胰腺浆液性及黏液性囊性肿瘤35例临床病理分析

Pancreatic serous and mucinous cystic neoplasm:a clinicopathological analysis of 35 cases

目的探讨胰腺浆液性及黏液性囊性肿瘤的临床及病理学特点。方法回顾性分析35例胰腺浆液性及黏液性囊性肿瘤的临床及病理资料。结果 35例患者平均年龄为54岁,男女之比为1∶1.77。肿瘤位于胰头7例(20%),胰颈4例(11.4%),胰体尾24例(68.6%)。临床影像学表现均为胰腺囊性占位。所有患者均行手术治疗,其中浆液性囊腺瘤27例(77.1%)(微囊型20例、寡囊型7例),黏液性囊性肿瘤伴异型增生8例(22.9%)(伴低级别异型增生6例、伴中级别异型增生2例)。浆液性囊腺瘤为多房囊性,囊壁衬覆扁平或立方上皮,胞质透亮,核圆形或卵圆形,无明显异型和核分裂。黏液性囊性肿瘤伴低级别异型增生为多房囊性,囊壁衬覆柱状上皮,细胞核增大、位于基底部,胞质内含有黏液,囊壁内有富于细胞的卵巢样间质;伴中级别异型增生者可见乳头状突起及隐窝样凹陷形成,细胞排列呈假复层,核拥挤、增大,可见核分裂。30例经6个月至4年的随访未发现肿瘤复发或转移,5例术后痊愈,随访失联。结论胰腺浆液性及黏液性囊性肿瘤相对少见,掌握临床病理特征有助于准确的病理诊断。

Purpose To explore the clinical and pathological characteristics of pancreatic serous and mucinous cystic neoplasm.Methods The clinicopathologic features were based on a retrospective analysis of 35 cases.Results The mean age of the 35 cases was 54 years,male：female ratio was 1∶1.77.Seven cases located in the head of the pancreas（20%）,4 cases in the neck（11.4%） and 24 cases in the body and tail（68.6%）.The imageological examination showed pancreatic cystic placeholder.All patients underwent surgery.There were 27 cases of pancreatic serous cystadenoma（77.1%）（20 cases of serous microcystic adenoma,7 cases of serous oligocystic adenoma） and 8 cases of mucinous cystic neoplasm of pancreas with low-or intermediate-grade dysplasia（22.9%）（6 cases of low-grade dysplasia,2cases of intermediate-grade dysplasia）.Histologically,the serous cystadenoma of pancreas was multilocular cystic.Cyst wall was lined with flat or cubical epithelium with clear cytoplasm,nucleus were round or oval,no significant nuclear atypia and mitosis.Mucinous cystic neoplasm of pancreas with low-grade dysplasia was multilocular cystic.Cyst wall lined columnar epithelium with mucinous epithelia and ovarian type stroma.Mucinous cystic neoplasm of pancreas with intermediate-grade dysplasia had mild-to-moderate architectural and cytological atypia with papillary projections or crypt-like invaginations,cellular pseudostratification caused by crowding of slightly enlarged nuclei,and occasional mitoses.After follow-up of 30 cases ranging from 6 months to 4 years,no tumor recurrence and metastasis were detected.5 cases were recovery after operations,but lost in the follow-up period.Conclusion Pancreatic serous and mucinous cystic neoplasm is a relatively rare tumor of pancreas and mostly occurs in female.To master the clinicopathological features is helpful to the accurate diagnosis.