胰腺浆液性微囊性囊腺瘤临床病理分析

Clinicopathologic Analysis of Serous Microcystic Adenomas of Pancreaseas

目的探讨胰腺浆液性微囊性囊腺瘤(serous microcystic adenomas of pancreaseas,SMAP)的临床病理学特征、免疫学表型和鉴别诊断要点。方法对3例发生在胰腺的SMAP进行光学显微镜观察和免疫组织化学标记,并结合文献复习。结果 SMAP临床表现多为腹痛伴不明原因的消瘦。镜检:SMAP为微囊结构,囊内衬扁平或立方上皮,胞质透明,细胞核居中。免疫表型:腔面上皮细胞EMA和CK19阳性,CA19-9局灶阳性,Ki67阳性率小于2%,肌上皮细胞SMA阳性。ER、PR、CEA、CgA、Syn、S-100、Vimentin和Ⅷ因子相关抗原均为阴性。结论 SMAP是一种好发于女性的罕见良性肿瘤,病理形态学检查可明确诊断。但有时与其他胰腺肿瘤鉴别诊断时需要免疫组织化学的帮助,自身的良恶性诊断也需要长期随访。

Objective To investigate the clinicopathologic features,immunological phenotype and differential diagnosis of serous microcystic adenoma of the pancreas （SMAP）.Methods Three cases of SMAP were analyzed by light microscopy and immunohistochemistry; and related literature was reviewed.Results SMAP manifested as abdominal pain accompanied with unexplained emaciation.In microscopy,SMAP were composed of multiple small cysts lined by cuboidal or flattened epithelial cells.The cytoplasm of these cells was clear,and the nucleus was in the center.Immunophenotype results shown that the cavosurface endothelial cells were positive for EMA and CK19,partly positive for CA19-9,less than 2% of these cells were positive for Ki67,and were negative for CEA,CgA,Syn,S-100,Vimentin and Ⅷ factor.Conclusion SMAP,as one tumor occurred predominantly in elder females,was a rare benign tumor and the conclusiye diagnosis was depended on the pathology examination.However,sometimes,it needed the immunohistochemical helps to differentiate from other pancreatic tumors.Moreover,it sometimes needed a long term follow-up in order to decide the nonmalignant or malignant diagnosis of the tumor.