胰腺实性假乳头状瘤的CT表现与病理对照分析

CT Imaging Features and Their Correlation with Pathological Findings of Solid Pseudopapillary Tumor of Pancreas

为了分析胰腺实性假乳头状瘤（SPTP）的CT表现，并与病理结果对照，提高对该病的诊断率，回顾性分析23例经手术病理证实的SPTP患者的临床、CT及病理资料。23例患者中，女21例（91.3％），男2例（8.7％）。最常见症状为腹部不适伴钝痛12例（52.2％），其他包括体检发现胰腺包块9例（39.1％），恶心呕吐2例（8.7％）。1例女性患者共有2处病灶，24例肿瘤中，位于胰头6例（25.0oA），胰颈3例（12.5%），胰体8例（33.3o.4），胰尾7例（29.2％）；肿瘤最长径2.1～20.1cm，平均6.4cm；9例以实性成分为主（37.5％），10例囊、实性成分比例相仿（41.7%），5例以囊性成分为主（20.8％）。9例患者的病灶伴钙化（39.1％）。2例患者的病灶伴出血（8.7％）。1例患者伴肝内胆管扩张（4.3％）。1例患者出现肝转移（4.3％）。CT增强扫描24例肿瘤实性成分动脉期轻度强化，门脉期持续强化，其强化程度不及正常胰腺组织，囊性成分各期均未见强化。24例镜下见假乳头状结构以及出血、坏死或囊性变。总之，SPTP的CT表现具有一定的特征性，反映其病理特征，结合临床表现有助于做出正确的诊断及鉴别诊断。

To analyze the CT features of solid pseudopapillary tumor of pancreas （SPTP）, and correlation with the pathological findings of the disease so as to improve the diagnostic abilities, the CT images and the clinical manifestations, we retrospectively analyzed the pathological materials of 23 cases with surgery and pathology proved SPTP. In the 23 patients, 21 cases were female （91.3%） and 2 were male （8.7%）. The most common symptom was abdominal discomfort with dull pain in 12 patients （52.2 % ）. Others included the pancreatic mass that was detected incidentally during physical examination in 9 patients （39.1%）, nausea/vomiting in 2 patients （8. 7%）. And 1 case of female patients had 2 lesions. In the 24 tumors, 6 cases were located at the head （25.0%）, 3 were at neck （12.5%）, 8 cases were at body （33.3%）, and 7 cases were at tail of pancreas respectively （29.2%）. The long-axis diameter ranged from 2. lcm to 20. lcm （mean 6.4cm）. 9 tumors were mostly solid component （37.5%）, 10 tumors were contained similar proportion of solid and cystic part （41.7 % ）, and mainly cystic components in 5 tumors （20.8% ）. In 9 of the 23 patients, calcification was found in the tumor （39.1%）. In 2 of the 23 patients, bleeding was seen in the mass （8.7 ~/0）. The dilation of intrahepatic bile duct was found in 1 patient （8.7%）. Liver metastasis was showed in one patient （8.7%）. On post-contrast CT scan, solid parts demonstrated mild enhancement at the arterial phase. At the portal phase, solid parts were enhanced continuously in all cases, and the enhancement degrees were lower than normal pancreatic tissue. The cystic parts of all lesions showed no enhancement. Pseudo papillary structure, hemorrhage, necrosis, or cystic degeneration were found in all patients by histological study. In a word, SPTP has comparatively characteristic CT imaging features consistent with histological features, when combined with clinical manifestations, could be correctly diagnosed and differentially diagnosed.