胰腺实性假乳头状瘤的影像诊断与良恶性预测因素分析
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摘要
目的分析胰腺实性假乳头状瘤(SPNP)的影像和临床表现,探讨CT和MRI对SPNP的诊断以及良恶性SPNP的预测价值。方法回顾性收集2010年1月至2017年12月中山大学孙逸仙纪念医院经病理证实的SPNP 60例,分析患者的临床表现和影像学特征,采用χ~2检验和Logistic回归分析患者临床、影像学特征与良恶性SPNP的相关性。结果 SPNP好发于年青女性(85.0%,51/60),中位发病年龄34.5岁,33例(55.0%)表现为非特异性症状,54例(90.0%)肿瘤特异性指标阴性。CT及MRI显示包膜缺损的患者并发症发生率(44.1%,15/34)高于包膜完整的患者(19.2%,5/26),经腹腔镜术后并发症发生率(10.5%,2/19)低于经腹术后并发症发生率(43.9%,18/41),差异均有统计学意义(χ~2=4.106、5.508,P=0.043、0.011)。SPNP肿瘤好发于胰体尾部(60.0%),形态多规则(61.7%),平均直径达5.7 cm。肿瘤具有包膜,增强扫描明显强化,MRI呈环形低信号;瘤内以囊实性为主(56.7%),密度及信号多不均匀(83.3%),可伴有钙化(21.7%)、出血(30.0%),钙化多呈环形位于边缘,增强扫描瘤内表现为渐进性中度强化(100.0%)。良、恶性SPNP患者的年龄、肿瘤的大小、形态以及包膜是否缺损比较,差异有统计学意义(P=0.047、0.029、0.049、<0.001),Logistic多因素回归分析显示上述因素均不是独立的危险因素。结论 SPNP好发于年轻女性,无特异性临床表现。SPNP的CT、MRI表现具有特征性,对肿瘤的术前诊断和良恶性的评估具有一定价值。手术是SPNP有效的治疗方法,腹腔镜手术可作为首选手术方式,预后效果好。
Objective To analyze the imaging and clinical manifestations of solid-pseudopapillary neoplasms of the pancreas(SPNP), and to explore the predictive value of CT and MRI for benign and malignant SPNP. Methods From January 2010 to December 2017, sixty patients with pathologically proved SPNP were collected from Sun Yat-sen Memorial Hospital. The patients' clinical and imaging data were analyzed retrospectively with χ~2 test and logistic regression. Results Fifty-one cases(85.0%) were young women with an average age of 34.5 years. Thirty-three patients(55.0%) had non-specific clinical symptoms and tumor markers were negative in 54 patients(90.0%). All the 60 patients had underwent surgery for treatment, with the incidence of postoperative complications higher in patients with tumor capsular defect(44.1%) than tumor capsular intact(19.2%)(χ~2=4.106, P=0.043), and lower in patients under laparoscopic surgery(10.5%) than laparotomy(43.9%)(χ~2=5.508, P=0.011). SPNP always occurred in the tail(60.0%), and most of them(61.7%) had regular shape with an average diameter of 5.7 cm. There were capsules with the tumors, which showed up as ring low signal on MRI and enhanced obviously. Most of the tumors were cystic mass(56.7%) and the density or signal was heterogeneous(83.3%), for peripheral calcification(21.7%) and hemorrhage(30.0%) could be found, and in all the cases, CT and MRI enhanced scans appeared as progressive and inhomogeneous. Clinical and CT imaging features including age, tumor size, shape, and tumor capsular defect in benign and malignant SPNP had statistical significance(P=0.047,0.029, 0.049, <0.001), while none of the above factors were independent risk factors by multivariate logistic regression. Conclusions SPNP is commonly seen in young females with no specific clinical symptoms. CT and MRI demonstrate characteristic features of SPNP, and have great value in differential diagnosis between malignant and benign SPNP. Surgery is effective for SPNP, and laparoscopic surgery can be the first choice for good prognosis.
Objective To analyze the imaging and clinical manifestations of solid-pseudopapillary neoplasms of the pancreas(SPNP), and to explore the predictive value of CT and MRI for benign and malignant SPNP. Methods From January 2010 to December 2017, sixty patients with pathologically proved SPNP were collected from Sun Yat-sen Memorial Hospital. The patients' clinical and imaging data were analyzed retrospectively with χ~2 test and logistic regression. Results Fifty-one cases(85.0%) were young women with an average age of 34.5 years. Thirty-three patients(55.0%) had non-specific clinical symptoms and tumor markers were negative in 54 patients(90.0%). All the 60 patients had underwent surgery for treatment, with the incidence of postoperative complications higher in patients with tumor capsular defect(44.1%) than tumor capsular intact(19.2%)(χ~2=4.106, P=0.043), and lower in patients under laparoscopic surgery(10.5%) than laparotomy(43.9%)(χ~2=5.508, P=0.011). SPNP always occurred in the tail(60.0%), and most of them(61.7%) had regular shape with an average diameter of 5.7 cm. There were capsules with the tumors, which showed up as ring low signal on MRI and enhanced obviously. Most of the tumors were cystic mass(56.7%) and the density or signal was heterogeneous(83.3%), for peripheral calcification(21.7%) and hemorrhage(30.0%) could be found, and in all the cases, CT and MRI enhanced scans appeared as progressive and inhomogeneous. Clinical and CT imaging features including age, tumor size, shape, and tumor capsular defect in benign and malignant SPNP had statistical significance(P=0.047,0.029, 0.049, <0.001), while none of the above factors were independent risk factors by multivariate logistic regression. Conclusions SPNP is commonly seen in young females with no specific clinical symptoms. CT and MRI demonstrate characteristic features of SPNP, and have great value in differential diagnosis between malignant and benign SPNP. Surgery is effective for SPNP, and laparoscopic surgery can be the first choice for good prognosis.
引文
[1]刘建滨,范立新,易正湘,等. 3.0T MRI对胰腺囊性肿瘤的诊断价值[J].放射学实践, 2011, 26(5):508-513.
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[5]Pulvirenti A, Marchegiani G, Malleo G, et al. Cystic neoplasm of the pancreas[J]. Indian J Surg, 2015, 77(5):387-392.
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[8]Senthilnathan P, Dhaker KC, Kaje V, et al. Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care center from south India[J]. Pancreatology, 2017, 17(6):927-930.
[9]McCluney S, Wijesuriya N, Sheshappanavar V, et al. Solid pseudopapillary tumour of the pancreas:clinicopathological analysis[J]. ANZ J Surg, 2018, 88(9):891-895.
[10] Lubezky N, Papoulas M, Lessing Y, et al. Solid pseudopapillary neoplasm of the pancreas:management and long-term outcome[J].Eur J Surg Oncol, 2017, 43(6):1056-1060.
[11] Bochis OV, Bota M, Mihut E, et al. Solid pseudopapillary tumor of the pancreas:clinical-pathological features and management of 13cases[J]. Clujul Med, 2017, 90(2):171-178.
[12]殷小平,梁广路,田笑,等.胰腺囊性肿瘤的多层螺旋CT表现[J].实用医学杂志, 2011, 27(3):472-475.
[13]刘庆余,张卫东,高明,等.胰腺实性-假乳头状肿瘤临床及多层螺旋CT表现特点[J/CD].中华普通外科学文献(电子版),2011, 5(5):391-394.
[14] Bostanc?EB,?ter V, Binarba??C, et al. Surgical outcomes of solid pseudopapillary neoplasm of the pancreas:a single institution's experience of 16 cases[J]. Arch Iran Med, 2016, 19(1):30-34.
[15] Wang XG, Ni QF, Fei JG, et al. Clinicopathologic features and surgical outcome of solid pseudopapillary tumor of the pancreas:analysis of 17 cases[J]. World J Surg Oncol, 2013, 11:38.
[16] Huang Y, Feng JF. Clinicopathologic characteristics and surgical treatment of solid pseudopapillary tumor of the pancreas[J].Hippokratia, 2013, 17(1):68-72.
[17] Zhang RC, Yan JF, Xu XW, et al. Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas[J].World J Gastroenterol, 2013, 19(37):6272-6277.
[18] Afridi SA, Kazaryan AM, Marangos IP, et al. Laparoscopic surgery for solid pseudopapillary tumor of the pancreas[J]. JSLS, 2014,18(2):236-242.
[19] Walsh RM. Current controversies in pancreatic cystic neoplasms[J].Am J Surg, 2017, 213(3):443-447.
[20] Ito T, Igarashi H, Jensen RT. Pancreatic neuroendocrine tumors:clinical features, diagnosis and medical treatment:advances[J].Best Pract Res Clin Gastroenterol, 2012, 26(6):737-753.
[21]陈璐,余日胜.胰腺囊性肿瘤影像学诊断价值[J/CD].中华肝脏外科手术学电子杂志, 2016, 5(6):367-375.
[2]张蕊,彭晓刚,赵雪峰,等.磁共振在胰腺囊性肿瘤鉴别诊断中的价值[J].中国临床医学影像杂志, 2016, 27(2):110-113.
[3]Song H, Dong M, Zhou J, et al. Solid pseudopapillary neoplasm of the pancreas:clinicopathologic feature, risk factors of malignancy,and survival analysis of 53 cases from a single center[J]. Biomed Res Int, 2017, 2017:5465261.
[4]司安创,杨晓春,庞红艳,等.胰腺实性假乳头状瘤的CT表现[J].实用放射学, 2013, 2(29):228-231.
[5]Pulvirenti A, Marchegiani G, Malleo G, et al. Cystic neoplasm of the pancreas[J]. Indian J Surg, 2015, 77(5):387-392.
[6]Cai H, Zhou M, Hu Y, et al. Solid-pseudopapillary neoplasms of the pancreas:clinical and pathological features of 33 cases[J]. Surg Today, 2013, 43(2):148-154.
[7]Yang F, Fu DL, Jin C, et al. Clinical experiences of solid pseudopapillary tumors of the pancreas in China[J]. J Gastroenterol Hepatol, 2008, 23(12):1847-1851.
[8]Senthilnathan P, Dhaker KC, Kaje V, et al. Laparoscopic management of solid pseudo papillary neoplasm of pancreas in tertiary care center from south India[J]. Pancreatology, 2017, 17(6):927-930.
[9]McCluney S, Wijesuriya N, Sheshappanavar V, et al. Solid pseudopapillary tumour of the pancreas:clinicopathological analysis[J]. ANZ J Surg, 2018, 88(9):891-895.
[10] Lubezky N, Papoulas M, Lessing Y, et al. Solid pseudopapillary neoplasm of the pancreas:management and long-term outcome[J].Eur J Surg Oncol, 2017, 43(6):1056-1060.
[11] Bochis OV, Bota M, Mihut E, et al. Solid pseudopapillary tumor of the pancreas:clinical-pathological features and management of 13cases[J]. Clujul Med, 2017, 90(2):171-178.
[12]殷小平,梁广路,田笑,等.胰腺囊性肿瘤的多层螺旋CT表现[J].实用医学杂志, 2011, 27(3):472-475.
[13]刘庆余,张卫东,高明,等.胰腺实性-假乳头状肿瘤临床及多层螺旋CT表现特点[J/CD].中华普通外科学文献(电子版),2011, 5(5):391-394.
[14] Bostanc?EB,?ter V, Binarba??C, et al. Surgical outcomes of solid pseudopapillary neoplasm of the pancreas:a single institution's experience of 16 cases[J]. Arch Iran Med, 2016, 19(1):30-34.
[15] Wang XG, Ni QF, Fei JG, et al. Clinicopathologic features and surgical outcome of solid pseudopapillary tumor of the pancreas:analysis of 17 cases[J]. World J Surg Oncol, 2013, 11:38.
[16] Huang Y, Feng JF. Clinicopathologic characteristics and surgical treatment of solid pseudopapillary tumor of the pancreas[J].Hippokratia, 2013, 17(1):68-72.
[17] Zhang RC, Yan JF, Xu XW, et al. Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas[J].World J Gastroenterol, 2013, 19(37):6272-6277.
[18] Afridi SA, Kazaryan AM, Marangos IP, et al. Laparoscopic surgery for solid pseudopapillary tumor of the pancreas[J]. JSLS, 2014,18(2):236-242.
[19] Walsh RM. Current controversies in pancreatic cystic neoplasms[J].Am J Surg, 2017, 213(3):443-447.
[20] Ito T, Igarashi H, Jensen RT. Pancreatic neuroendocrine tumors:clinical features, diagnosis and medical treatment:advances[J].Best Pract Res Clin Gastroenterol, 2012, 26(6):737-753.
[21]陈璐,余日胜.胰腺囊性肿瘤影像学诊断价值[J/CD].中华肝脏外科手术学电子杂志, 2016, 5(6):367-375.