胰腺实性假乳头状瘤的CT征象分析

CT findings analysis of solid pseudopapillary tumor of the pancreas

目的：探讨胰腺实性假乳头状瘤（SPTP）的CT征象,提高对本病的诊断能力。方法：回顾性分析经手术和病理证实的10例SPTP患者的CT资料,其中女8例,男2例,年龄12-54岁,平均27.2岁。10例患者术前均行螺旋CT胰腺平扫与增强扫描。结果：10例SPTP均表现为孤立肿物,其中5例位于胰头,4例位于胰尾,1例位于胰体。3例肿块呈类圆形,4例呈卵圆形,3例呈不规则形,肿块最大径2.1-8.6 cm,平均6.5 cm。肿瘤全部由实性和囊性成分构成,以实性组织为主者5例,囊、实结构比例相近3例,以囊性结构为主者2例。动态增强扫描实性部分呈渐进性强化,囊性部分无强化。5例肿瘤的实体部分可见线形、小结节或斑块状钙化。1例肿瘤内可见液体-碎屑平面及＂浮云征＂。1例囊性为主肿瘤CT平扫囊性成分中见片状高密度影,术后病理证实为陈旧性出血。7例肿瘤有完整包膜,增强后强化明显,3例包膜不完整,手术见与周围组织有粘连,其中1例镜下可见侵犯邻近下腔静脉旁脂肪组织及十二指肠壁。肿瘤引起胰管增宽与肝管扩张各1例。所有病例均未见腹腔淋巴结肿大及远处脏器转移。结论：胰腺实性假乳头状瘤主要见于青年女性,具有相对特征的CT表现,即胰腺较大囊实性肿物,边缘清晰,实性部分呈渐近性强化,少数伴出血、钙化。

Objective：To demonstrate the CT features of solid pseudopapillary tumor of the pancreas（SPTP） so as to improve the imaging diagnostic abilities.Methods：The CT materials of 10 cases with surgery and pathology proved SPTP were retrospectively analyzed,including 8 females and 2 males,their age ranged from 12 to 54（average being 27.2）.All of the 10 cases underwent spiral CT scan and also with contrast enhancement before surgery.Results：All of the 10 cases were isolated mass.They were located at the head（n=5）,tail（n=4）,and body（n=1） of fhe pancreas.Their shapes were round（n=3）,oval（n=4）,and irregular（n=3）.The long-axis diameter ranged from 2.1～8.6cm（mean 6.5cm）.All of the neoplasms consisted of solid and cystic components,mostly solid components in 5 cases,nearly the same proportion of solid and cystic part in 3 cases,and mostly cystic components in 2 cases.After dynamic contrast-enhanced,the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhancement.Calcification was noted in 5 cases,such as the spot,line-like,small nodules or patchy calcification.Fluid-debris level and ＂floating cloud＂ sign were noted in one case.In one case of mostly cystic components,patchy area of high attenuation were shown on CT imaging which then was proved as old hemorrhage by pathologic evaluation.Seven cases were completely encapsulated and made more remarkable on post-contrast images.Three cases had incomplete capsules,and adhesion to the surrounding tissues could be seen during operation,including one case in which invasion to the adjacent adipose tissues near the inferior vena cava and walls of the duodenum could be seen under the microscope.Pancreatic duct broadening or hepatic duct dilatation was caused by tumor each in 1 case.All of the 10 cases had no enlargement of the intra-abdominal lymph nodes or distant organ metastasis.Conclusion：SPTP were mainly seen in young women,has comparatively characleristic CT imaging features：a large solid and cystic tumor of pancreas,sharp edges,the solid parts of the lesion showed progressive enhancement,a few with hemorrhage and calcification.