胰腺实性假乳头状瘤47例临床分析
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摘要
目的:探讨胰腺实性假乳头状瘤(SPTP)的临床特征、治疗及其预后。方法:回顾性分析南昌大学第一附属医院普通外科2007年1月—2018年12月经收治并经术后病理证实的47例SPTP患者的临床资料。结果:全组男11例,女36例,平均年龄(32±15)岁;肿瘤位于胰头部16例,胰颈部8例,胰体尾部23例;术前通过影像学初步诊断为SPTP者21例(44.7%),6例术前行超声内镜引导下细针穿刺活检术,仅1例(16.7%)确诊为SPTP;行胰十二指肠切除术10例,胰体尾联合脾脏切除术12例,保留脾脏的胰体尾切除术8例,胰腺中段切除术5例,肿瘤局部切除术10例,保留十二指肠胰头切除术1例,胰体尾联合脾脏、左肾及左肾上腺切除+下腔静脉切开取栓术1例。术后并发症发生率为19.1%(9/47),无再手术和手术相关死亡。肿瘤免疫组化结果显示,PR、CD56、NSE呈阳性表达居多。术后43例获随访,平均随访时间(41.7±31.4)个月,1例术后复发,所有随访患者均存活。结论:SPTP是一种好发于年轻女性的潜在低度恶性肿瘤,其临床表现无特异性,确诊有赖于病理组织学检查,手术切除是首选治疗方法,预后良好。
Objective: To investigate the clinical characteristics, treatment and prognosis of solid pseudopapillary tumor of the pancreas(SPTP).Methods: The clinical data of 47 patients treated and pathologically confirmed as SPTP in the Department of General Surgery of the First Affiliated Hospital of Nanchang University from January 2007 to December 2018 were retrospectively analyzed. Results: Of the whole group, 11 patients were males and 36 were females, with the mean age of(32±15) years; the tumor was located in the head of the pancreas in 16 cases, in the neck of the pancreas in 8 cases, and in the body and tail of the pancreas in 23 cases; 21 cases(44.7%) were preliminarily diagnosed as SPTP by preoperative imaging examinations, and 6 cases underwent endoscopic ultrasound-guided fine-needle aspiration, by which,only 1 case(16.7%) was diagnosed as SPTP; 10 cases underwent pancreaticoduodenectomy, 12 cases underwent distal pancreatectomy combined with splenectomy, 8 cases underwent spleen-preserving distal pancreatectomy, 5 cases underwent middle segmental pancreatectomy, 10 cases underwent tumor enucleation, 1 case underwent duodenum-preserving pancreatic head resection, and 1 case underwent distal pancreatectomy combined with splenectomy, left nephrectomy, left adrenalectomy, and inferior vena cava thrombectomy. No reoperation was required and no death occurred in any of the patients. Immunohistochemical staining of the tumor specimens showed that positive expressions of PR, CD56 and NSE presented in most of them. The incidence of postoperative complications was 19.1%(9/47). Postoperative followed-up was conducted in 43 patients for(41.7±31.4) months, recurrence occurred in 1 patient and all these patients were alive.Conclusion: SPTP is a potential low-grade malignant tumor, which is more likely to occur in young women. Its clinical manifestations are non-specific, and the diagnosis depends on histopathological examination. Surgical resection is the favored option, with a good prognosis.
Objective: To investigate the clinical characteristics, treatment and prognosis of solid pseudopapillary tumor of the pancreas(SPTP).Methods: The clinical data of 47 patients treated and pathologically confirmed as SPTP in the Department of General Surgery of the First Affiliated Hospital of Nanchang University from January 2007 to December 2018 were retrospectively analyzed. Results: Of the whole group, 11 patients were males and 36 were females, with the mean age of(32±15) years; the tumor was located in the head of the pancreas in 16 cases, in the neck of the pancreas in 8 cases, and in the body and tail of the pancreas in 23 cases; 21 cases(44.7%) were preliminarily diagnosed as SPTP by preoperative imaging examinations, and 6 cases underwent endoscopic ultrasound-guided fine-needle aspiration, by which,only 1 case(16.7%) was diagnosed as SPTP; 10 cases underwent pancreaticoduodenectomy, 12 cases underwent distal pancreatectomy combined with splenectomy, 8 cases underwent spleen-preserving distal pancreatectomy, 5 cases underwent middle segmental pancreatectomy, 10 cases underwent tumor enucleation, 1 case underwent duodenum-preserving pancreatic head resection, and 1 case underwent distal pancreatectomy combined with splenectomy, left nephrectomy, left adrenalectomy, and inferior vena cava thrombectomy. No reoperation was required and no death occurred in any of the patients. Immunohistochemical staining of the tumor specimens showed that positive expressions of PR, CD56 and NSE presented in most of them. The incidence of postoperative complications was 19.1%(9/47). Postoperative followed-up was conducted in 43 patients for(41.7±31.4) months, recurrence occurred in 1 patient and all these patients were alive.Conclusion: SPTP is a potential low-grade malignant tumor, which is more likely to occur in young women. Its clinical manifestations are non-specific, and the diagnosis depends on histopathological examination. Surgical resection is the favored option, with a good prognosis.
引文
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[10]Dinarvand P,Lai J.Solid Pseudopapillary Neoplasm of the Pancreas:A Rare Entity With Unique Features[J].Arch Pathol Lab Med,2017,141(7):990-995.doi:10.5858/arpa.2016-0322-RS.
[11]Yang F,Yu X,Bao Y,et al.Prognostic value of Ki-67 in solid pseudopapillary tumor of the pancreas:Huashan experience and systematic review of the literature[J].Surgery,2016,159(4):1023-1031.doi:10.1016/j.surg.2015.10.018.
[12]Yu P,Cheng X,Du Y,et al.Solid Pseudopapillary Neoplasms of the Pancreas:a 19-Year Multicenter Experience in China[J].JGastrointest Surg,2015,19(8):1433-1440.doi:10.1007/s11605-015-2862-8.
[13]Suzuki S,Hatori T,Furukawa T,et al.Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution[J].Dig Surg,2014,31(2):143-150.doi:10.1159/000363420.
[14]Tognarini I,Tonelli F,Nesi G,et al.In vitro effects of oestrogens,antioestrogens and SERMs on pancreatic solid pseudopapillary neoplasm-derived primary cell culture[J].Cell Oncol,2010,32(5/6):331-343.doi:10.3233/CLO-2010-0522.
[15]Kurokawa S,Hirabayashi K,Hadano A,et al.Do Solid Pseudopapillary Neoplasms Shrink After Menopause?:Review of the Literature[J].Pancreas,2015,44(6):998-999.doi:10.1097/MPA.0000000000000358.
[16]Chen XM,Zhang Y,Sun DL.Laparoscopic central pancreatectomy for solid pseudopapillary tumors of the pancreas:our experience with ten cases[J].World J Surg Oncol,2014,12:312.doi:10.1186/1477-7819-12-312.
[17]Afridi SA,Kazaryan AM,Marangos IP,et al.Laparoscopic surgery for solid pseudopapillary tumor of the pancreas[J].JSLS,2014,18(2):236-242.doi:10.4293/108680813X13753907291837.
[18]肖卫东,林生荣,吴安涛,等.保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤:单中心66例报告[J].中国普通外科杂志,2018,27(3):284-288.doi:10.3978/j.issn.1005-6947.2018.03.003.Xiao WD,Lin SR,Wu AT,et al.Organ preserving pancreatectomy for pancreatic benign or low-grade malignant tumor:a report of 66cases in a single institution[J].Chinese Journal of General Surgery,2018,27(3):284-288.doi:10.3978/j.issn.1005-6947.2018.03.003.
[19]Naar L,Spanomichou DA,Mastoraki A,et al.Solid Pseudopapillary Neoplasms of the Pancreas:A Surgical and Genetic Enigma[J].World J Surg,2017,41(7):1871-1881.doi:10.1007/s00268-017-3921-y.
[20]Yu PF,Hu ZH,Wang XB,et al.Solid pseudopapillary tumor of the pancreas:a review of 553 cases in Chinese literature[J].World JGastroenterol,2010,16(10):1209-1214.
[21]Tajima H,Takamura H,Kitagawa H,et al.Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization:A case report[J].Oncol Lett,2015,9(4):1733-1738.doi:10.3892/ol.2015.2967.
[22]Krug S,Bartsch DK,Schober M,et al.Successful selective internal radiotherapy(SIRT)in a patient with a malignant solid pseudopapillary pancreatic neoplasm(SPN)[J].Pancreatology,2012,12(5):423-427.doi:10.1016/j.pan.2012.07.014.
[23]You L,Yang F,Fu DL,Prediction of malignancy and adverse outcome of solid pseudopapillary tumor of the pancreas[J].World J Gastrointest Oncol,2018,10(7):184-193.doi:10.4251/wjgo.v10.i7.184.
[24]Kang CM,Choi SH,Kim SC,et al.Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection:a multicenter analysis in Korea[J].Ann Surg,2014,260(2):348-355.doi:10.1097/SLA.0000000000000583.
[25]Jutric Z,Rozenfeld Y,Grendar J,et al.Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas:A Closer Look at Patients with Metastatic Disease[J].Ann Surg Oncol,2017,24(7):2015-2022.doi:10.1245/s10434-017-5772-z.
[26]Zhang H,Wang W,Yu S,et al.The prognosis and clinical characteristics of advanced(malignant)solid pseudopapillary neoplasm of the pancreas[J].Tumour Biol,2016,37(4):5347-5353.doi:10.1007/s13277-015-4371-5.
[27]Hao EIU,Hwang HK,Yoon DS,et al.Aggressiveness of solid pseudopapillary neoplasm of the pancreas:A literature review and meta-analysis[J].Medicine(Baltimore),2018,97(49):e13147.doi:10.1097/MD.0000000000013147.
[2]中华医学会外科学分会胰腺外科学组,中国研究型医院学会胰腺病专业委员会,中华外科杂志编辑部.胰腺术后外科常见并发症诊治及预防的专家共识(2017)[J].中华外科杂志,2017,55(5):328-334.doi:10.3760/cma.j.issn.0529-5815.2017.05.003.Study Group of Pancreatic Surgery in Chinese Socie,Pancreatic Disease Committee of Chinese Research Hospital,Editorial Board of Chinese Journal of Surgery.A consensus statement on the diagnosis,treatment,and prevention of common complications after pancreatic surgery(2017)[J].Chinese Journal of Surgery,2017,55(5):328-334.doi:10.3760/cma.j.issn.0529-5815.2017.05.003.
[3]Frantz VK.Tumors of the pancreas[A]//Atlas of tumor pathology[M].Washington:Armed Forces Institute of Pathology,1959:32-33.
[4]Kl鰌pel G,Heitz PU,Capella C,et al.Pathology and nomenclature of human gastrointestinal neuroendocrine(carcinoid)tumors and related lesions[J].World J Surg,1996,20(2):132-141.
[5]Kl鰌pel G,Lüttges J,Klimstra D,et al.Solid-pseudopapillary neoplasm[A]//Hamilton SR,Aaltonen LA,editors.WHOclassification of tumours.Pathlogy and genetics of tumors of of the digestive system[M].Lyon:International Agency for Research on Cancer,2000:246-248.
[6]Bosman FT,Carneiro F,Hruban RH,et al.WHO classification of tumours of the digestive system[M].4th ed.Lyon:International Agency for Research on Cancer,2010:327-330.
[7]Law JK,Ahmed A,Singh VK,et al.A systematic review of solid pseudopapillary neoplasms:are these rare lesions?[J].Pancreas,2014,43(3):331-337.doi:10.1097/MPA.0000000000000061.
[8]Hu S,Zhang H,Wang X,et al.Asymptomatic versus symptomatic solid pseudopapillary tumors of the pancreas:clinical and MDCTmanifestations[J].Cancer Imaging,2019,19(1):13.doi:10.1186/s40644-019-0198-4.
[9]Law JK,Stoita A,Wever W,et al.Endoscopic ultrasound-guided fine needle aspiration improves the pre-operative diagnostic yield of solid-pseudopapillary neoplasm of the pancreas:an international multicenter case series(with video)[J].Surg Endosc,2014,28(9):2592-2598.doi:10.1007/s00464-014-3508-8.
[10]Dinarvand P,Lai J.Solid Pseudopapillary Neoplasm of the Pancreas:A Rare Entity With Unique Features[J].Arch Pathol Lab Med,2017,141(7):990-995.doi:10.5858/arpa.2016-0322-RS.
[11]Yang F,Yu X,Bao Y,et al.Prognostic value of Ki-67 in solid pseudopapillary tumor of the pancreas:Huashan experience and systematic review of the literature[J].Surgery,2016,159(4):1023-1031.doi:10.1016/j.surg.2015.10.018.
[12]Yu P,Cheng X,Du Y,et al.Solid Pseudopapillary Neoplasms of the Pancreas:a 19-Year Multicenter Experience in China[J].JGastrointest Surg,2015,19(8):1433-1440.doi:10.1007/s11605-015-2862-8.
[13]Suzuki S,Hatori T,Furukawa T,et al.Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas at a Single Institution[J].Dig Surg,2014,31(2):143-150.doi:10.1159/000363420.
[14]Tognarini I,Tonelli F,Nesi G,et al.In vitro effects of oestrogens,antioestrogens and SERMs on pancreatic solid pseudopapillary neoplasm-derived primary cell culture[J].Cell Oncol,2010,32(5/6):331-343.doi:10.3233/CLO-2010-0522.
[15]Kurokawa S,Hirabayashi K,Hadano A,et al.Do Solid Pseudopapillary Neoplasms Shrink After Menopause?:Review of the Literature[J].Pancreas,2015,44(6):998-999.doi:10.1097/MPA.0000000000000358.
[16]Chen XM,Zhang Y,Sun DL.Laparoscopic central pancreatectomy for solid pseudopapillary tumors of the pancreas:our experience with ten cases[J].World J Surg Oncol,2014,12:312.doi:10.1186/1477-7819-12-312.
[17]Afridi SA,Kazaryan AM,Marangos IP,et al.Laparoscopic surgery for solid pseudopapillary tumor of the pancreas[J].JSLS,2014,18(2):236-242.doi:10.4293/108680813X13753907291837.
[18]肖卫东,林生荣,吴安涛,等.保留器官的胰腺切除术治疗胰腺良性或低度恶性肿瘤:单中心66例报告[J].中国普通外科杂志,2018,27(3):284-288.doi:10.3978/j.issn.1005-6947.2018.03.003.Xiao WD,Lin SR,Wu AT,et al.Organ preserving pancreatectomy for pancreatic benign or low-grade malignant tumor:a report of 66cases in a single institution[J].Chinese Journal of General Surgery,2018,27(3):284-288.doi:10.3978/j.issn.1005-6947.2018.03.003.
[19]Naar L,Spanomichou DA,Mastoraki A,et al.Solid Pseudopapillary Neoplasms of the Pancreas:A Surgical and Genetic Enigma[J].World J Surg,2017,41(7):1871-1881.doi:10.1007/s00268-017-3921-y.
[20]Yu PF,Hu ZH,Wang XB,et al.Solid pseudopapillary tumor of the pancreas:a review of 553 cases in Chinese literature[J].World JGastroenterol,2010,16(10):1209-1214.
[21]Tajima H,Takamura H,Kitagawa H,et al.Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization:A case report[J].Oncol Lett,2015,9(4):1733-1738.doi:10.3892/ol.2015.2967.
[22]Krug S,Bartsch DK,Schober M,et al.Successful selective internal radiotherapy(SIRT)in a patient with a malignant solid pseudopapillary pancreatic neoplasm(SPN)[J].Pancreatology,2012,12(5):423-427.doi:10.1016/j.pan.2012.07.014.
[23]You L,Yang F,Fu DL,Prediction of malignancy and adverse outcome of solid pseudopapillary tumor of the pancreas[J].World J Gastrointest Oncol,2018,10(7):184-193.doi:10.4251/wjgo.v10.i7.184.
[24]Kang CM,Choi SH,Kim SC,et al.Predicting recurrence of pancreatic solid pseudopapillary tumors after surgical resection:a multicenter analysis in Korea[J].Ann Surg,2014,260(2):348-355.doi:10.1097/SLA.0000000000000583.
[25]Jutric Z,Rozenfeld Y,Grendar J,et al.Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas:A Closer Look at Patients with Metastatic Disease[J].Ann Surg Oncol,2017,24(7):2015-2022.doi:10.1245/s10434-017-5772-z.
[26]Zhang H,Wang W,Yu S,et al.The prognosis and clinical characteristics of advanced(malignant)solid pseudopapillary neoplasm of the pancreas[J].Tumour Biol,2016,37(4):5347-5353.doi:10.1007/s13277-015-4371-5.
[27]Hao EIU,Hwang HK,Yoon DS,et al.Aggressiveness of solid pseudopapillary neoplasm of the pancreas:A literature review and meta-analysis[J].Medicine(Baltimore),2018,97(49):e13147.doi:10.1097/MD.0000000000013147.