胰岛素瘤及无功能胰腺内分泌肿瘤的影像学及病理学特征

Imaging and pathologic features of insulinoma and nonfunctional pancreatic endocrine tumor

目的:探讨胰岛素瘤以及无功能胰腺内分泌肿瘤(non functional pancreatic endocrine tumor,NFPNET)的影像学和病理性特征。方法:收集2006年至2014年经病理证实为胰岛素瘤20例和无功能内分泌肿瘤10例,选取此30例瘤旁正常胰岛组织作为对照。结果:CT对两种肿瘤检查检出率低于MRI检出率(P<0.05)。手术活检病理检查发现,胰岛素瘤良性肿瘤病灶多于NFPNET(P<0.05)。胰岛素瘤患者的胰岛素、白血病相关蛋白-16(Leukemia related protein-16,LRP-16)、雌激素受体α(estrogenreeeptora,ERα)、胰高血糖素样肽-1(glueagonlikeptide-1,GLP-1)、胰高血糖素样肽-1受体(glueagonlikepeptide-1 receptor,GLP-1R)阳性表达率高于NFPNET患者(P<0.05)。胰岛素瘤常表现为Whipple三联征,易发生于胰尾,而NFPNET病人肿瘤的直径较胰岛素瘤大,易发生于胰头,且核分裂象和Ki67阳性细胞更多见,NFPNET相比于胰岛素瘤更易发生浸润转移。结论:MRI检查对胰腺肿瘤具有很好的诊断价值,为临床早期诊断和及时采取治疗措施提供有力的证据。

Objective： To analysis the imaging and pathological characteristics of insulinoma and nonfunctional pancreatic endocrine tumor（ NFPNET）. Methods： Insulinoma（ 20 cases） and nonfunctional endocrine tumor（ 10 cases） pathologically confirmed from 2006 to 2014 were collected,adjacent normal pancreatic islet tissue（ 30 cases） selected as control group. Results： The detection rate of insulinoma and NFPNET by CT was lower than that by MRI（ P〈0. 05）. Surgical biopsy pathological examination revealed benign lesions of insulinoma were more than NFPNET（ P〈0. 05）. The positive rates of insulin,LRP-16,ER alpha,GLP-1,GLP-1R in insulinoma were higher than those in NFPNET（ P〈0. 05）. Insulinoma was often shown as Whipple triad,and more likely to happen in the tail of the pancreas,while the diameter of NFPNET was greater than that of insulinoma. And compared with insulinoma,NFPNET is more prone to occur in the head of pancreas,in which mitotic and Ki67 positive cells are more common,and invasion and metastasis developed more easily. Conclusion： MRI is of great value in the diagnosis of pancreatic cancer,which can provide sufficient evidence for clinical diagnosis in early stage and immediate therapeutic measures.