胰腺实性假乳头状瘤的多层螺旋CT表现与病理对照

Solid-pseudopapillary tumor of pancreas:MSCT imaging features and correlation with pathological findings

目的分析胰腺实性假乳头状瘤(SPTP)的MSCT表现。方法分析19例SPTP患者的MSCT双期或三期增强扫描CT表现,并与手术病理结果对照分析。结果 SPTP为胰腺单发外突性生长肿瘤,12例呈分叶状,6例呈卵圆形,1例呈类圆形。10例最大径≥5.0cm,17例见完整包膜,1例未见包膜,1例包膜破裂、不完整,4例见壁结节。肿瘤呈多囊实性混杂病变,增强后肿瘤实性部分动脉期轻、中度强化,门脉期呈渐进性延迟强化。2例伴出血,7例伴钙化,1例伴胰管扩张。18例镜下可见假乳头状结构以及出血坏死囊变,病理证实1例肠系膜区淋巴结转移,2例脉管浸润,3例胰腺周围正常组织受侵,1例十二指肠受侵。结论 SPTP的MSCT表现具有一定的特征性,平扫及多期增强扫描有助于诊断及鉴别诊断。

Objective To analyze the CT features of solid-pseudopapillary tumor of the pancreas （SPTP）. Methods Nineteen patients with SPTP proved pathologically underwent two-phase or three-phase enhanced CT,and the CT findings were analyzed combined with pathological findings. Results SPTP manifested as solitary and exogenous masses,appeared as lobulated in 12 patients,as oval in 6,and similar to round in 1 patient. The maximal diameter of SPTP was beyond 5 cm in 10 patients,complete capsule was observed in 17 patients,incomplete capsule was observed in 1 patient,no capsule was fourd in 1 patient and wall nodular was seen in 4 patients. The lesion showed as a heterogeneous mass composed of solid and polycystic parts. After contrast administration,the solid composition showed mild-moderate enhancement in arterial phase,and progressive delayed enhancement in portal phase. Hemorrhage was seen in 2 patients,calcification was seen in 7 patients,pancreatic duct dilation was showed in 1 patient. Pseudopapillary structure,hemorrhage,necrosis and cystic degeneration were seen in 18 patients under microscopy. Mesenteric lymph nodule metastasis was showed in 1 patient,vascular invasion in 2,pancreatic tissue invasion in 3 and duodenal invasion in 1 patient. Conclusion SPTP has characteristic CT features. Non-enhanced and multiphase contrast-enhanced CT scanning are helpul to the diagnosis and differential diagnosis of SPTP.