胰腺腺泡细胞癌的临床诊治分析(附8例报告)

Diagnosis and treatment of pancreatic acinar cell carcinoma:8 cases report

目的：探讨胰腺腺泡细胞癌的病理改变、临床特点、诊治及预后。方法：回顾2004年1月至2013年8月我院收治的8例胰腺腺泡细胞癌病例,分析其临床病理特征,结合随访资料进行总结。结果：8例胰腺腺泡细胞癌病人的平均年龄为（55.1±8.9）（37~67）岁,均为男性。术前主诉为腹胀（1例）、腹痛或不适（3例）、黄疸（2例）和体重下降（1例）。术前血清CA19-9平均值为（83.3±14.1）（3.7~285.1）U/mL。肿瘤位于胰头部3例,胰体尾部5例。术后病理学分期ⅠA期1例,ⅠB期3例,ⅡA期4例,无Ⅲ、Ⅳ期病例。术后死亡3例,死因分别为腹腔感染伴出血、全身多发转移伴恶病质和消化道出血。2例病人带瘤生存,分别为肝转移和肝、骨转移,其余3例情况良好。结论：胰腺腺泡细胞癌是一种少见的胰腺上皮源性恶性肿瘤,男性为主,预后较差,但明显好于胰腺导管腺癌。手术是胰腺腺泡细胞癌治疗首选。新辅助化疗和辅助化疗是否可改善病人预后,尚有待研究。

Objective To investigate the pathology, clinical characteristics, diagnosis, treatment and prognosis of pancreatic acinar cell carcinoma （PACC）. Methods Retrospective analysis of 8 cases with PACC admitted in Changhai Hospital in Shanghai from January 2004 to August 2013 was performed. The clinical and pathological features were analyzed and the follow-up data were summarized. Results The mean age of 8 patients with PACC was （55.1±8.9）（37-67） years and all male. Main complaints were abdominal distension （1 case）, abdominal pain/discomfort （3 cases）, jaundice （2 cases） and weight loss （1 case）. The preoperative value of CA19-9 in serum was （83.3±14.1） （3.7-285.1） U/mL. Tumor located at the head of pancreas in 3 cases and at the body and tail 5 cases. The pathologic staging showed 1 case stage Ⅰ A, 3 cases stage Ⅰ B, and 4 cases stage Ⅱ A postoperatively. There was no cases in stage Ⅲ and Ⅳ. Three cases died after operation due to the causes： intra-abdominal infection with hemorrhage, systemic metastasis with cachexia and hemorrhage of digestive tract respectively. Two patients survived with liver metastasis and/or bone metastasis. The other 3 patients were healthy. Conclusions PACC is a rare type of pancreatic epithelial tumos with male predominant. The prognosis is poor but better than pancreatic ductal adenocarcinoma. Surgery is the best treatment of PACC. Further study need to be performed to determine the effect of neoadjuvant and adjuvant chemotherapy on the prognosis of PACC.