Spiral CT localization of pancreatic function-ing islet cell tumors

BACKGROUND: Surgeons are always concerned about the localization of pancreatic functioning islet cell tumor. If the tumor is accurately localized before operation, resection of the pancreatic body and tail without intention can be avoided. The purpose of this study was to evaluate spiral CT localization of pancreatic functioning islet cell tumors and CT techniques. METHODS: CT manifestations in 6 patients with clinically and pathologically proved pancreatic functioning islet cell tumors ware analyzed retrospectively. RESULTS: In 4 patients with insulinomas and 2 patients with glucagonomas, 5 were localized accurately by CT be- fore surgery and 1 was detected retrospectively. The en- hancement of tumors was greater than that of normal pan- creas in arterial phase and pancreatic parenchymal phase. Four patients showed mild high-density and 2, iso-density in the portal venous phase. CONCLUSION: Spiral CT multi-phase enhanced scan with 1.5 ml/kg contrast agent and 2-5 mm slice width can loca- lize functioning islet cell tumors accurately.

SPECTRUM OF FUNCTIONING ISLET CELL TUMOR ON MULTISLICE COMPUTED TOMOGRAPHY:EXPERIENCE ON 70 PATIENTS

Objective To review experience in preoperative detection of islet cell tumors using multislice computed tomography （MSCT） and summarize various imaging features of functioning islet cell tumors on enhanced MSCT. Methods Seventy patients with clinical or pathological diagnosis of functioning pancreatic islet cell tumor between October 2003 and February 2007 were included in this retrospective study. Seventy-four enhanced MSCT scans in these patients were identified. All MSCT scans were interpreted by two experienced radiologists by consensus interpretation. Surgery and pathology reports were used to confirm the diagnosis, localization, and size of tumors. Results Totally, 73 functioning islet cell tumors including 65 benign insulinomas, 2 benign glucagonomas, 3 malignant insulinomas, and 3 malignant glucagonomas were pathologically diagnosed. Tumors in only two cases were not found by MSCT. In 67 benign lesions, 32 showed typical enhancement style, 21 showed prolonged enhancement in portal venous phase, 4 showed delayed enhancement, 4 had iso-dense enhancement with normal pancreatic parenchyma, 2 had no enhancement at all in arterial phase and portal venous phase, and 4 had inhomogeneous enhancement with necrosis or cyst-formation. Patchy or spotty calcifications were found in 3 of the 67 tumors. In 6 malignant islet cell tumors, vessel invasion （2/6） and bowel invasion （1/6） were seen. Different enhancement patterns were shown. All hepatic metastases showed hyper-enhancement during their arterial phase. Conelttsions Pancreatic islet cell tumor may display a wide spectrum of presentations in MSCT. Tumors with unusual appearances often present as diagnostic challenges. Non-contrast and post-contrast multiphase scans are recommended for the localization of functioning islet cell tumors.

CLINICOPATHOLOGIC FEATURES AND SURGICAL TREATMENT OF NONFUNCTIONING ISLET CELL TUMORS

Objective.To in vestigate clinicopathologic characteristics and surgical results of nonfunctiona l islet cell tumors.Methods.We performed retrospective analysis of50patient s with nonfunctional islet cell tumor treat-ed at Peking Union Medical College Hospital from July1968to July1999,and summarized clinical symptoms and signs,primary diagnosis before surgery,surgical treatments,pathologic and im munohisto-logical characteristics.Results.Of the50cases examined from July 1968to July1999,12were found during physical examinations. The most common symptoms were upper abdominal pain and upper abdominal dis-com fort,which appeared in20casesand17casesrespectively,an d the most common sign was abdominal masses.B-ultrasound and CT are the most commonly used means for preoperative examination,with posit ive rates of97.8%and100%respectively.Op-e rative mortality was2%.Five-year survival rate of radical surgery of maligna nt cases was75%.Immuno-histological examinations showed that tumors rich i n multi-peptide linked hormones,neuron-specific eno-lase and chromaffin were in65%cases,90.6%and73.3% respectively.The positive rates of insulin,glucagons,somatostatin,pancreat ic polypeptide,gastrin and vasoactive intestinal peptide were68.2% ,51.2%,42.9%,40% ,25%and15.8%respectively.Conclusion.Nonfuncti onal islet cell tumors lack diagnostic specificity.Ultrasound and CT are primar y examination methods.Immunohistological analysis indicates different hormones ,but lacks the presence of related clinical symptoms.Surgery is an effective treatment for nonfunctional islet cell tumors,and even for those with distal m etastasis,immediate surgical removal and treatment can improve prognosis.

Pancreatic and peri-pancreatic lesions mimic pancreatic islet cell tumor in multidetector computed tomography

Objective This pictorial review aimed to summarize the most possible differential diagnosis of pancreatic islet cell tumor （PICT）. Data sources Data used in this review were mainly from Medline and Pubmed in English. And all clinical images in this review were from Department of Radiology, Peking Union Medical College Hospital, Beijing, China. Study selection Cases of pancreatic cystadenoma, solid pseudo-papillary tumor of the pancreas, pancreatic metastasis, pancreatic adenocarcinoma, para-pancreatic neuroendocrine tumors, Castleman disease, gastrointestinal stromal tumor, splenic artery aneurysm and accessory spleen were selected in this pictorial review for differential diagnosis of PICT.

巨大胃肠间质瘤并发非胰岛细胞肿瘤性低血糖患者一例的护理

总结1例巨大胃肠间质瘤患者并发非胰岛细胞肿瘤性低血糖患者的护理经验。该例患者因低血糖意识不清入院,经多学科协作,采用数字化血糖监测和管理,结合中西医治疗策略,有效控制了其低血糖症状和腹胀问题。护理措施主要包括:高频次血糖监测以及时发现低血糖反应,遵医嘱调整药物治疗方案以稳定血糖水平,并采用中西医结合方法缓解患者的腹胀并提高其舒适度。经过积极治疗与护理,该例患者低血糖发作显著减少,营养状况得到改善,病情稳定后转至当地医院继续治疗。该患者的救治过程中,多学科协作在处理罕见副肿瘤综合征中十分重要,可为临床护理提供参考。

Current surgical management of pancreatic endocrine tumor liver metastases

BACKGROUND: The management of metastatic disease in pancreatic endocrine tumors (PETs) demands a multidisciplinary approach and the cooperation of several medical specialties. The role of surgery is critical, even when a radical excision cannot always be achieved. DATA SOURCES: A PubMed search of relevant articles published up to February 2011 was performed to identify current information about PET liver metastases regarding diagnosis and management, with an emphasis on surgery. RESULTS: The early diagnosis of metastases and their accurate localization, most commonly in the liver, is very important. Surgical options include radical excision, and palliative excision to relieve symptoms in case of failure of medical treatment. The goal of the radical excision is to remove the primary tumor bulk and all liver metastases at the same time, but unfortunately it is not feasible in most cases. Palliative excisions include aggressive tumor debulking surgeries in well-differentiated carcinomas, trying to remove at least 90% of the tumor mass, combined with other additional destructive techniques such as hepatic artery embolization or chemoembolization to treat metastases or chemoembolization to relieve symptoms in cases of rapidly growing tumors. The combination of chemoembolization and systemic chemotherapy results in better response and survival rates. Other local destructive techniques include ethanol injection, cryotherapy and radiofrequency ablation. CONCLUSION: It seems that the current management of PETs can achieve important improvements, even in advanced cases.

胰岛细胞瘤的MRI表现与鉴别诊断

目的探讨MRI在胰岛细胞瘤诊断和鉴别诊断中的价值。方法回顾性分析病理证实的9例胰岛细胞瘤的MRI表现特点。MRI检查包括SET1WI、抑脂FSET2WI和FSPGR动态增强扫描。结果9例在MRI共发现10个病灶,1例无功能胰岛细胞瘤有2个病灶。抑脂T2WI高信号(7/10),抑脂FSPGRT1WI低信号(7/10)。三期明显强化(4/10);动脉期强化不明显,静脉和平衡期强化逐渐明显(4/10);环形强化(2/10)。结论MR检查在胰岛细胞瘤诊断和鉴别诊断中有重要价值。

胰岛细胞瘤的CT表现与鉴别诊断

目的 探讨CT在胰岛细胞瘤诊断和鉴别诊断中的价值。资料与方法 回顾性分析 10例经病理证实的胰岛细胞瘤CT表现并对CT检查方法进行比较。其中常规CT扫描并增强 6例 ,螺旋CT扫描并双期增强扫描 4例。结果 胰岛素瘤 5例 ,大小为 0 .9～ 2 .0cm。 3例常规CT平扫并增强扫描未发现肿瘤 ,2例螺旋CT平扫为等密度 ,增强扫描在动脉期为高密度 ,门脉期为等密度。无功能性胰岛细胞瘤 5例 ,大小为 2 .0～ 6 .0cm ,其中 3例常规CT平扫 ,1例未发现肿瘤 ,2例呈不均匀密度 ,均匀稍高密度 ;增强扫描呈周边明显强化 ,中心稍强化、均匀强化 ;2例螺旋CT平扫呈不均匀密度 ,双期增强呈周边强化 ,不均匀强化。结论 CT检查对于 >2cm的胰岛细胞瘤有较大的诊断价值 ,而对于

无功能性胰岛细胞瘤的影像学与临床对照研究

目的 研究无功能性胰岛细胞瘤的临床及影像学特征 ,并进行对照分析及鉴别诊断。材料与方法 选取经病理证实的无功能性胰岛细胞瘤 2 0例。全部患者术前均行CT、B超检查 ,观察肿瘤的位置、数目、大小 ,瘤内有否出血、坏死、囊变以及钙化 ,局部组织的浸润 ,远处脏器的转移等。结果 位于胰头部 9例 ,胰体、尾部 11例 ,均为单发性肿瘤 ,肿块直径 3 .0～ 14 .2cm ,平均8.1cm。 12例发生坏死、囊性变 (60 % ) ,2例肿瘤有钙化 (10 % ) ,6例发生转移 (3 0 % )。结论 加深对无功能性胰岛细胞瘤临床表现、影像学特征的认识有助于提高该病的诊断率。

胰岛细胞瘤的CT和MRI表现

目的:探讨胰岛细胞瘤的CT和MRI表现。方法:对9例手术证实的胰岛细胞瘤的CT和MRI表现进行回顾性分析,其中功能性胰岛细胞瘤7例,无功能性胰岛细胞瘤2例。结果:9例胰岛细胞瘤均富血供,边界清楚,与周围胰腺分界清楚,无血管、胰管侵犯。功能性胰岛细胞瘤多较小,无功能性胰岛细胞瘤较大。结论:胰岛细胞瘤有典型的CT和MRI表现,CT和MR增强扫描能准确诊断胰岛细胞瘤。

超声内镜在胰岛细胞瘤术前定位诊断中的价值

目的探讨超声内镜(endoscopic ultrasound,EUS)在胰岛细胞瘤(insulinoma)术前定位诊断中的价值。方法 2006-2012年我院51例经手术切除后病理确诊的胰岛细胞瘤患者,对其术前不同检查方法的影像学资料进行回顾性分析,探讨胰岛细胞瘤术前检查方法的选择。结果各检查方法术前定位的敏感性和准确性:EUS为97.9%和90.2%,经腹超声为20.7%和18.7%,超声造影为93.5%和78.4%,增强CT为57.1%和54.1%,增强MRI为89.5%和77.3%,血管造影为76.9%和71.4%。结论 EUS检查对胰岛细胞瘤的术前定位具有重要价值,安全可靠,可作为首选,如患者条件允许,可再选择超声造影和腹部增强MRI。

非功能性胰岛细胞瘤的诊治

对１５例非功能性胰岛细胞瘤进行回顾性分析，以探讨该病的诊断和治疗。钡餐、Ｂ超、ＣＴ、选择性腹腔动脉造影以及ＥＲＣＰ对该病有诊断价值。作者认为应将癌细胞异形性、核分裂相和瘤细胞侵犯被膜或血管作为诊断恶性的标准。手术切除是治疗非功能性胰岛细胞瘤的主要方法。１５例中单纯行肿瘤摘除术４例，胰体尾切除术８例，胰十二指肠切除术２例。手术切除率９３．３％（１４／１５）。

26例胰岛细胞肿瘤的临床诊治

目的:探讨功能性与无功能性胰岛细胞肿瘤术前定位方法、术中决策及预后。方法:对1989～2000年12年间收治的26例胰岛细胞肿瘤进行回顾性分析。结果:全组26例,功能组20例,无功能组6例;男性9例(34.6%),女性17例(65.4%),年龄范围:15～72岁;术前23例明确诊断,3例为术后病理诊断证实。功能组B超定位准确率55.0%,CT44.5%,MRI60.0%,血管造影(DSA)71.0%;无功能组B超定位准确率100%,CT100%,MRI66.7%。结论:胰岛细胞肿瘤定位:无功能组较功能组诊断阳性率高,肿瘤体积大,经各种检查仍不能定位时,可根据临床表现实行开腹探查;首选胰岛细胞瘤摘除术,必要时可行胰十二指肠切除或胰体尾切除;对无法彻底切除的恶性胰岛细胞肿瘤,应尽量切除原发和转移病灶。无功能组较功能组治愈率低,生存期较短,预后较差。

CT灌注成像在胰腺肿瘤诊断中的应用价值

目的:探讨胰腺肿瘤的CT灌注成像(CTPI)特征,评价CTPI在胰腺肿瘤诊断中的价值。方法:对50例胰腺肿瘤患者和45例非胰腺疾病患者行CTPI,选择获得良好灌注图像者共76例,其中胰腺肿瘤患者44例和非胰腺病变患者32例。测量ROI的血流量(BF)、血容量(BV)、达峰时间(TTP)和表面通透性(PS)的值,并进行统计学分析。结果:胰腺癌组织的BF、BV、PS较正常胰腺组织明显减低,TTP较正常胰腺组织升高,差异均有统计学意义。实性假乳头状肿瘤组织的BF、BV、PS较正常胰腺组织明显减低,差异有统计学意义。胰岛细胞瘤的BF、BV较正常胰腺组织明显增高,差异有统计学意义。结论:CTPI可反映胰腺肿瘤的血流动力学特征,对胰腺肿瘤的临床诊断及鉴别诊断有重要的作用。

无功能胰岛细胞瘤9例报告

本文报告无功能胰岛细胞瘤9例,其中癌2例,分别于术后4个月和1年死亡,良性肿瘤7例,术后随诊3个月～18年均健在。患者均以上腹包块为主诉,随肿块逐渐增大可有上腹饱胀、疼痛、黄疸和消化道梗阻等相应的症状及体征。超声、胃肠透视、CT和腹腔动脉造影对定位诊断有较大帮助。行肿瘤切片免疫组织化学染色,其胰高血糖素、胰岛素及生长抑素均阴性,镜下区分良、恶性肿瘤的标志之一要视肿瘤有否转移。主要的治疗方法是手术切除肿瘤。

术中超声定位在胰岛细胞瘤外科治疗中的应用体会

目的:探讨术中超声定位在胰岛细胞瘤外科治疗中的临床应用价值。方法:回顾性分析我院2004年10月至2010年8月行手术治疗结合术中超声定位的8例胰岛细胞瘤患者的临床资料。结果:围手术期无死亡病例(0/8)。良性肿瘤患者7例,恶性患者1例,其中功能性6例,无功能性2例。术后恢复良好,无严重并发症。术前影像联合定位诊断准确率62.5%(5/8),术中超声定位诊断准确率100.0%(8/8)。结论:胰岛细胞瘤的术中超声定位诊断准确率高,不仅能快速精确定位,还能减少因盲目扩大切除造成不必要的创伤,值得临床推广。

无功能性胰岛细胞瘤15例诊治体会

报告无功能性胰岛细胞瘤15例的诊治结果,其中14例可扪及腹部肿块,3例伴有急性胰腺炎,2例伴有黄疸。术后病理学检查证实均为本病,其中3例为恶性。B超检查阳性率为100%,定位准确率66.6%;CT检查8例均为阳性,定位准确率75%。12例良性者术后随访效果良好。无功能性胰岛细胞瘤经适时手术,除恶性外,预后均良好。

神经内分泌标志物在无功能胰岛细胞瘤中的表达及意义

目的:研究神经内分泌标记嗜铬粒蛋白(CG)、突触素(Syn)和神经特异性烯醇化酶(NSE)在无功能胰岛细胞瘤中的表达及意义。方法:用链菌素亲生物蛋白-过氧化物酶法(S-P法)对我院收治的1988～2001年间共14例无功能胰岛细胞瘤石蜡标本进行了嗜铬粒蛋白(CG)、突触素(Syn)和神经特异性烯醇化酶(NSE)免疫组织化学研究。结果:14例无功能胰岛细胞瘤中NSE、CG和Syn的阳性表达分别有12、8和12例,阳性率分别为85.7％、51.7％和85.7％。除1例外,其余病例中3种激素至少有一种阳性表达。结论:CG、Syn、NSE在无功能胰岛细胞瘤中呈强阳性表达,是胰腺无功能胰岛细胞瘤的良好标记,联合检测有助于提高检测的敏感性。

嗜银核仁组成区法在研究肿瘤增生活性中的应用

作者应用研究增生活性的方法之一——嗜银核仁组成区法(AgNOR),测定了难以区分良恶性的结肠肿瘤50例及胰岛细胞瘤的增生活性,发现恶性组的AgNOR值非常明显地高于良性组,同时,对目前常用的研究肿瘤增生活性的不同方法进行了扼要的比较与讨论。

胰腺实性假乳头状瘤与胰岛细胞瘤的临床病理对比研究

目的研究胰腺实性假乳头状瘤(SPTP)与胰岛细胞瘤(ICT)的临床表现和病理学特点。方法回顾性总结15例SPTP与12例ICT的临床症状、CT表现和病理特征,并对比分析肿瘤病理特征与CT影像的关系。结果SPTP患者平均年龄22.4岁,12例以腹部肿块为首发症状;组织学上,其特征性表现是以肿瘤细胞围绕纤维血管轴心排列形成假乳头状结构;CT平扫可见囊性与实性成分相间,增强扫描动脉期肿瘤实性成分呈现轻度强化,静脉期强化增强。ICT患者平均年龄39.3岁,其中8例功能性胰岛细胞瘤患者症状均明显,表现为典型的Whipple三联征;组织学上,肿瘤细胞排列成小梁状、团块状、腺泡状或实性,血供丰富;对于瘤体较小者,CT平扫常难以发现,增强扫描动脉期肿瘤呈现明显强化,静脉期强化稍减弱。结论临床表现、组织学特征结合CT影像检查有助于SPTP与ICT的鉴别诊断。