胰腺浆液性囊腺瘤21例临床及病理分析

Serous cystadenoma of the pancreas： clinicopathologic analysis in 21 cases

目的探讨胰腺浆液性囊腺瘤（SCAP）的临床与病理特点。方法回顾性分析21例SCAP患者的临床及病理资料。结果21例SCAP患者的平均年龄为61岁，男：女为1：1．33，18例（85．7％）有腹痛、腹胀、腹部包块、消瘦等症状，3例（14．3％）为体检发现。肿瘤位于胰头部9例，胰体尾部12例。临床表现均为胰腺囊性占位。21例患者均行手术治疗。病理检查见囊壁完整，内衬扁平或立方上皮细胞，胞质透亮，核圆形或卵圆形，大小一致，无明显核异型和核分裂象，病理诊断为微囊型15例、寡囊型6例。免疫组化显示肿瘤细胞EMA、CK7、CK19均阳性，碘酸一雪夫（PAS）染色亦阳性，Ki-67阳性表达率在1％～3％之间。19例经3个月到7年不等的随访未发现复发及转移。结论SCAP好发于老年女性，多数患者有临床症状。SCAP多位于胰体尾部，表现为胰腺导管上皮分化特征。患者预后良好。

Objective To investigate the clinicopathological features of patients with serous cystadenomas of the pancreas （SCAP）. Methods The clinical and pathological features of 21 cases of SCAP were retrospectively analyzed. Results The mean age of the 21 cases was 61 years old, male： female ratio was I： 1.33, 18 （85.7%） patients presented with abdominal pain, bloating, abdominal mass, weight loss, and 3 （14.3%） patients were found during check-up. The tumors were located in pancreatic head in 9 patients, in pancreatic body and tail in 12 patients. The clinical manifestations were pancreatic cystic lesions. All patients underwent surgery. Histologically, the cyst wall was complete and lined with flat or cuboidal epithelium, cytoplasm was translucent, nucleus were round or oval with similar size, no significant nuclear atypia and mitotic activity was found. The pathologic diagnosis was micro-cyst type in 15 cases, single-cyst type in 6 cases. Immunohistochemistry method showed EMA, CK7, CK19 positive and PAS staining positive. The positive expression rate of Ki 67 was between 1% and 3%. After follow-up of 19 cases ranging from 3 months to 7 years, no recurrence and metastasis was detected. Conclusions SCAP is seen predominantly in elderly female patients with significant symptoms. A majority of tumors are located in the pancreatic body and tail. SCAP presents with characteristics of pancreatic ductal epithelial, and the prognosis is excellent.