胰腺浆液性微囊性腺瘤临床诊治观察

Observation of clinical diagnosis and treatment of serous microcystic adenoma of pancreas

目的分析胰腺浆液性微囊性腺瘤(serous microcystic adenoma of pancreas,SMAP)的临床病理表现,提高诊治率。方法对4例患者临床病史及辅助检查等进行回顾性分析。结果实验室检查显示肿瘤标记物值在正常范围,2例患者血糖值高于正常。肿物大体蜂窝状,镜下可见粗大的纤维组织将其分隔为大小不等的囊腔,囊壁衬覆单层立方上皮。免疫组织化学标记上皮细胞显示EMA、CK7、CK19、CKL和inhibin均为阳性,而HMB45、Cg A、Melan A和Vimentin均为阴性。随访时长2到10个月,1例无复发及转移,1例因胰漏等并发症去世,2例失访。结论 SMAP是发生于胰腺外分泌部的少见肿瘤,临床表现无特异性,结合临床影像学、病理组织学和免疫表型有助于诊断及鉴别诊断。手术切除肿瘤为最有效的治疗方法,但应预防并发症。

Objective To study the clinicopathologic characteristics and diagnosis of serous microcystic adenoma of pancreas（SMAP）, and to improve the rate of its diagnosis and treatment. Methods Immunohistochemical study was carried out, and the clinical and pathologic features were evaluated in 4cases. Results Laboratory tests indicated that the values of tumor markers were all in normal range, and the blood glucose level was higher than normal in 2 patients. The form of a honeycomb was observed, and fibers divided the tumor into multiple small cysts lined by simple layer cells. The tumor cells were positive for EMA,CK7, CK19, CKL and inhibin, and negative for HMB45, Cg A, Melan A and Vimentin. In the follow up from 2to 10 months, 1 cases had no recurrence or metastasis, 1 case died of pancreatic leakage, and 2 case did not follow up. Conclusion SMAP is a rare tumor of the exocrine pancreas which has no special clinical manifestations. Histopathological and immunohistochemical features combined with clinical history,radiological imaging was helpful in making a serous microcystic adenoma diagnosis. Surgical removal is the most effective treatment of SMAP.