胰腺实性假乳头状瘤的不典型CT表现

The atypical CT appearances of solid pseudopapillary tumor of the pancreas

目的总结胰腺实性假乳头状瘤(SPTP)的不典型CT表现,以减少术前误诊率。方法回顾性分析经手术病理证实53例SPTP的临床和CT资料,其中11例表现不典型,均行CT平扫和增强扫描。结果不典型CT表现的SPTP所占比约为20.7%(11/53)。其中3例完全囊性:CT平扫均呈边界清晰薄壁囊性肿物,2例囊壁合并结节状钙化,1例囊内有多发纤细分隔;增强扫描囊壁呈轻度延迟强化。5例实性:CT平扫呈均匀低密度影,边界欠清晰;增强扫描呈均匀轻度延迟强化,其中1例合并胰腺体尾部萎缩、胰管扩张。2例富血供囊实性肿块:CT平扫表现为边界清晰软组织密度,瘤内均见点状钙化;增强扫描肿块动脉期呈明显强化,静脉期对比剂快速廓清,瘤内均见局灶性坏死。1例异位的囊实性肿块:肿块位于腹膜后,CT平扫表现为软组织密度为主,内多发点状钙化;增强扫描肿块呈明显延迟强化,瘤内见局灶性坏死。结论SPTP的不典型CT表现具有多样性特征,了解其不典型表现,有助于减少术前误诊率。

Objective To summarize the atypical CT appearances of solid pseudopapillary tumor of the pancreas(SPTP),and reduce preoperative misdiagnosis.Methods The CT materials of 53 SPTP confirmed by pathology were analyzed retrospectively.For 11 cases with atypical CT appearances,all of them were underwent unenhanced and enhanced CT Results The rate of SPTP with atypical CT appearances accounted for around 20.1%(11/53).3 cases were complete cystic lesions:they depicted well-defined and thinwalled cystic mass on unenhanced CT images.The nodular calcification was present in 2 cases,and multiple thin septa was present in one case.The walls of them were mildly prolonged enhanced on enhanced CT scan.5 cases were solid with ill-defined hypodensity masses which were mildly homogenously prolonged enhanced on enhanced CT scan.One of them was associated with the atrophy of pancreatic tail and dilated pancreatic duct.2 cases were hypervascular and mixed solid and cystic lesions.They were both markedly enhanced on arterial phase CT scan,and washed out quickly on venous phase with focal necrosis in the tumors.1 case was mixed solid and cystic lesions outside the pancreas:a retroperitoneal mass presented well-defined mass with focal calcifications,which was markedly enhanced on arterial phase CT scan with amounts of dilated blood vessels.They showed prolonged enhanced on 3-phase CT scan with focal necrosis in the mass.Conclusion The atypical CT appearances of SPTP presents variable which is helpful to decrease the preoperative misdiagno sis.