胰腺浆液性微囊性囊腺瘤2例报道并文献复习

Serous microcystic cystadenoma of the pancreas: report of two cases and literature review

目的探讨胰腺浆液性微囊性囊腺瘤(SMC)的临床病理学特征。方法分析2013~2014年本科室诊断的2例SMC的临床表现、影像学特点、组织病理学及免疫组化特点。结果 2例SMC既往有上腹部隐痛不适或腰痛等病史,均行CT检查示胰腺占位。肿瘤为单发、境界清楚的圆形肿物,大体呈微囊、海绵状,壁薄,囊内含清亮、稀薄液体;镜下见囊壁由含糖原的单层立方或扁平上皮构成,核小,居中,细胞无明显异型性。免疫表型:瘤细胞CK7、CK19、vimentin、MUC1、inhibin-α、EMA阳性,特殊染色PAS阳性,NSE、Cg A、CD10、CD34等阴性。术后随访4~19个月均未见肿瘤复发及转移。结论 SMC是发生于胰腺外分泌部的一种罕见肿瘤,多数位于胰体、尾部,常见于老年女性患者,大部分患者实验室检查及血清肿瘤标志物均正常。经病理常规和免疫组化检测可以确诊。

Objective To explore the clinicopathologic features of serous microcystic cystadenomas( SMC) of the pancreas.Methods Two SMC cases of the pancreas from 2013 to 2014 in our department were analyzed for clinical features,imaging characteristics,histopathology and immunohistochemistry. Results Both had a history of epigastric discomfort and lumbago,and then CT scanning showed pancreatic lesions. The tumor was a well-defined single mass,generally round,microcystic and spongy. Its thin wall contained clear and thin liquid. Microscopically,the tumor was composed of multiple small cysts lined by a single layer of glycogen-rich cuboidal or flattened cells with small nuclei in the middle,but the cells had no obvious atypia. Immunohistochemically,the tumor cells were positive for CK7,CK19,vimentin,MUC1,inhibin-α,EMA,and periodic acid-Schiff( PAS) staining but negative for NSE,Cg A,CD10 and CD34. No recurrence or metastasis were confirmed during follow-up at 4 months and 19 months respectively. Conclusions SMC,a rare type of pancreatic exocrine tumor,is mainly observed in the pancreatic body or tail,and commonly found in elderly female patients. The laboratory examinations and serum tumor markers of most patients are normal,but routine pathologic and immunohistochemical detections can make accurate diagnosis.