumor of the pancreas:MR imaging findings in 21 patients[J].Clin Imaging,2014,38(4):475-482.
[24]隋燕霞,党诚学,张勇,等.原发性胰腺神经内分泌肿瘤60例临床病理分析[J].临床与实验病理学杂志,2015,31(8):873-876.
[25]杨洋,张旭,李冰.胰腺粘液性囊性肿瘤32例诊疗体会[J].大连医科大学学报,2017,39(1):62-65.
[26]Kosmahl M,Seada LS,J?nig U,et al.Solid-pseudopapillary tumor of the pancreas:its origin revisited[J].Virchows Arch,2000,436(5):473-480.
[27]Zhang H,Liang TB,Wang WL,et al.Diagnosis and treatment of solid-pseudopapillary tumor of the pancreas[J].Hepatobiliary Pancreat Dis Int,2006,5(3):454-458.
[28]Miao J,Kusafuka T,Kuroda S,et al.Mutation of betacatenin and its protein accumulation in solid and cystic tumor of the pancreas associated with metastasi[J].Int J Mol Med,2003,11(4):461-464.
[29]Abraham SC,Klimstra DS,Wilentz RE,et al.Solid-pseudopapillary tumors of the pancreas are genetically distinct from pancreatic ductal adenocarcinomas and almost always harbor beta-catenin mutations[J].Am J Pathol,2002,60(4):1361-1369.
[30]Tanaka Y,Kato K,Notohara K,et al.Frequent betacatenin mutation and cytoplasmic/nuclear accumulation in pancreatic solid-pseudopapillary neoplasm[J].Cancer Res,2001,61(23):8401-8404.
[31]Papavramidis T,Papavramidis S.Solid pseudopapillary tumors of the pancreas:review of 718 patients reported in English literature[J].J Am Coll Surg,2005,200(6):965-972.
[32]El Nakeeb A,Abdel Wahab M,Elkashef WF,et al.Solid pseudopapillary tumour of the pancreas:Incidence,prognosis and outcome of surgery(single center experience)[J].Int J Surg,2013,11(6):447-457.
[33]Peng CH,Chen DF,Zhou GW,et al.The solid-pseudopapillary tumor of pancreas:the clinical characteristics and surgical treatment[J].J Surg Res,2006,131(2):276-282.
[34]Lakhtakia R,Al-Wahaibi K,Zahid KF,et al.Solid pseudopapillary neoplasm of the pancreas:a case report with review of the diagnostic dilemmas and tumor behavior[J].Oman Med J,2013,28(6):441-444.
[35]Chang H,Gong Y,Xu J,et al.Clinical strategy for the management of solid pseudopapillary tumor of the pancreas:aggressive or less?[J].Int J Med Sci,2010,7(5):309-313.
[2]Balaratnasingam C,Samnakay N,Hamdorf JM.Solid-pseudopapillary neoplasm of pancreas[J].ANZ J Surg,2004,74(10):914-915.
[3]Punch C,Garg N,Harris P.Recurrence of solid pseudopapillary tumor:a rare pancreatic tumor[J].Case Rep Oncol Med,2016:7523742.
[4]Patil TB,Shrikhande SV,Kanhere HA,et al.Solid pseudopapillary neoplasm of the pancreas:a single institution experience of 14 cases[J].HPB(Oxford),2006,8(2):148-150.
[5]Guo N,Zhou QB,Chen RF,et al.Diagnosis and surgical treatment of solid pseudopapillary neoplasm of the pancreas:analysis of 24 cases[J].Can J Surg,2011,54(6):368-374.
[6]Ozguven BY,Tuncel D,Polat N,et al.Solid-pseudopapillary neoplasm of the pancreas:clinicopathologic and immunohistochemical analysis of nine cases[J].Indian J Pathol Microbiol,2015,58(3):292-295.
[7]Hongjian X,Dujuan L,Shuang X,et al.Solid pseudopapillary tumor of the pancreas in a 50-year-old man:a case report and review of the literature[J].Case Rep Pancreat Cancer,2016,2(1):23-27.
[8]Bassi C,Dervenis C,Butturini G,et al.Postoperative pancreatic fistula an international study group(ISGPF)definition[J].Surgery,2005,138(1):8-13.
[9]Wente MN,Velt JA,Bassi C,et al.Postpancreatcctomy hemorrhage(PPH):International Study Group of Pancreatic Surgery(ISGPS)definition[J].Surgery,2007,142(1):20-25.
[10]曹结,张太平,赵玉沛.胰腺实性假乳头状瘤的诊断与治疗[J].中华外科杂志,2016,54(7):550-552.
[11]Hanahan D,Weinberg RA.The hallmarks of cancer[J].Cell,2000,100(1):57-70.
[12]Terris B,Cavard C.Diagnosis and molecular aspects of solid-pseudopapillary neoplasms of the pancreas[J].Semin Diagn Pathol,2014,31(6):484-490.
[13]Tang WW,Stelter AA,French S,et al.Loss of cell-adhesion molecule complexes in solid pseudopapillary tumor of pancreas[J].Mod Pathol,2007,20(5):509-513.
[14]Park M,Kim M,Hwang D,et al.Characterization of gene expression and activated signaling pathways in solid-pseudopapillary neoplasm of pancreas[J].Mod Pathol,2014,27(4):580-593.
[15]Cavard C,Audebourg A,Letourneur F,et al.Gene expression profiling provides insights into the pathways involved in solid pseudopapillary neoplasm of the pancreas[J].J Pathol,2009,218(2):201-209.
[16]展翰翔,程玉刚,韩海峰,等.胰腺实性假乳头状瘤的临床特征及治疗[J].中华消化外科杂志,2017,16(10):1005-1012.
[17]宋禾,董明,周建平,等.胰腺实性假乳头状瘤临床诊治分析[J].中华普通外科杂志,2016,31(1):1-3.
[18]Guimar?es LS,de Melo AM,Ruiz MR,et al.Solid pseudopapillary tumor of the pancreatic:evaluation of clinical,radiological and surgical profiles[J].Rev Col Bras Cir,2013,40(5):398-403.
[19]Murhekar K,Ramakrishnan AS,Ramani B,et al.Solid pseudo-papillary tumor of pancreas:A rare case report and review of Indian literature[J].J Cancer Res Ther,2013,9(3):507-510.
[20]Machado MC,Machado MA,Bacchella T,et al.Solid pseudopapillary neoplasm of the pancreas:distinct patterns of onset,diagnosis,and prognosis for male versus female patients[J].Surgery,2008,143(1):29-34.
[21]Buetow PC,Buck JL,Pantongrag-Brown L,et al.Solid and papillary epithelial neoplasm of the pancreas:imagingpathologic correlation on 56 cases[J].J Radiology,1996,199:707-711.
[22]张锴,马超,丁月超,等.胰腺实性假乳头状瘤69例手术体会[J].中国现代医学杂志,2017,27(5):135-137.
[23]Guermehe Y,Soyer P,Dohan A,et al.Solid-pseudopapillary tumor of the pancreas:MR imaging findings in 21 patients[J].Clin Imaging,2014,38(4):475-482.
[24]隋燕霞,党诚学,张勇,等.原发性胰腺神经内分泌肿瘤60例临床病理分析[J].临床与实验病理学杂志,2015,31(8):873-876.
[25]杨洋,张旭,李冰.胰腺粘液性囊性肿瘤32例诊疗体会[J].大连医科大学学报,2017,39(1):62-65.
[26]Kosmahl M,Seada LS,J?nig U,et al.Solid-pseudopapillary tumor of the pancreas:its origin revisited[J].Virchows Arch,2000,436(5):473-480.
[27]Zhang H,Liang TB,Wang WL,et al.Diagnosis and treatment of solid-pseudopapillary tumor of the pancreas[J].Hepatobiliary Pancreat Dis Int,2006,5(3):454-458.
[28]Miao J,Kusafuka T,Kuroda S,et al.Mutation of betacatenin and its protein accumulation in solid and cystic tumor of the pancreas associated with metastasi[J].Int J Mol Med,2003,11(4):461-464.
[29]Abraham SC,Klimstra DS,Wilentz RE,et al.Solid-pseudopapillary tumors of the pancreas are genetically distinct from pancreatic ductal adenocarcinomas and almost always harbor beta-catenin mutations[J].Am J Pathol,2002,60(4):1361-1369.
[30]Tanaka Y,Kato K,Notohara K,et al.Frequent betacatenin mutation and cytoplasmic/nuclear accumulation in pancreatic solid-pseudopapillary neoplasm[J].Cancer Res,2001,61(23):8401-8404.
[31]Papavramidis T,Papavramidis S.Solid pseudopapillary tumors of the pancreas:review of 718 patients reported in English literature[J].J Am Coll Surg,2005,200(6):965-972.
[32]El Nakeeb A,Abdel Wahab M,Elkashef WF,et al.Solid pseudopapillary tumour of the pancreas:Incidence,prognosis and outcome of surgery(single center experience)[J].Int J Surg,2013,11(6):447-457.
[33]Peng CH,Chen DF,Zhou GW,et al.The solid-pseudopapillary tumor of pancreas:the clinical characteristics and surgical treatment[J].J Surg Res,2006,131(2):276-282.
[34]Lakhtakia R,Al-Wahaibi K,Zahid KF,et al.Solid pseudopapillary neoplasm of the pancreas:a case report with review of the diagnostic dilemmas and tumor behavior[J].Oman Med J,2013,28(6):441-444.
[35]Chang H,Gong Y,Xu J,et al.Clinical strategy for the management of solid pseudopapillary tumor of the pancreas:aggressive or less?[J].Int J Med Sci,2010,7(5):309-313.