胰腺浆液性微囊性腺瘤2例临床病理观察

Clinicopathological features of serous microcystic adenoma of pancreas

目的探讨胰腺浆液性微囊性腺瘤的临床与病理学特点。方法对2例胰腺浆液性微囊性腺瘤进行临床病理、特殊染色及免疫组化观察并随访。结果 2例均为中老年女性,均因上腹部不适或疼痛就诊。肿瘤均位于胰体近胰尾部,最大径分别为3 cm和2.6 cm;切面呈蜂窝状,囊内含清亮液体或灰红色液体。镜下见瘤组织由多个小囊腔构成,似疏松的海绵状、蜂窝状,囊腔直径0.1～0.5 cm;囊壁内衬单层立方或扁平上皮细胞,胞质丰富,嗜酸性,部分胞质较透明;细胞核大小一致,无明显异型性,未见核分裂。免疫组化:CK7、CK20和CA19-9(+),CgA、Syn和CEA(-)。结论胰腺浆液性微囊性腺瘤为胰腺罕见的肿瘤,临床上多无明显症状,依据其特有的病理组织学形态及免疫组化染色可明确诊断。本病预后很好,恶性变的风险很小。治疗上目前仍以手术治疗为主,手术彻底切除可以根治。

Abstract： Objective To investigate the clinicopathologieal features of serous microcystic adenoma of the pancreas. Methods Clinicopathological analysis, histochemical and immunohistochemical studies were performed in 2 cases of serous microcystic adenoma of the pancreas. Results Both of the patients were females who were 58 years old and 50 years old, respectively. Both patients presented with upper abdominal uncomfortable or pain. Tumors varied in size from 2. 6 cm to 3 cm in maximal diameter, and both had a muhicystic appearance. Histologically, all tumors were composed of numerous microcysts lined by a single layer of cuboidal or flattened cells. The tumor cells contained clear cytoplasm with glycogen and centrally located round nuclei mostly uniform without any atypia. Mitoses were absent. Immunohistochemieally, the tumor cells revealed diffuse positivity of CKT, CK20 and CA19-9, whereas CEA, CgA, Syn, CD34, vimentin, p53 and S-100 protein were negative. Follow-up in 10 patients （range from 12 to 71 months） showed no recurrence of serous cystadenomas. Conclusion Serous microcystic adenoma of the pancreas is an extremely rare tumor. It is often non-symptomatic. Its diagnosis is mainly dependent on its unique morphological immunohistochemical feature.