胰腺浆液性微囊性腺瘤11例临床病理分析

Clinicopathologic analysis of 11 cases of serous microcystic adenoma of pancreas

目的探讨胰腺浆液性微囊性腺瘤（serous microcystic adenoma of pancreas,SMAP）临床病理学特征及鉴别诊断。方法采用免疫组化En Vision两步法对11例SMAP进行检测,回顾性分析其临床病理学特征,并复习相关文献。结果 11例SMAP患者均为女性,发病年龄41~68岁,平均55岁,伴右上腹疼痛、恶心、呕吐、消瘦等临床症状。肿物位于胰腺头部5例（45.5%）。11例SMAP中10例为单发,1例为多发,肿瘤界清,切面呈蜂窝状。镜下见肿瘤由大小不一的小囊构成,囊壁内衬单层扁平或立方上皮细胞,胞质透亮,细胞核小、无异型。免疫表型：11例SMAP均表达CK、CK7、CK18、CK19、EMA,3例表达NSE、α-ACT,Cg A、Syn、vimentin、TG、Calretinin均阴性,Ki-67增殖指数﹤1%,D2-40、CD34血管阳性,二者在肿瘤细胞中阴性。结论 SMAP是一种少见的胰腺良性肿瘤,需与胰腺寡囊型囊腺瘤、假性囊肿、黏液性囊腺瘤、淋巴管瘤和毛细血管瘤、间皮瘤鉴别。

Purpose To study the clinicopathologic features and differential diagnosis of serous microcystic adenoma of pancreas（ SMAP）. Methods Immunohistochemical study was carried out,and the clinical and pathologic features were evaluated in 11 cases of SMAP,and review the literatures. Results The age of onset of 11 cases of SMAP ranged from 41 ~ 68 years（ average = 55 years）.All of them were females. The clinical presentations were right upper abdominal pain,nausea,vomiting and weight loss. Five tumors located in the pancreas head（ 45. 5%）. Grossly,ten cases were solitary,one case was multiple. The boundary of tumor was clear,the cut surface of tumor was honeycomb. Histologic examination showed that the tumors were made up of small sized capsule wall lining of single-layer flat or cube epithelial cell. The cytoplasm was clear,nucleus was small and no atypical features. Immunohistochemical study showed that all of the 11 cases were positive for CK,CK7,CK18,CK19,EMA,3 cases were positive for NSE,α-ACT,all of the 11 cases were negative for Cg A,Syn,vimentin,TG,Calretinin. Ki-67 〈 1%. Vascular vessels were positive for D2-40 and CD34.Conclusions SMAP is a very rare benign tumor of pancreas. It should be distinguished from oligo-cystic cystadenoma,pseudocyst,mucinous cystadenoma,lymphangioma and capillary hemangioma,mesothelioma.