胰腺实性假乳头状瘤超声表现及病理特点

Ultrasonic manifestations and pathological characteristics of pancreatic solid pseudopapillary neoplasm

目的观察胰腺实性假乳头状瘤(SPTP)的超声表现及病理特点。方法回顾性分析37例经术后病理证实的SPTP患者,男7例、女30例,平均年龄(33.6±16.4)岁,观察病灶超声表现及病理特点。结果37例均为单发病灶,超声呈圆形或类圆形不均质低回声,平均长径(49.43±5.17)mm,平均短径(39.51±4.18)mm;12例位于胰头,位于胰尾11例、胰体10例、胰颈4例;32例边界清,29例形态规则,28例见低或无回声裂隙;26例呈囊实性,21例可见包膜,8例存在钙化;8例见少许点状血流(AdlerⅠ级),2例见少许条状血流(AdlerⅡ级),10例边缘有血流(AdlerⅢ级),17例未见血流(Adler 0级)。3例血清CA199、CA50、CEA及AFP 4项标志物中至少2项高于正常范围,结合超声及病理表现诊断为恶性。大体病理见肿瘤呈类圆形或不规则形,光镜下实性区肿瘤细胞较小且大小一致,排列紧密呈巢片状,细胞核呈圆形或卵圆形,胞质丰富,多数异型性不明显。结论SPTP超声表现有一定特异性,结合病理表现及血清肿瘤标志物有助于定性诊断。

Objective To observe the ultrasonic manifestations and pathological characteristics of solid pseudopapillary tumor of pancreas(SPTP).Methods Data of 37 patients with SPTP confirmed by postoperative pathology were retrospectively analyzed.There were 7 males and 30 females,with an average age of(33.6±16.4)years.The ultrasonic manifestations and pathological characteristics of the lesions were observed.Results Round or quasi-round,solitary lesion with heterogeneous hypoecho was found in all 37 cases,with an average long diameter of(49.43±5.17)mm and an average short diameter of(39.51±4.18)mm.The lesions located in the head of the pancreas in 12 cases,in the tail of pancreas in 11 cases,in the body of the pancreas in 10 cases,while in the neck of pancreas in 4 cases.Clear boundary of lesions were observed in 32 cases,with regular morphology in 29 cases,with low or no echogenic cleft in 28 cases.Cystic-solid lesion was noticed in 26 cases,21 cases with capsule,and 8 cases with calcification.A little punctual blood flow(AdlerⅠ)was detected in 8 cases,a little strip blood flow(AdlerⅡ)was observed in 2 cases,marginal blood flow(AdlerⅢ)was observed in 10 cases,while lesion in 17 cases were found without blood flow(Adler 0).For serum carbohydrate antigen 199(CA199),CA50,carcino embryonic antigen(CEA)and alpha-fetoprotein(AFP),at least 2 of the above 4 were higher than the normal range in 3 cases,and the lesions were diagnosed as malignant combining with ultrasonic manifestations and pathological characteristics.Macropathology showed round or irregular shaped tumors in all 37 cases.Under light microscope,tumor cells in solid area were small and uniform in size,closely arranged in nest shape,and the nuclei were round or oval,with abundant cytoplasm and unapparent atypia in some cells.Conclusion Ultrasound manifestations of pancreatic SPTP had certain specificities.Combining ultrasound manifestations,pathological findings and serum tumor markers was helpful for qualitative diagnosis of SPTP.