胰腺黏液性囊性肿瘤38例临床诊治分析

Clinicopathological Features of Mucinous Cystic Neoplasms of the Pancreas:Analysis of 38 Cases from a Single Center

目的探讨胰腺黏液性囊性肿瘤(mucinous cystic neoplasms,MCN)的临床病理特征。方法回顾性分析我院2014年I月至2018年12月间手术切除且术后病理确诊为MCN的38例患者的临床及病理资料,比较良性、交界性及恶性MCN之间的临床及病理特征差异及生存差异。结果38例MCN患者平均年龄(49±14.1)岁,男女比例为1:6.6,男性患者的平均年龄显著高于女性。肿瘤位于胰头部4例(10.5%),胰颈1例(2.6%),胰体尾部33例(86.8%)。术前影像学正确诊断率为36.8%(14/38),表现为单房性肿物26例(68.4%),多房性病灶12例(31.6%),囊壁含实性结节或乳头状突起10例(26.3%),囊壁增厚或伴有钙化者9例(25.7%)。肿瘤平均直径(5.3±2.8)cm。术后病理证实35例(92.1%)为良性MCN(轻-中度异型增生),1例为重度异型增生(原位癌),2例浸润性癌。35例良性MCN患者的病灶平均直径为(5.4±2.8)cm,明显小于恶性组患者(9.0±1.4)cm。除1例腺癌浸润患者术后29个月死于肿瘤转移外,其余患者均存活至今,中位随访时间33月。结论MCN相对少见,临床表现缺乏特异性,术前诊断率低,手术治疗后总体预后良好。治疗决策应综合考虑肿瘤大小、增长速度、囊壁特点、肿瘤部位、临床症状及患者年龄等因素制定个体化策略,既要避免遗漏恶性尤其是浸润性MCN,也应尽量避免过度治疗增加患者负担及手术风险。

Objective To investigate the clinicopathological characteristics of mucinous cystic neoplasms of the pancreas.Methods The clinical and pathological data of 38 patients with surgical resection and confirmed postoperative histological diagnosis of MCN in our hospital from January 2014 to December 2018 were retrospectively analyzed.And the characterization and survival data between benign,borderline,and malignant MCN were compared.Results Of 38 MCN patients,the mean age was(49±14.1)years,with the male-to-female ratio 1:6.6,and the average age of male patients was significantly higher than that of females.Four(10.5%)tumors located in the head of the pancreas,1(2.6%)in the pancreatic neck,and 33(86.8%)tumors located in thebody and tail of the pancreas.The preoperative diagnostic accuracy rate was 36.8%(14/38).According to the preoperative images,12(31.6%)tumors were multilocular,10 cases(26.3%)have solid nodules or papillae on the cyst wall,and 9 cases(25.7%)have thickened cystic wall or calcification.The mean tumor diameter was(5.3±2.8)cm.Postoperative pathology showed that 35 cases(92.1%)were benign MCN(mild-moderate dysplasia),1 with severe dysplasia(carcinoma in situ),and 2 with invasive carcinomas.The average diameter of the tumors in 35 patients with benign MCN was significantly smaller than that with malignant MCN(5.4 v.s.9.0 cm,P=0.001).One case with invasive MCN died of tumor metastasis 29 months after surgery,while all the remaining patients still survived till date,with a median follow-up time of 33 months.Conclusions MCN is relatively rare,with the clinical manifestations lacking specificity.It is difficult to make the correct preoperative diagnosis,and the overall prognosis after resection is good.Therapeutic strategies should be determined considering multiple factors including tumor size,growth rate,characteristics of the cystic wall,tumor location,clinical symptoms,and age of the patient,in order to avoid missing the malignant cases,meanwhile not to increase the risk of surgery.