胰腺黏液性囊性肿瘤的不典型CT表现及鉴别诊断

Atypical CT presentations of pancreatic mucinous cystic neoplasm and its differential diagnosis

目的 探讨胰腺黏液性囊性肿瘤(MCN)的不典型CT表现及鉴别诊断。方法 选取经病理诊断为胰腺MCN而术前影像表现不典型的17例患者资料,总结分析其临床症状、CT表现及术前诊断等。结果 17例患者中伴有临床症状13例,术前CT检查发现病变位于胰腺头颈部7例,体尾部10例;单囊单房样5例,多囊单房样3例,伴有明显实性成分7例,囊壁增厚6例,瘤内出血3例、伴有胰管和(或)胆管扩张8例、周围脂肪间隙模糊/淋巴结肿大/血管侵犯等侵袭性征象5例。CT术前诊断为囊腺瘤4例,囊腺瘤/囊肿2例,胰腺恶性肿瘤(胰腺癌/囊腺癌/转移)3例,实性假乳头状瘤/导管内乳头状黏液性囊腺瘤1例,囊(实)性肿物7例。结论 胰腺MCN不典型表现多种多样,良性胰腺MCN可伴有明显实性成分,囊壁增厚、瘤内出血、胰管扩张、周围脂肪间隙模糊/淋巴结肿大/血管侵犯等不典型侵袭性特征,恶性胰腺MCN可无侵袭性间接征象、无肿瘤标记物升高等。认识其不典型的影像学表现有利于为临床诊治提供更准确的诊断依据。

Objective To examine the atypical CT manifestations and differential diagnosis of mucinous cystic neoplasm of the pancreas. Methods The data of 17 patients with pancreatic mucinous cystic neoplasmconfirmedby pathology, but, with atypical preoperative clinical imaging manifestations, were reviewed and their clinical symptoms, CT manifestations, preopera tive diagnosis, and so forth were summarized. Results Among those 17 patients, there were 13 patients with clinical symptoms. The preoperative CT examination revealed that the lesions were located in the head and neck of the pancreas in 7 cases, in the body and tail of the pancreas in 10 cases, with single cystic monoatrial pattern in 5 cases, with multiple cystic monoatrial pattern in 3 cases, with obvious solid components in 7 cases, with cystic wall thickening in 6 cases, with intratumoral hemorrhage in 3 cases, with dilatation of pancreatic duct and/or bile duct in 8 cases, and with invasive signs such as blurring of the surrounding fatty space/enlarged lymph nodes/vascular invasion in 5 cases. There were 4 cases of cystadenoma, 2 cases of cystadenoma/cyst, 3 cases of pancreatic malignancy(pancreatic cancer/cystadenocarcinoma/metastatic neoplasm), 1 case of solid pseudopapillary tumor/intraductal papillary mucinous tumor, and 7 cases of cystic(solid) masses/occupations in the preoperative CT diagnoses. Conclusion Mucinous cystic neoplasm of the pancreas has a variety of atypical presentations. Benign mucinous cystic tumors of the pancreas may be associated with atypical aggressive features such as obvious solid components, thickening of the cystic wall, intratumoral hemorrhage, pancreatic duct dilatation, ambiguous surrounding fatty spaces/lymph node enlargement/vascular invasion. Malignant mucinous cystic neoplasm of the pancreas can be associated with some features such as no invasive indirect signs, no elevated tumor markers. It is helpful to understand the atypical imaging manifestations to differentiate the diagnosis and treatment of this disorder.