胰腺实性假乳头状肿瘤1例及文献复习
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摘要
目的分析胰腺实性假乳头状肿瘤(SPTP)的临床表现、临床病理特征、鉴别诊断及其预后。方法对1例SPTP进行大体、光镜及免疫组织化学检测,并结合文献复习。结果 29岁女性患者,因上腹部饱胀不适入院,CT示胰尾部肿物。组织病理学检查示,肿瘤由被覆数层上皮细胞的假乳头和囊腔形成,瘤细胞呈小圆形,无明显异型性,未见核分裂像,局部见包膜外浸润。免疫组织化学显示肿瘤细胞β-Catenin强阳性,NSE、α-AT、CD10和vimentin均阳性,Cg A、CKpan均阴性。随访二年未见复发或转移。结论SPTP是一种少见的低度恶性肿瘤,易被误诊为良性疾病,诊断依据其临床特征、病理组织学特点及免疫组化结果,手术切除是首选治疗方法,预后良好。
Objective To investigate the clinical manifestation,the clinicopathological features,differential diagnosis and prognosis of solid pseudopapillary tumor of pancreas( SPTP). Methods A case of SPTP was analyzed grossly, light microscopically and immunohistochemically and related literatures were reviewed. Results A 29-year-old female patient was found to have the tumor in pancreatic tail on a chest CT after epigastric unwell. Histopathologically,the tumor were composed of pseudopapillary structure and cystic structure,surrounded by epithelial cells without significant nuclear atypia. Morphology of tumor cells were small circle and more consistent. Mitosis were not observed in tumors. Immunohistochemically,the tumor cells were strongly positive for β-Catenin. Pseudopapillary structure were positive for NSE,α-AT,CD10 and vimentin. Cg A and CKpan were all negative. The patient was followed up for 36 months,and she had no recurrence and metastasis. Conclusions SPTP is a rare low-grade malignancy,easily misdiagnosed as benign disease,Clinical feature,pathological morphology and immunohistochemistry are very important in the diagnosis and differential diagnosis of SPTP. Surgical resection is curative for these patients. The patients have a relatively good prognosis.
Objective To investigate the clinical manifestation,the clinicopathological features,differential diagnosis and prognosis of solid pseudopapillary tumor of pancreas( SPTP). Methods A case of SPTP was analyzed grossly, light microscopically and immunohistochemically and related literatures were reviewed. Results A 29-year-old female patient was found to have the tumor in pancreatic tail on a chest CT after epigastric unwell. Histopathologically,the tumor were composed of pseudopapillary structure and cystic structure,surrounded by epithelial cells without significant nuclear atypia. Morphology of tumor cells were small circle and more consistent. Mitosis were not observed in tumors. Immunohistochemically,the tumor cells were strongly positive for β-Catenin. Pseudopapillary structure were positive for NSE,α-AT,CD10 and vimentin. Cg A and CKpan were all negative. The patient was followed up for 36 months,and she had no recurrence and metastasis. Conclusions SPTP is a rare low-grade malignancy,easily misdiagnosed as benign disease,Clinical feature,pathological morphology and immunohistochemistry are very important in the diagnosis and differential diagnosis of SPTP. Surgical resection is curative for these patients. The patients have a relatively good prognosis.
引文
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[8]张喜卿,初霞,王志威,等.胰腺实性-假乳头状瘤临床病理分析[J].实用医技杂志,2013,20(5):558-559.
[9]Fred T.Bosman,Fátima Carneiro,Ralph H.Hruban,Neil D.theise.WHO Classification of Tumours of the Digestive System[M].Lyon:IARC Press,2008:582-586.
[2]Allen PJ,Dangelica M,Gonen M,et al.A selective approach to the resection of cystic lesions of the pancreas:results from 539consecutive patients[J].Ann Surg,2006,244(4):572-582.
[3]Mulkeen AL,Yoo PS,Cha C,et al.Less common neoplasms of the pancreas[J].World J Gastroenterol,2006,12(20):3180-3185.
[4]Frago R,Fabregat J,Jorba R,et al.Solid pseudopapillary tumors of the pancreas:diagnosis and curative treatment[J].Rev Esp Enferm Dig,2006,98(11):809-816.
[5]Kawamoto S,Scudiere J,Hruban RH,et al.Solid-pseudopapillary neoplasm of the pancreas:spectrum of findings on multidetector CT[J].Clin Imaging,2011,35(1):21-28.
[6]Fred T.Bosman,Fátima Carneiro,Ralph H.Hruban,Neil D.theise.WHO Classification of Tumours of the Digestive System[M].Lyon:IARC Press,2008:582-586.
[7]张日欣,王立明,王澍,等.12例胰腺实性假乳头状瘤的诊治分析[J].胃肠病学,2013,18(6):356-359.
[8]张喜卿,初霞,王志威,等.胰腺实性-假乳头状瘤临床病理分析[J].实用医技杂志,2013,20(5):558-559.
[9]Fred T.Bosman,Fátima Carneiro,Ralph H.Hruban,Neil D.theise.WHO Classification of Tumours of the Digestive System[M].Lyon:IARC Press,2008:582-586.