恶性胰腺导管内乳头状粘液性肿瘤临床及影像学特征分析

The clinical and imaging features of malignant intraductal papillary mucinous tumor of pancreas

目的探讨恶性胰腺导管内乳头状粘液性肿瘤(IPMN)临床及影像学特征,旨在提高对该病认识。方法回顾性分析本院2015年1月至2019年12月收治的7例恶性IPMN患者的临床资料。结果7例恶性IPMN均获取病理确诊,男S例,女2例;年龄58~82岁,平均73岁。最常见症状为腹痛4例,黄疸2例。1例伴慢性胰腺炎,CA199>37 U/ml 3例,CEA>5 ng/ml 3例。患者完善腹部增强CT及超声内镜检查,病变均位于胰腺头部,均未见肿大淋巴结节。主胰管型4例,混合型2例,分支胰管型1例;发现强化实性囊内壁结节2例(28.6%),主胰管直径≥10 mm 4例(57.1%),病灶≥30 mm 4例(57.1%),增厚强化囊壁3例(42.9%),非强化的壁结节3例(42.9%),主胰管直径5~9 mm 2例(28.6%),主胰管直径突然改变伴远端胰腺萎缩2例(28.6%),无胰周淋巴结肿大;恶性IPMN满足:“高风险特征”≥1项或“令人担忧特征”≥2项。结论恶性IPMN好发于老年患者,常有临床症状,腹痛最常见。若影像学检查发现IPMN具有“高风险特征”或≥2项“令人担忧特征”,需要高度怀疑恶性可能。目前临床诊断IPMN良恶性主要联合不同影像学检查方法及临床特征,诊断准确率仍有待提高。

Objective To investigate the clinical and imaging characteristics of malignant intraductal papillary mucinous neoplasm(IPMN)in order to improve the understanding of the disease.Methods The clinical data of 7 patients with malignant IPMN treated in our hospital from January 2015 to December 2019 were retrospectively analyzed.Results 7 cases of malignant IPMN were confirmed by pathology,5 males and 2 females aged 58~82 years,with an average age of 73 years.The most common symptoms were abdominal pain in 4 cases and jaundice in 3 cases.1 with chronic pancreatitis,CA199>37 U/ml in 3 cases,CEA>5ng/ml in 3 cases.The patient completed abdominal enhanced CT and ultrasound endoscopy.The lesions were located in the head of the pancreas,and no enlarged lymph nodes were found.There were 4 cases of main pancreatic duct type,2 cases of mixed pancreatic duct type,and 1 case of branch pancreatic duct type.2 cases(28.6%)of enhanced solid cystic nodules were found,4 cases(57.1%)of main pancreatic duct diameter≥10 mm,and lesions≥30 mm in 4 cases(57.1%),thickened and strengthened the capsule wall in 3 cases(42.9%),no reinforced mural nodules in 3 cases(42.9%),main pancreatic duct diameter of 5〜9 mm in 2 cases(28.6%),main pancreatic duct diameter Sudden changes were accompanied by distal pancreatic atrophy in 2 cases(28.6%),no lymphadenopathy.Malignant IPMN satisfies:"high-risk stigmata"M 1 or"worrisome features"M2.Conclusion Malignant IPMN occurs in elderly patients,often with clinical symptoms,and abdominal pain is the most common.If the imaging examination finds that the IPMN has a high-risk stigmata"or no less than two"worrisome features",a high degree of suspicion of malignancy may be required.At present,the clinical diagnosis of IPMN is mainly combined with different imaging methods and clinical characteristics,and the accuracy of diagnosis still needs to be improved.