胰腺浆液性微囊性腺癌临床病理观察

Serous microcystic adenocarcinoma of pancreas: clinicopathological observation

目的报道1例罕见的胰腺浆液性微囊性腺癌,并结合WHO(2000)胰腺肿瘤病理学和遗传学分类对浆液性微囊性肿瘤进行介绍。方法对1例胰腺浆液性微囊性肿瘤进行临床病理分析及免疫组化观察。结果肿瘤位于胰尾,与脾分界不清,侵及胃壁、脾并与脾动、静脉粘连。肿瘤由大量微小的囊组成,呈海绵状,囊腔内充满蛋白性质的液体,囊内壁衬以单层排列的扁平-立方上皮细胞,胞质透明,核小、圆形,无异型,脾内、脉管周围及胃壁平滑肌间均可见肿瘤浸润。结论浆液性囊腺癌组织学特征与浆液性微囊性腺瘤极其相似,侵袭和转移等恶性生物学行为是其诊断恶性的要点,但其生长缓慢,切除肿瘤治疗效果好。

Objective To report a rare case of serous microcystic adenocarcinoma of the pancreas, and to introduce the serous microcystic tumor according to the WHO classification of Tumor Pathology and Genetics of Pancreatic Tumors. Methods A case of serous microcystic pancreatic tumor was studied with clinical pathology and immunohistochemistry. Results The patient was female and 60 years old. The tumor was located in the tail of pancreas, which was not well defined with the spleen. Besides, it invaded the gastric wall and spleen,and adhered to splenic vain and artery. The tumor was composed of multipe small cysts and the patterns of cysts was similar to sponge. Microscopically, the cysts contained proteinaccous fluid and lined by a single layer of cuboidal of flattened epithelial cells. The cytoplasm was clear, nuclei was small and round, without nuclear atypia. Tumor invasion could be seen in spleen around vessels and among the smooth muscle of gastric wall. Conclusions Serous cystadenocarcinoma has generally the same histologic features as serous microcystic adenoma. Malignant biological behaviors such as invasion and metastasis are the key points in the diagnosis. The tumor grows slowly, and there is good outcome with complete resection of the tumor.