胰腺双部位实性假乳头肿瘤1例

Bifocal solid pseudopapillary tumor of the pancreas:a report of one case

目的:总结1例胰腺双部位实性假乳头肿瘤(SPT)的临床病理特点,探讨其可能起源.方法:手术行标准胰十二指肠切除术和胰体尾及脾切除术,分析该病例SPT的临床病理特点,并行多个抗体的免疫组织化学检查.结果:患者术后血糖5.5-8.9mmol/L,第5天开始恢复饮食,未发生胰漏、胆漏及腹腔感染等并发症.大体形态的囊实性比例不尽相同,但镜下肿瘤细胞形态学一致,均确诊为SPT,对各个免疫表型的表达具有异质性,其中VIM、S100、AAT、CyclinD1、PR及Nestin均呈阳性.结论:SPT可能起源于胰腺干细胞及与其发育密切相关的胚胎神经嵴的神经前体细胞,由干细胞发育过程中分化不成熟所致.

AIM：To analyze the pathological characteristics and origin of bifocal solid pseudopapillary tumor （SPT） of the pancreas.METHODS：The clinical data of a patient with bifocal SPT of the pancreas,who underwent pancreatoduodenectomy and distal pancreatectomy with splenectomy at our hospital,were retrospectively analyzed.The expression of multiple differentiation markers was detected by immunohistochemistry to evaluate the origin of the tumor.RESULTS：The postoperative course was uneventful.The postoperative blood glucose levels ranged from 5.5 to 8.9 mmol/L.The patient restored food intake five days after operation.No postoperative complications occurred.Pathological examination showed different combination ratios of solid and cystic components between the tumors arising from both foci.However,the morphology of neoplastic cells was similar between them.Both of them were diagnosed as SPT of the pancreas.The SPT cells were highly positive for some differentiation markers such as vimentin （VIM）,S100,alpha-1 antitrypsin （AAT）,cyclin D1,PR,and nestin proteins.CONCLUSION：Bifocal SPT of the pancreas shows heterogeneous differentiation.SPT may be originated from pancreatic embryonic stem cells and results from immature differentiation of pluripotential stem cells during pancreas genesis.