胰腺癌肉瘤临床病理观察

Pancreatic carcinosarcoma: a clinicopathologic analysis

目的探讨胰腺癌肉瘤的临床病理特点、病理诊断及预后。方法对1例胰腺癌肉瘤进行组织形态学观察和免疫组化检测,同时复习相关文献。结果患者女性,74岁。CT示胰尾占位病变。手术切除肿物。胰体尾部4 cm×4 cm×5 cm大小黄白色结节状肿物,切面实性质硬,境界欠清。镜下见肿瘤由2种成分组成,即中等分化的导管腺癌和多形性梭形细胞肉瘤。免疫组化:肉瘤成分vimentin和CD68(+),癌成分CK、CK-H、CK-L和CEA(+),而两者desmin和SMA均为(-),腺癌成分Ki-67阳性率为31%,肉瘤成分为22%。结论胰腺癌肉瘤是包含肉瘤成分和癌成分的高级别恶性肿瘤,其诊断依赖于形态学和免疫表型。

Objective To explore the clinicopathological characteristics and pathological diagnosis and prognosis of pancreatic carcinosarcoma. Methods One case of pancreatic carcinosarcoma was studied by morphological and immunohistochemical techniques. Results The nodular and firm tumor located in the body and tail of pancreas with 4 cm× 4 cm × 5 cm in size and showed gray-yellow appearance on cut surface. Microscopically,the neoplasm was composed of two components including medium differentiated adenocarcinoma and pleomorphic spindle cell sarcoma.Immunohistochemical staining showed different immunophenotypes of components of carcinoma and sarcoma. Sarcoma was positive for vimentin and CD68,and carcinoma was positive for CK,CK-H,CK-L and CEA. Both components were negative for desmin and smooth muscle actin. Conclusions Pancreatic carcinosarcoma is a high grade malignant tumor with sarcoma and carcinoma elements. Diagnosis of pancreatic carcinosarcoma depends on morphology and immunophenotype.