胰腺浆液性微囊性腺瘤13例临床病理分析

Serous microcystic adenoma of the pancreas: a clinicopathological analysis of 13 cases

目的探讨胰腺浆液性微囊性腺瘤(serous microcystic adenoma,SMA)临床病理特征、诊断与鉴别诊断。方法回顾性分析13例SMA患者的临床影像学特征、组织病理学及免疫表型,并复习相关文献。结果 13例SMA中女性10例,男性3例;年龄39～74岁,平均58.8岁;8例为体检时发现,无临床症状。9例伴肝和(或)肾囊肿,其中3例中央可见骨化。镜下见肿瘤主要由大小不等的囊腔组成,囊壁衬覆单层立方上皮,细胞质透明并富含糖原。肿瘤细胞核小而圆,居中,无核仁,无核分裂象。间质可见粗大的纤维组织分隔。免疫表型:上皮细胞CK(AE1/AE3)、CK7、CK19、CK8/18、Cyclin D1和EMA均阳性,CEA、CD34、ER和PR均阴性。随访2～65个月,未见复发及转移。结论胰腺SMA是发生于胰腺外分泌部的少见肿瘤,结合临床影像学、病理组织学和免疫表型有助于诊断及鉴别诊断。手术切除肿瘤后预后良好。

Purpose To study the clinieopathological features, diagnosis and differential diagnosis of serous microeystic adenoma （SMA） of pancreas. Methods The clinical manifestations, radiological, histopathological and immunohistochemical features were an- alysed in 13 cases of SMA of pancreas. Related literatures were reviewed. Results Of 13 cases, 10 patients were females, 3 were males. The age ranged from 39 to 74 years with a mean age of 58.8 years. 8 cases were found on routine medical examinations without clinical symptoms. Nine patients of SMA were found to accompany cystic diseases of liver and/or kidney in which 3 cases with ossifica- tion. Microscopically, the tumors were composed of multiple small cysts lined by simple layer of fiat or cuboidal cells with mildly atypi- cal nuclei and clear cytoplasm containing abundant glycogen. Mitosis was absent. The stroma of the tumor was found to contain thick fi- brous tissue. Immunohistochemically, the tumor cells were positive for CK （ AE1/AE3）, CK7, CK19, CK8/18, Cyclin D1 and EMA, and negative for CEA, CD34, ER and PR. No recurrence or metastases was confirmed during follow-up from 2 to 65 months. Conclu- sions SMA of pancreas is a rare tumor originated from the pancreatic acinus. Histopathological and immunohistochemical features combined with radiological were helpful in making a SMA diagnosis and differential diagnosis. Pancreatic SMA carry a good prognosis after surgical removal.