胰腺错构瘤1例组织病理学诊断及文献复习

Histopathologic diagnosis of pancreatic hamartoma:A case report and literature review

分析1例胰腺错构瘤(pancreatic hamartomas,PH)的临床病理学特征,患者为女性,62岁,因无明显诱因出现上腹部持续性疼痛6个月余而入院,影像学检查显示胰腺颈部有1个实性占位,考虑神经内分泌肿瘤而行肿瘤切除术。大体上,肿瘤呈实性结节,与周围胰腺组织分界清楚,切面实性,灰白灰红色。组织学上,肿瘤与周围胰腺组织界限清楚,但无包膜。肿瘤由分化成熟的腺泡、导管和胰岛杂乱无章地分布于致密的梭形增生的间质中。免疫组织化学显示导管上皮和腺泡表达CK、CK8/18,其间可夹杂少量CgA和Syn阳性表达的神经内分泌细胞;间质梭形细胞表达vimentin和CD34,不表达CD117、CD99、SMA、Bcl-2、S100和Desmin;Ki-67增殖指数约2%。大多数导管周围同心圆结构的弹力纤维断裂或缺失。PH是一种少见的胰腺非肿瘤性病变,术前影像学检查难以明确诊断,明确诊断需要组织形态学结合免疫组织化学。

The clinicopathological features of a case of pancreatic hamartoma(PH)were retrospectively analyzed.The patient,a 62-year-old female,was admitted to the hospital because of persistent upper abdominal pain for more than 6 months without obvious inducements.Imaging examination showed that there was a solid mass in the neck of the pancreas,and tumor resection was performed for considering neuroendocrine tumor.Grossly,the tumor was a well-demarcated and solid nodular with grey-white and grayish red color on the cut section.Histologically,there was a clear boundary between the tumor and the surrounding pancreatic tissues without capsule.The tumor was composed of mature acini,ducts,and islets which disorderly distributed within the dense spindle cell stroma.Immunohistochemical staining showed that CK and CK8/18 were expressed in ductal epithelium and acini with a small number of neuroendocrine cells positive for CgA and Syn,interstitial spindle cells,expressed vimentin and CD34,but not CD117,CD99,SMA,Bcl-2,S100 and Desmin.Ki-67 proliferation index was about 2%.Histochemical staining showed that most of the elastic fibers of concentric structures around the ducts were broken or missing.PH is a rare non-neoplastic lesion of the pancreas.It is difficult to make a definite diagnosis by imaging examination before the/an operation,and histomorphology and immunohistochemistry are required for the diagnosis.