无功能性胰腺神经内分泌癌的CT诊断及临床分析

CT diagnosis and clinical analysis for nonfunctioning pancreatic neuroendocrine carcinoma

目的探讨无功能性胰腺神经内分泌癌(NF-p NEC)的CT表现及临床特点。方法回顾性分析2011年7月至2017年4月间经上海市金山区中西医结合医院诊治的9例NF-p NEC患者的CT及临床资料。结果 9例肿瘤均为单发,位于胰头部5例,胰颈部1例,胰体尾部1例,胰尾部2例。最大直径平均约67 mm。CT平扫肿瘤实性成分为等及较低密度,囊性成分为低密度。增强4例实性肿瘤明显持续强化,4例囊实性肿瘤中度强化,1例囊性肿瘤轻度强化。4例包膜较完整,5例包膜不完整并侵犯周边结构,3例肝脏转移,1例淋巴结转移。9例均经手术治疗,其中7例达到根治性切除,2例行姑息手术。术后随访6~47个月,4例死亡,中位生存时间28.8个月,另外5例存活。结论 NF-p NEC临床缺乏特异性症状而预后相对较好,其CT表现具有一定特征,一旦确诊应争取根治性切除。

Objective To explore CT and clinical features of nonfunctioning pancreatic neuroendocrine carcinoma（NF-pNEC）. Methods CT and clinical data of 9 patients with NF-pNEC, who admitted to Jinshan TCM-Integrated Hospital of Shanghai from July 2011 to April 2017, were analyzed retrospectively. Results All 9 cases were solitary tumor, of which 5 cases located in pancreatic head, 1 case located in pancreatic neck, 1 case located in pancreatic body and tail, and 2 cases located in pancreatic tail. The mean diameter was nearly 67 mm. On unenhanced CT, the solid components of all tumors showed equal and low density, and the cystic component showed low density. On enhanced CT, 4 cases of solid tumors showed marked enhancement persistently, 4 cases of cystic and solid tumors showed moderate enhancement, and 1 case of cystic tumor showed mild enhancement. The capsule of 4 cases were complete, while 5 cases showed incomplete capsule and infringed peripheral structures, 3 cases showed metastasis of liver and 1 cases showed lymphatic metastasis. All 9 cases accepted surgical treatment, of which 7 cases achieved radical resection and 2 cases accepted palliative operation. All 9 cases were followed up for 6-47 months. During the follow-up, 4 cases died, with the median survival time of 28.8 months, and the other 5 cases survived. Conclusion NF-pNEC lacks specific symptoms in clinic with good prognosis relatively. Its CT performances show certain characteristics, and radical resection should be performed once diagnosed.