Reoperation for heterochronic intraductal papillary mucinous neoplasm of the pancreas after bile duct neoplasm resection:A case report

BACKGROUND Intraductal papillary neoplasm of the bile duct(IPNB)and intraductal papillary mucinous neoplasm(IPMN)of the pancreas have similar pathological manifestations.However,they often develop separately and it is rare for both to occur together.Patients presenting with heterochronic IPMN after IPNB are prone to be misdiagnosed with tumor recurrence.CASE SUMMARY A 67-year-old male patient was admitted 8.5 years after IPNB carcinoma and 4 years after the discovery of a pancreatic tumor.A left hepatic bile duct tumor with distal bile duct dilatation was found 8.5 years ago by the computed tomography;therefore,a left hepatectomy was performed.The postoperative pathological diagnosis was malignant IPNB with negative cutting edge and pathological stage T1N0M0.Magnetic resonance imaging 4 years ago showed cystic lesions in the pancreatic head with pancreatic duct dilatation,and carcinoembryonic antigen continued to increase.Positron emission tomography showed a maximum standard uptake value of 11.8 in the soft tissue mass in the pancreatic head,and a malignant tumor was considered.Radical pancreatoduodenectomy was performed.Postoperative pathological diagnosis was pancreatic head IPMN with negative cutting edge,pancreaticobiliary type,stage T3N0M0.He was discharged 15 d after the operation.Follow-up for 6 mo showed no tumor recurrence,and quality of life was good.CONCLUSION IPNB and IPMN are precancerous lesions with similar pathological characteristics and require active surgery and long-term follow-up.

Pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16cm×12cm×4cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.

Solid pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasms are rare.This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas,including the epidemiology,cytology,molecular pathology,differential diagnosis,treatment,and prognosis.Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns.Solid pseudopapillary neoplasms occur predominantly in young women.Although solid pseudopapillary neoplasms can occur throughout the pancreas,they arise slightly more frequently in the tail of the pancreas.The aetiology is unknown.Extremely rare cases have been reported in the setting of familial adenomatous polyposis.There are no symptoms unique to solid pseudopapillary neoplasms,however,the most common symptom is abdominal pain or discomfort.The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour.Typically,well-demarcated masses with variably solid and cystic appearances.Microscopically,these tumours are composed of epithelial cells forming solid and pseudopapillary structures,frequently undergoing haemorrhagic cystic degeneration.Typically,these tumours express nuclear and/or cytoplasmicβ-catenin.Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1,the gene encodingβ-catenin.The overall prognosis is excellent,and most patients are cured by complete surgical resection.

Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions

Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.

Solid pseudopapillary tumor of the pancreas in male patients: Report of 16 cases

AIM: To investigate the clinical characteristics, surgical strategies and prognosis of solid pseudopapillary tumors (SPTs) of the pancreas in male patients. METHODS: From July 2003 to March 2013, 116 patients were diagnosed with SPT of the pancreas in our institution. Of these patients, 16 were male. The patients were divided into two groups based on gender: female (group 1) and male (group 2). The groups were compared with regard to demographic characteristics, clinical presentations, surgical strategies, complications and follow-up outcomes. RESULTS: Male patients were older than female patients (43.1 +/- 12.3 years vs 33.1 +/- 11.5 years, P = 0.04). Tumor size, location, and symptoms were comparable between the two groups. All patients, with the exception of one, underwent complete surgical resection. The patients were regularly followed up. The mean follow-up period was 58 mo. Two female patients (1.7%) developed tumor recurrence or metastases and required a second resection, and two female patients (1.7%) died during the follow-up period. CONCLUSION: Male patients with SPT of the pancreas are older than female patients. There are no significant differences between male and female patients regarding surgical strategies and prognosis. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Current status of diagnosis and therapy for intraductal papillary neoplasm of the bile duct

Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts.Clinicopathological images of these tumours are distinctive and diverse,including histological images with a low to high grade dysplasia,infiltrating and noninfiltrating characteristics,excessive mucus production,and similarity to intraductal papillary mucinous neoplasm(IPMN)of the pancreas.The World Health Organization Classification of Tumours of the Digestive System in 2010 named these features,intraductal papillary neoplasm of the bile duct(IPNB),as precancerous lesion of biliary carcinoma.IPNB is currently classified into type 1 that is similar to IPMN,and type 2 that is not similar to IPMN.Many of IPNB spreads superficially,and diagnosis with cholangioscopy is considered mandatory to identify accurate localization and progression.Prognosis of IPNB is said to be better than normal bile duct cancer.

Prognosis of cancer with branch duct type IPMN of the pancreas

AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of IPMN.RESULTS: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of gastric cancer, colon cancer, breast cancer, and pan-creatic cancer were 25.5%, 15.7%, 13.7%, and 9.8%, respectively. Twenty (13.8%) of the patients died. The cause of death was extra-pancreatic carcinoma in 40%,pancreatic cancer in 25%, IPMN per se in 20%, and benign disease in 15% of the patients.CONCLUSION: The prognosis for IPMN depends not on the IPMN per se, but on the presence of intraor extra-pancreatic cancer.

Surgical treatment for uncinate process carcinoma of the pancreas

Objectives: To analyze the clinical features of unci- nate process carcinoma of the pancreas and to im- prove the resection rate. Methods: From January 1990 to June 1999, 10 pa- tients with pancreas uncinate process carcinoma re- ceived Whipple's operation. Portal vein (PV) resec- tion and reanastomosis were performed in 5 patients, and the resected length varied from 2.0 to 4.2 cm. Two patients underwent PV lateral wall partial resec- tion. Results: Among the 7 patients undergoing PV resec- tion, 1 died of hepatic failure 3 days after operation. One patient suffered from postoperative chylous asci- tes. These 6 patients survived 13 to 29 months post- operatively. Among the 3 patients without PV resec- tion, 2 survived 13 months and 14 months respective- ly. One patient was alive by the end of follow-up for 11. 5 months postoperatively. Conclusion: Although uncinate process carcinoma of the pancreas has a tendency to invade the adjacent PV and superior mesentery vein, it should not be simply regarded as a contraindication of radical resection.

IMAGING EVALUATION OF SEROUS CYSTADENOMAS AND MUCINOUS CYSTIC TUMORS OF THE PANCREAS

Objective To evaluate imaging features of the serous cystadenomas and mucinous cystic tumors of the pancreas. Methods The imaging findings in 59 patients with pathologically proven serous cystadenomas (SCs), mucinous cystadenomas (MCs), and mucinous cystadenocarcinomas (MCCs) of the pancreas were reviewed for location, thickness of septa or the cyst wall, number of cysts, diameter of the largest cyst, lesion calcification, presence of mural node or solid enhancing component, dilatation of the main pancreatic duct (MPD), lesion communication with MPD, invasion of surrounding organs, and regional lymphadenopathy.Results The characteristic imaging feature of SCs was that of microcystic lesion with >6 cysts, the diameter of the largest cyst being <2 cm. Mucinous cystic tumors (MCTs) including MCs and MCCs were that of macrocystic lesion with <6 cysts, the diameter of the largest cyst being >2 cm. MCs was that of a lesion with smooth and regular cyst wall and septa, the wall/septa thickness being <0.3 cm. MCCs was that of a cystic lesion with thick irregular septa, presence of mural node or solid enhancing component, invasion of surrounding structures. These findings were of statistical significance. Conclusion SCs, MCs, and MCCs have characteristic imaging features. Analysis of the number of cysts, septation features, mural node or solid enhancing component, diameter of the largest cyst, dilatation of the pancreatic duct, and invasion of surrounding structures often can successfully subtype tumors into benign SCs or potentially malignant MCs or malignant MCCs.

SOLID PSEUDOPAPILLARY TUMOR OF THE PANCREAS:CLINICAL AND COMPUTED TOMOGRAPHIC FINDINGS WITH PATHOLOGIC CORRELATION IN 21 CASES

Objective To correlate the clinical and imaging features of the solid pseudopapillary tumor (SPPT) of the pancreas with the pathologic diagnosis. Methods The computed tomographic findings in 21 patients (18 women and 3 men) with pathologically proven solid pseudopapillary tumor of the pancreas were reviewed retrospectively. Two radiologists reviewed images for location, size and morphology, capsule and margin, density, enhancement pattern, calcification, dilatation of pancreatic duct, lymphadenopathy, vascular invasion, distant metastasis, and recurrence. Results On CT, the lesion presented as solitary, round (28.57%), oval (57.14%), or lobulated (14.28%) mass in pancreatic head (47.62%) with complete capsule (85.71%). Lesions smaller than 4cm in maximum diameter (47.62%) presented as predominantly solid mass whereas lesions greater than 4cm in diameter (52.28%) presented as heterogenous mass. On contrast administration, the viable solid portion of the tumor showed mild peripheral enhancement in arterial phase [enhancement degree<20Hounsfield unit (HU)] with progressive fill in during the portal and hepatic parenchyma phase (enhancement degree 20-40HU). Eighteen lesions (85.7%) had complete capsule. Two lesions (9.5%) had areas of high density (>60HU) on plain CT which due to hemorrhage. Dilatation of the pancreatic duct was rare (25%), and distant metastasis, regional lymphadenopathy, and tumor recurrence were absent. Nine patients (42.85%) had an abdominal CT follow-up for 24.55months (range, 2-60months) post-surgery without recurrence or distant metastasis. Conclusion Solid pseudopapillary tumor of the pancreas usually occurs in young females in the pancreatic head or tail. On CT, they manifest as moderate vascular mixed tumor, progressive enhancement of the viable solid portion, distinct tumor margin with capsule formation, and absence of regional lymphadenopathy.

胰腺癌中livin、caspase-3的表达及其临床意义

目的探讨livin和caspase-3蛋白在胰腺癌中的表达及其与临床病理参数和预后的相关性及意义。方法应用高通量的组织芯片技术和免疫组化SP法检测88例无术前放化疗史的胰腺癌手术标本和11例非肿瘤性胰腺组织中livin和caspase-3蛋白的表达情况,运用Spearman秩相关分析两者之间的相关性,并对随访2个月～6年的54例病例作生存分析。结果88例胰腺癌组织中,livin的阳性表达率为76.1%(67/88),而caspase-3在非肿瘤性胰腺组织中的阳性表达率为90.9%(10/11),显著高于胰腺癌组织(40.9%,36/88),差异均有统计学意义(P<0.01);livin表达与患者性别、肿瘤大小、TNM分期及淋巴结转移相关(P<0.05),caspase-3表达与患者性别、组织学分化、TNM分期及淋巴结转移相关(P<0.01);经Spearman秩相关分析显示,livin和caspase-3在胰腺癌中有协同表达(P<0.01);在有随访结果的54例中,单因素COX分析显示,livin表达及淋巴结转移情况与预后相关(P<0.05),caspase-3表达及患者性别、年龄、部位、肿瘤大小、组织学分化程度、TNM分期与预后无关(P>0.05);多因素COX分析显示,只有livin表达具有独立的预后意义(P<0.05)。结论livin表达与胰腺癌临床病理参数及预后密切相关,可作为胰腺癌的独立预后指标,caspase-3可能参与细胞凋亡的调控和胰腺癌生物学进程。

新肿瘤标志CA_（242）对胆胰恶性肿瘤诊断意义

应用免疫放射分析（ＩＲＭＡ）糖类抗原２４２（ＣＡ＿（２４２））在胆胰恶性肿瘤诊断中的价值，检测６６例胆胰恶性肿瘤患者，７４例胆胰良性疾病患者血清中ＣＡ＿（２４２）含量。其结果ＣＡ＿（２４２）分别为３３．５２７±１９．９８２Ｕ／ｍｌ，８．４３７±５．９８７Ｕ／ｍｌ，恶性肿瘤值显著高于良性疾病组（Ｐ＜０．０１）．以１２Ｕ／ｍｌ为界值，诊断胆胰恶性肿瘤灵敏度为８０．３％，特异度８２．４％，为临床较早的诊断胆胰恶性肿瘤提供了重要依据。

三维适形放疗联合高强度聚焦超声治疗中晚期胰腺癌临床疗效

目的观察三维适形放疗(3DCRT)联合高强度聚焦超声(HIFU)治疗中晚期胰腺癌的临床疗效。方法对住院的73例胰腺癌连续病例,随意分为3DCRT+HIFU治疗组(联合治疗组)、3DCRT治疗组(放疗组)和HIFU治疗组3组。联合治疗组先行放疗,30min内接受HIFU治疗。放疗单次剂量为180～200cGy,1次/d,5次/周,总剂量5000～7000cGy;HIFU治疗每次1h,隔天一次,3次/周。结果联合治疗组、放疗组、HIFU治疗组的总有效率分别为63.64%(14/22)、44.83%(13/29)、40.91%(9/22),临床受益率(CBR)分别为95.45%(21/22)、86.21%(25/29)、86.36%(19/22);一、二年生存率分别为59.09%(13/22)、50.00%(11/22),41.38%(12/29)、24.14%(7/29),40、91%(9/22)、22.73%(5/22);中位生存期分别为17.64个月、12.43个月和12.35个月。结论 3DCRT+HIFU治疗胰腺癌具有协同增效作用,能有效的提高中晚期胰腺癌的临床疗效。

Pancreatic Head Carcinoma Versus Chronic Pancreatitis of Pancreatic Head: MR Imaging

Objective: To evaluate the manifestation of pancreatic head carcinoma andchronic pancreatitis of pancreatic head on magnetic resonance (MR) imaging and to determine whetherMR imaging can distinguish the two diseases. Methods: A retrospective review of MR findings wasperformed for 24 patients with pancreatic head carcinoma and 3 patients with chronic pancreatitis ofpancreatic head. SE T1WI and FSE T2WI sequences with and without fat suppression were performed onall 27 cases. Enhanced SE T1WI with fat suppression was performed on 8 patients with carcinomas and3 patients with pancreatitis, respectively. When dilatation of the pancreatic and/or biliary ductswas noted on T2WI sequence, MRCP were performed on 23 patients with carcinoma and 1 patient withpancreatitis, respectively. Results: Cases of carcinoma presented hypointensity (n=8) or mildhypointensity (n=16) on conventional SE T1WI, hy-perintensity (n=8), mild hyperintensity (n=5),isointensity (n=10) or hypointensity (n=1) on conventional FSE T2WI,hyperintensity (n=11),isointensity (n=11) or mild hypointensity (n=2) on FSE T2WI with fat suppression, and hypointensity(n=24) on fat-suppressed SE T1WI. MRCP demonstrated typical 'double duct sign' and abruptinterruption at distal segment of dilated common bile duct. All 8 patients with carcinoma showedlittle enhancement. All 3 patients with chronic pancreatitis showed mild hypointensity oriosintensity on conventional SE T1WI and hyperintensity on conventional FSE T2WI sequences,respectively. Two patients showed isointensity and mild hyperintensity on fat-suppressed SE T1WI andFSE T2WI sequences, respectively. The remaining patient showed hypointensity and heterogeneousintensity on fat-suppressed SE T1WI and FSE T2WI sequences respectively and a mild dilated commonbiliary duct with irregularly dilated proximal pancreatic duct on MRCP. All 3 patients with chronicpancreatitis showed various enhancements. Conclusion: Both pancreatic head carcinoma and chronicpancreatitis show various signals on various sequences and abnormal pancreatic enhancement patternand most cases of pancreatic head carcinoma and some cases of chronic pancreatitis show abnormalMRCP appearances. With the combined use of multiple sequences, especially precontrast andpostcontrast SE T1WI FS and MRCP, pancreatic head carcinoma and chronic pancreatitis of pancreatichead may be distinguished from each other.

Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses

AIM:To evaluate the usefulness of contrast-enhanced harmonic endoscopic ultrasound(CH-EUS)in differentiating between pancreatic adenocarcinomas and other pancreatic disease.METHODS:This retrospective cohort study evaluated90 patients who were seen between November 2010and May 2013.All these patients had solid pancreatic masses that had a hypoechoic appearance on EUS.All patients underwent CH-EUS to evaluate this diagnostic method’s usefulness.The mass lesions observed on CH-EUS were classified into three categories based on their echo intensity:hypoenhanced,isoenhanced,and hyperenhanced lesions.We adjusted the sensitivity and the specificity of each category for detecting malignancies.We also estimated the accuracy of CH-EUS by comparing it to a pathological diagnosis.RESULTS:Of the 90 patients,62 had a pancreatic adenocarcinoma.Fifty-seven out of 62 pancreatic adenocarcinomas showed a hypoenhanced pattern on CHEUS.The sensitivity was 92%,the specificity 68%and the accuracy approximately 82%.The area under the curve of the receiver operating characteristic analysis for CH-EUS was 0.799.There is a significant association between the hypoenhanced pattern on CH-EUS and pancreatic duct adenocarcinoma(χ2=35.264,P<0.001).In pathological examinations,the number of specimens for EUS-fine needle aspiration(EUS-FNA)was considered insufficient for diagnosis in three patients,and in two patients,the results were reported to be negative for malignancy.Pancreatic masses in all five patients revealed a hypoenhanced pattern with CH-EUS.Three patients were diagnosed with pancreatic adenocarcinoma based on the pathology results of a biopsy,and the remaining two patients were clinically diagnosed with malignancy.CONCLUSION:CH-EUS is useful for distinguishing between pancreatic adenocarcinoma and other pancreatic disease.When a pancreatic mass shows a hypoenhanced pattern on CH-EUS but involves either insufficient samples or negative results with EUS-FNA,clinicians might consider performing another pathologic diagnosis on the basis of an EUS-FNA sample or a biopsy.

Surgical palliation of unresectable pancreatic head cancer in elderly patients

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and themedian overall survival were also signifi cantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

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.

Use of oral contraceptives and risk of pancreatic cancer in women:A recalculated meta-analysis of prospective cohort studies

In a recent systematic review and meta-analysis of observational studies,the author found potential errors in the selection and extraction processes.The recalculated summary relative risks and the results of a dose-response metaanalysis showed that oral contraceptive use may not be associated with the risk of pancreatic cancer in women.

Artificial intelligence in pancreatic surgery:current applications

Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,decision-making and training toward an optimized patient care.Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability,intraoperative decision support,surgical training as well as a postoperative risk stratification to per-sonalize the management of complications.This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.

超声内镜对胃异位胰腺与间质瘤的鉴别诊断价值

目的探讨超声内镜在胃异位胰腺与间质瘤鉴别诊断中的价值。方法回顾分析经病理证实的40例胃异位胰腺与141例间质瘤患者的临床资料和超声检查结果，包括病变的部位、大小、起源层次、生长方式、内部回声等。结果胃异位胰腺最常位于胃窦部（92．5％），胃间质瘤多位于胃体（45．4％）、胃窦（23．4％）和胃底（22．0％），两者病变部位差异有统计学意义（P〈0．001）。胃异位胰腺与间质瘤在最长／最短直径比值方面差异无统计学意义（P=0．057）。间质瘤与异位胰腺大小差异有统计学意义[（19．98±12．80）mm对（11．25±3．61）mm，P〈0．001）]。异位胰腺多起源于第3层（黏膜下层，75％），间质瘤常起源于第4层（固有肌层，54．6％）和第2层（黏膜肌层，34．0％），两者起源层次差异有统计学意义（P〈0．001）。异位胰腺以肌壁内生长为主（82．5％），问质瘤以肌壁内生长（37．6％）、腔外生长（24．8％）和腔内生长（22．7％）为主，两者生长方式差异有统计学意义（P〈0．001）。内部回声方面，异位胰腺以低回声（32．5％）、中等回声（27．5％）和混合回声（27．5％）为主，间质瘤多为均匀低回声（72．3％）。结论超声内镜下异位胰腺与间质瘤在病变部位、大小、起源层次、生长方式和回声方式上差异有统计学意义，对胃异位胰腺和问质瘤的鉴别有重要价值。