胰腺实性假乳头状瘤与胰岛细胞瘤的临床病理对比研究

Comparative Study of Clinical Pathology of Solid-Pseudopapillary Tumor of The Pancreas and Islet Cell Tumor

目的研究胰腺实性假乳头状瘤(SPTP)与胰岛细胞瘤(ICT)的临床表现和病理学特点。方法回顾性总结15例SPTP与12例ICT的临床症状、CT表现和病理特征,并对比分析肿瘤病理特征与CT影像的关系。结果SPTP患者平均年龄22.4岁,12例以腹部肿块为首发症状;组织学上,其特征性表现是以肿瘤细胞围绕纤维血管轴心排列形成假乳头状结构;CT平扫可见囊性与实性成分相间,增强扫描动脉期肿瘤实性成分呈现轻度强化,静脉期强化增强。ICT患者平均年龄39.3岁,其中8例功能性胰岛细胞瘤患者症状均明显,表现为典型的Whipple三联征;组织学上,肿瘤细胞排列成小梁状、团块状、腺泡状或实性,血供丰富;对于瘤体较小者,CT平扫常难以发现,增强扫描动脉期肿瘤呈现明显强化,静脉期强化稍减弱。结论临床表现、组织学特征结合CT影像检查有助于SPTP与ICT的鉴别诊断。

Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas （SPTP） and islet cell tumor （ICT）. Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomo- graphy （CT） image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.