无功能性胰腺神经内分泌癌的CT诊断

CT diagnosis of nonfunctioning pancreatic neuroendocrine carcinoma

目的：探讨无功能性胰腺神经内分泌癌（NPNEC）的临床特点及CT表现。方法回顾性分析10例经手术或穿刺活检病理证实为NPNEC患者的CT与临床资料。结果10例患者临床上无内分泌相关症状，7例患者以上腹部扪及肿块就诊，2例患者体检发现胰腺肿块，1例患者因胸部外伤就诊时发现胰腺肿块。10例胰腺肿瘤均为单发，病灶位于胰头5例、胰体1例、体尾交界部1例、胰尾3例；病灶形态多为类圆形或不规则形，最大径线为4.0～16.0 cm，平均（7.45±3.92）cm；病灶内密度不均匀，伴囊变坏死区4例，肿瘤内钙化2例；伴有肝内多发转移4例，脾脏、结肠受侵2例，其中1例同时累及左肾。增强扫描显示肿瘤强化多较显著，中度以上者8例，3例包膜强化明显。结论NPNEC大多缺乏特征性临床表现，CT表现有一定的特征性。

Objective To improve the diagnostic accuracy of nonfunctioning pancreatic neuroendocrine carcinoma by analyzing the CT manifestation and clinical features. Methods Retrospectively analyzed the CT manifestation and clinical data of 10 patients with NPNEC confirmed by pathology. Results None of the 10 cases had clinical symptoms related to endocrine system. Mass in the upper abdomen was touched in 7 cases, Mass in the pancreas was foundered in 2 cases for physical examination, and 1 case was detected during thoracic injury. All of the 10 cases were single lesion; tumor of 5 cases were located in pancreatic head, 1 case was located in pancreatic body and 1 case was located in body border of pancreatic tail, 3 cases were located in the tail of pancreas. The shape of tumor were round or irregular, and the longer di-ameter of tumor was 4.0-16.0 cm,the average longer diameter was （7.45±3.92）cm. The density of tumor was inhomogeneous;necrosis or cystic were found in 4 cases and calcification were found in 2 cases. Four cases had metastatic tumor in liver, the pancreas tumor invaded spleen and colon in 2 cases, one of the cases invaded left kidney. The manifestation of CT contrast enhancement of the tumor was enhanced obviously; more than moderate enhancement in 8 cases, the margin enhancement obviously in 3 cases. Conclusions There were no special symptoms in almost all NPNEC patients. The manifestation of CT was characteristic in a certain extent.