胰腺导管内乳头状黏液性肿瘤4例病理分析并文献复习

A clinicopathological study on intraductal papillary mucinous neoplasm of pancreas: a report of 4 cases and literature review

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的临床病理特点、诊断及鉴别诊断。方法结合临床病史,回顾性分析4例IPMN的病理学特点、诊断及鉴别诊断、治疗及预后,并进行文献复习。结果 4例IPMN均为老年男性,临床均以"胰头占位"收治入院。临床症状包括黄疸、慢性胰腺炎、急性胰腺炎愈后、进行性消瘦及肝功能异常。镜下见扩张的导管衬覆黏液柱状上皮细胞,形成含有纤维血管轴心的乳头状结构,上皮有异型性,局灶伴浸润。结论IPMN是胰腺最常见的导管内病变,多表现为胰腺囊肿。IPMN的诊断需要结合大体与组织学形态,免疫组化对其诊断和组织学分型有一定帮助。IPMN应与胰腺的其他囊性病变相鉴别。根据是否伴有浸润性癌,IPMN患者预后差异显著。

Objective To explore the clinical and pathological features, diagnosis and differential diagnosis of intraductal papillary mu- cinous neoplasm （IPMN） of pancreas. Methods The clinical features, pathological findings, diagnosis and differential diagnosis, treatment and prognosis of patients with IPMN were analyzed and related literatures had been reviewed. Results 4 cases of IPMN were old men, with pancreatic head mass. Their clinical symptoms include jaundice, manifestations of chronic panereatitis or healed acute pancreatitis, progressive emaciation and abnormal liver function. Microscopically, IPMN is characterized by intraductal proliferation of columnar mucin - producing cells. The neoplas- tic epithelia are usually papillary structure and dysplasia is variable. Invasive carcinoma is observed in a focal region. Conclusion IPMN is a common cystic neoplasm of pancreas located in its duct. Diagnosis of IPMN should be combined with macroscopic and histopathologie examination. Immumohistochemical staining is helpful for its diagnosis and papillary typing. IPMN and cystic lesions of pancreas need differential diagnosis. IPMN with invasive carcinoma is usually associated with significantly worse survival than IPMN with dysplasia.