molecular pathology of intraductal papillary mucinous neoplasms of the pancreas

Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases.However,the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions.The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed.We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy.The knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.

Comparison of imaging-based and pathological dimensions in pancreatic neuroendocrine tumors

AIM To establish the ability of magnetic resonance(MR) and computer tomography(CT) to predict pathologic dimensions of pancreatic neuroendocrine tumors(Pan NET) in a caseload of a tertiary referral center.METHODS Patients submitted to surgery for Pan NET at the Surgical Unit of the Pancreas Institute with at least 1 preoperative imaging examination(MR or CT scan) from January 2005 to December 2015 were included and data retrospectively collected. Exclusion criteria were: multifocal lesions, genetic syndromes, microadenomas or mixed tumors, metastatic disease and neoadjuvant therapy. Bland-Altman(BA) and Mountain-Plot(MP) statistics were used to compare size measured by each modality with the pathology size. Passing-Bablok(PB) regression analysis was used to check the agreement between MR and CT.RESULTS Our study population consisted of 292 patients. Seventy-nine(27.1%) were functioning Pan NET. The mean biases were 0.17 ± 7.99 mm, 1 ± 8.51 mm and 0.23 ± 9 mm, 1.2 ± 9.8 mm for MR and CT, considering the overall population and the subgroup of non-functioning-Pan NET, respectively. Limits of agreement(LOA) included the vast majority of observations, indicating a good agreement between imaging and pathology. The MP further confirmed this finding and showed that the two methods are unbiased with respect to each other. Considering ≤ 2 cm non-functioning-Pan NET, no statistical significance was found in the size estimation rate of MR and CT(P = 0.433). PBR analysis did not reveal significant differences between MR, CT and pathology.CONCLUSION MR and CT scan are accurate and interchangeable imaging techniques in predicting pathologic dimensions of Pan NET.

Enhancement parameters of contrast-enhanced computed tomography for pancreatic ductal adenocarcinoma: Correlation with pathologic grading

BACKGROUND Pancreatic ductal adenocarcinoma(PDA)is a malignancy with a high mortality rate and short survival time.The conventional computed tomography(CT)has been worldwide used as a modality for diagnosis of PDA,as CT enhancement pattern has been thought to be related to tumor angiogenesis and pathologic grade of PDA.AIM To evaluate the relationship between the pathologic grade of pancreatic ductal adenocarcinoma and the enhancement parameters of contrast-enhanced CT.METHODS In this retrospective study,42 patients(Age,mean±SD:62.43±11.42 years)with PDA who underwent surgery after preoperative CT were selected.Two radiologists evaluated the CT images and calculated the value of attenuation at the aorta in the arterial phase and the pancreatic phase(VAarterial and VApancreatic)and of the tumor(VTarterial and VTpancreatic)by finding out four regions of interest.Ratio between the tumor and the aorta enhancement on the arterial phase and the pancreatic phase(TARarterial and TARpancreatic)was figured out through dividing VT arterial by VAarterial and VTpancreatic by VApancreatic.Tumor-to-aortic enhancement fraction(TAF)was expressed as the ratio of the difference between attenuation of the tumor on arterial and parenchymal images to that between attenuation of the aorta on arterial and pancreatic images.The Kruskal-Wallis analysis of variance and Mann-Whitney U test for statistical analysis were used.RESULTS Forty-two PDAs(23 men and 19 women)were divided into three groups:Welldifferentiated(n=13),moderately differentiated(n=21),and poorly differentiated(n=8).TAF differed significantly between the three groups(P=0.034)but TARarterial(P=0.164)and TARpancreatic(P=0.339)did not.The median value of TAF for poorly differentiated PDAs(0.1011;95%CI:0.01100-0.1796)was significantly higher than that for well-differentiated PDAs(0.1941;95%CI:0.1463-0.3194).CONCLUSION Calculation of TAF might be useful in predicting the pathologic grade of PDA.

Immunohistochemical detection of ras p21 expression in pancreatic adenocarcinoma and its clinicopathological significance

By using anti-ras p21 mouse monoclonal antibody(McAb),SCI-oncogema 1,the au-thors examined immunohistochemical staining in pancreatic adenocarcinoma.The percentage ofpositive staining was 55.8%(24/43)and was related to either histopathological grade or clinicalstage.Upon statistical analysis of the correlation between the positive staining of anti-ras p21and patient prognosis with Klaplan-Meier curve and Log-rant test,the positive staining casesshowed comparatively better prognosis than the negative ones,suggesting that ras p21 expres-sion may be important in the early stage of pancreatic carcinoma.

Clinicopathological features of giant cell carcinoma of the pancreas

BACKGROUND: Giant cell carcinoma of the pancreas (GCCP) as a tumor of high malignancy, large size, and inflammatory reaction occupies 2.1%-12.8% of all cases of pancreatic malignancies. This study was to analyze cases of GCCP collected in 8 years at our hospital in an attempt to describe some features of GCCP in Chinese people. METHODS: The clinicopathological features of 19 patients who had been pathologically diagnosed as having GCCP from 1021 patients with pancreatic malignancies collected by Pancreatic Disease Research Group (PDRG) of Chang- hai Hospital were retrospectively analyzed compared with those of 96 patients with common pancreatic carcinoma (PC) who were randomly selected from 1002 patients with pancreatic carcinoma. The differences of location, clinical symptoms, imagings, laboratory test, operation and the prognosis of these two groups were defined. RESULTS: Tumors in the head of the pancreas were found in 8 patients (42.1%), and those in the body or tail of the pancreas in 11 (57.9%). The initial symptom was abdomi- nal pain in most patients (57.9%). Abdominal pain (73.7%), dyspepsia (63.2%), weight loss (36.8%) but jaun- dice were common at the time of diagnosis. The abnormal rates of routine laboratory tests in the GCCP group were lower than those in the common PC group. The assay of tumor markers between the groups of GCCP and common PC was approximately the same. The sensitivity and accu- racy of ultrasonography, spiral computed tomography and magnetic resonance imaging were considerably high. Large carcinoma in stage was seen in 9 patients or 47.4% of the GCCP group, a rate higher than that in the common PC group. Osteoid formation was found microscopically in some patients, and poorly differentiated tumor cells were found in most patients. The 1-year survival rate was 17.6%, which was lower than that in the common PC group. CONCLUSION: The clinicopathological features of GCCP are different from those of common PC. Imaging tests can be used together with the assay of tumor markers to diag- nose GCCP as early as possible and to improve the progno-sis of GCCP patients.

Comparison of cytological and histological preparations in the diagnosis of pancreatic malignancies using endoscopic ultrasoundguided fine needle aspiration

BACKGROUND:Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) has become a crucial diagnostic technique for pancreatic malignancies.The specimen obtained by EUS-FNA can be prepared for either cytological or histological examinations.This study was to compare diagnostic performance of cytological and histological preparations using EUSFNA in the same lesions when pancreatic malignancies were suspected.METHODS:One hundred and eighteen patients who underwent EUS-FNA for suspected pancreatic malignancies were consecutively enrolled.All procedures were conducted by a single echoendoscopist under the same conditions.Four adequate preparations were obtained by 22-gauge needles with 20 to-and-fro movements for each pass.The 4 preparations included 2 cytological and 2 histological specimens.The pathologic reviews of all specimens were conducted independently by a single experienced cytopathologist.Sensitivity,specificity,and accuracy of the 2 preparations were compared.RESULTS:The enrolled patients consisted of 62 males(52.5%),with the mean age of 64.6±10.5 years.Surgery was performed in 23(19.5%) patients.One hundred and sixteen(98.3%) lesions were classified as malignant,while 2(1.7%) were benign.Sensitivity of cytology and histology were 87.9% and 81.9%,respectively,with no significant difference(P=0.190).Accuracy was also not significantly different.Cytological preparation was more sensitive when the size of lesion was <3 cm(86.7% vs 68.9%,P=0.033).CONCLUSIONS:Our results suggested that the diagnostic performances of cytological and histological preparations are not significantly different for the diagnosis of pancreatic malignancies.However,cytological preparation might be more sensitive for pancreatic lesions <3 cm.

Taxotere resistance in SUIT Taxotere resistance in pancreatic carcinoma cell line SUIT 2 and its sublines

AIM: To investigate the specific mechanisms of intrinsic and acquired resistance to taxotere (TXT) in pancreatic adenocarcinoma (PAC). METHODS: MTT assay was used to detect the sensitivity of PAC cell line SUIT-2 and its sublines (S-007, S-013, S-020, S-028 and TXT selected SUIT-2 cell line, S2/TXT) to TXT. Mdr1 (P-gp), multidrug resistance associated protein (MRP), lung resistance protein (LRP) and beta-tubulin isotype gene expressions were detected by RT-PCR. The functionality of P-gp and MRP was tested using their specific blocker verapamil (Ver) and indomethacin (IMC), respectively. The transporter activity of P-gp was also confirmed by Rhodamine 123 accumulation assay. RESULTS: S-020 and S2/TXT were found to be significantly resistant to TXT(19 and 9.5-fold to their parental cell line SUIT-2, respectively). RT-PCR demonstrated strong expression of Mdr1 in these two cell lines, but weaker expression or no expression in other cells lines. MRP and LRP expressions were found in most of these cell lines. The TXT-resistance in S2-020 and S2/TXT could be reversed almost completely by Ver, but not by IMC. Flow cytometry showed that Ver increased the accumulation of Rhodamine-123 in these two cell lines. Compared with S-020 and SUIT-2, the levels of beta-tubulin isotype II, III expressions in S-2/TXT were increased remarkably. CONCLUSION: The both intrinsic and acquired TXT-related drug resistance in these PAC cell lines is mainly mediated by P-gp, but had no relationship to MRP and LRP expressions. The increases of beta-tubulin isotype II, III might be collateral changes that occur when the SUIT-2 cells are treated with TXT.

胰腺体部神经鞘瘤1例

胰腺神经鞘瘤是一种极为罕见的神经源性肿瘤,缺乏特征性临床表现和影像学征象,术前明确诊断存在较大困难,常与其他胰腺良恶性肿瘤难以鉴别。文章报道1例胰腺体部神经鞘瘤患者的诊治经过,患者为44岁女性,因体检发现胰腺肿物5 d入院,行腹部增强CT提示胰腺体部肿物,约6.4 cm×5.4 cm,予行胰腺中段切除+远端胰腺残端空肠Roux-en-Y吻合术,术后病理回报符合胰腺上皮样神经鞘瘤。术后随访2年余,未见肿瘤复发或转移。该例为临床医师诊治胰腺神经鞘瘤提供了临床参考。

胃肠胰神经内分泌肿瘤活检病理与免疫组化的临床意义分析

目的分析活检病理与免疫组化在胃肠胰神经内分泌肿瘤(GEP-NEN)中的作用,研究其临床意义。方法选取我院2019.01-2021.12收治的64例疑似GEPNEN的患者,全部进行活检病理与免疫组化分析,并统计检查结果以及检查的准确性。结果58例(90.63%)患者经胃肠内镜活检和胰腺CT引导检查后确诊为GEP-NEN。经活检病理后,共47例患者确诊GEP-NEN,诊断准确率为81.03%;经免疫组化检查后,共49例患者确诊GEP-NEN,诊断准确率为84.48%。其中,发病部位在胃肠、胰腺的占比分别为63.27%、36.73%,男女比例为28/21,G1占比为77.55%,G2为22.45%,无G3病例。结论活检病理与免疫组化在GEP-NEN的诊断中具有重要作用,并且免疫组化结果能进一步提高诊断的准确性,应用价值较高。

多层螺旋CT与MRI对胰腺神经内分泌肿瘤病理分级和肿瘤血供评估的前瞻性研究

目的研究多层螺旋CT(MSCT)与MRI对胰腺神经内分泌肿瘤病理分级和肿瘤血供评估的差异性。方法本研究为前瞻性研究,选取我院2019年1月~2022年6月进行诊断并治疗的胰腺神经内分泌肿瘤患者70例作为研究对象,其中G1级患者25例,G2级患者23例,G3级患者22例,富血供胰腺神经内分泌肿瘤患者29例,另选取同期进行健康体检的志愿者70例作为对照组,比较两组、不同肿瘤分级、肿瘤血供的MSCT指标以及MR指标之间的差异,研究MSCT与MRI对胰腺神经内分泌肿瘤病理分级和肿瘤血供评估的诊断意义。结果观察组患者的动脉期以及门脉期的CT绝对强化值低于对照组(P<0.05);观察组患者的动脉期高信号、门脉期高信号低于对照组(P<0.05);不同分级、不同血液供应患者的MSCT动脉期以及门脉期的CT绝对强化值、边缘、形状、囊变坏死、主胰管扩张以及远处转移情况之间的差异有统计学意义(P<0.05);不同分级、不同血液供应患者的MRI动脉期高信号、门脉期高信号、边缘、形状、囊变坏死、主胰管扩张以及远处转移情况之间的差异有统计学意义(P<0.05);MSCT、MRI联合诊断的特异性高于单独检测(P<0.05)。结论MSCT与MRI对胰腺神经内分泌肿瘤病理分级和肿瘤血供评估具有积极的意义。

胰腺实性-假乳头状瘤2例临床病理分析

目的 探讨胰腺实性 -假乳头状瘤 (SPT)的临床病理学特征及诊断、鉴别诊断。方法 对 2例SPT行临床病理学分析及免疫组化研究。结果 2例患者均有腹部包块及腹痛症状。组织学 :单形性肿瘤细胞构成实性及假乳头状结构 ,常伴有出血、囊性变 ,间质不同程度硬化。免疫表型 :Vim(+)、NSE(+)、α1 AT(+)、ER(+)、PR(+) ;α ACT灶性 (+) ;上皮性标志(- )、Syn(- )、CgA (- )、CD6 8(- )。 结论 胰腺SPT是较少见的、预后较好的交界性肿瘤 ,其诊断与鉴别诊断主要依据临床资料。

胰腺实性-假乳头状瘤影像与病理诊断分析

目的 探讨胰腺实性 假乳头状瘤的影像及病理学的诊断要点。资料与方法 回顾分析 11例经手术切除、病理学和免疫组织化学证实的胰腺实性 假乳头状瘤患者的临床资料 ,以比较其影像和病理学特点。结果 (1)本病多发于 30岁以下女性 ,临床主要表现为腹痛。 (2 )CT、MRI表现为肿瘤内有实性和囊性结构 ,可分为 3型 ;特征性表现为“浮云征”。 (3)肿瘤大部分位于胰腺 ,多有完整包膜 ,不伴有胆总管扩张。 (4 )病理学特点为肿瘤实性部分由实性区、假乳头区及两者过渡区以不同比例混合而成。囊性区由坏死、液化、陈旧性出血组成。 (5 )肿瘤的囊实性结构是形成“浮云征”的病理基础。结论 胰腺实性 假乳头状瘤有相对特征性的影像和病理学表现 。

胰腺实性-假乳头状肿瘤研究进展

胰腺实性-假乳头状肿瘤（solid pseudopapillary tumor，SPT）是一种胰腺少见的肿瘤，主要发生在年轻女性，13～15岁的年龄段发病率最高，临床症状不明显，部分患者症状为腹痛、呕吐、腹胀和消化不良等，超声和CT上一般可见到有囊性和实性部分组成的异质性的包块，缺乏其他特征性的结构。大体为囊壁厚薄不一内含血性液体的囊肿，其中可有破棉絮状的坏死组织，组织学特点是细胞形态单一，有纤细的假乳头结构，实性区域有蜕变坏死。SPT的超微结构研究显示，细胞内有直径50～2640nm的膜包围的颗粒；免疫组化Vimentin、α1—AT、α1-ACT阳性而腺癌的标记为阴性；DNA分析发现有染色体丢失和移位。较成熟的诊断方式是影像学和病理学，实验室检查对诊断帮助不大。最佳治疗措施是手术切除，但应注意随访，因为该肿瘤有恶性潜能和复发倾向。

胰腺癌中P53通路相关蛋白的表达及其临床意义

背景与目的:P53通路在胰腺癌的发生发展中发挥重要作用,然而关于此通路是如何启动、如何作用的研究较少,故本研究探讨P53通路相关基因(ATM/P53/Mdm2/P21WAF/CIP1)蛋白在167例胰腺癌发生、发展中及与预后的关系。方法:应用组织芯片和免疫组化法研究ATM、P53、Mdm2和P21WAF/CIP1在167例胰腺外分泌恶性肿瘤和101例癌旁组织以及11例胰腺良性病变中的表达情况。结果:ATM、P53、Mdm2和P21WAF/CIP1在癌组织中的阳性率分别为67.7%、57.5%、64.1%和39.5%,在非癌组织中阳性率分别为82.1%、6.3%、5.4%和71.4%。与非癌组织相比,癌组织中P53和Mdm2表达明显升高(P<0.01),而ATM和P21WAF/CIP1的表达明显降低(P<0.05)。P21WAF/CIP1的阳性表达与发病年龄、神经受累显著相关(P<0.05);P53的阳性表达与肿瘤的分化、淋巴结转移和神经受累均显著相关(P<0.05);Mdm2的阳性表达与肿瘤的分化显著相关(P<0.05);ATM的阳性表达与年龄相关(P<0.05);四者阳性表达两两之间统计学上具有关联性(P<0.05)。44例获1年以上随访者中ATM+/Mdm2+/P53+P21WAF/CIP1+、ATM-/Mdm2-/P53-/P21WAF/CIP1-、ATM+Mdm2+/P53+分别为9、11、5例,平均生存期依次为9.3、26.1、20月。Kaplan-Meier分析显示全阳性组预后较全阴性组和P21阴性组预后差。结论:P53和Mdm2的过表达以及ATM和P21WAF/CIP1的缺失表达可能会导致胰腺癌的形成和进展;4种蛋白可能以ATM-P53-Mdm2-P21WAF/CIP1通路的方式作用于细胞的转化和肿瘤的形成;联合检测P53和Mdm2的表达可用于评定胰腺癌的恶性程度。

小儿胰腺囊实性乳头状肿瘤8例报告——附文献复习

背景与目的:胰腺囊实性乳头状瘤是罕见的儿童胰腺肿瘤,临床资料较少,对其临床特点及治疗缺乏经验。结合本组病例,总结经验,探讨小儿胰腺囊实性乳头状肿瘤的病理与临床特点。方法:回顾性分析2000～2005年在小儿外科手术及病理证实的8例患儿,结合文献分析小儿胰腺囊实性乳头状肿瘤的病理与临床特点。结果:8例患者中,女性7例,男性1例,年龄11～16岁,中位年龄12.5岁。该肿瘤在儿童多以腹胀、腹痛、腹块为首发症状,肿瘤位于胰头或胰尾。1例行肿瘤切除术,5例行远端胰腺切除术,1例行胰十二指肠切除术,1例仅行病理活检术。除1例失访外,余7例患者生存至今,随访2个月至4年,2例复发。镜下观察:8例肿瘤均以实性区、囊性区及乳头状突起为其特征。免疫组化阳性率:α抗胰蛋白酶100%(8/8),波形蛋白87.5%(7/8),神经元特异性烯醇化酶62.5%(5/8)。结论:胰腺囊实性乳头状肿瘤多见于青春期女孩,组织病理来源不清,属低度恶性,具有良性临床病程,手术治愈率高,预后良好。

神经前体细胞表达下调蛋白9在胰腺癌组织中的表达及临床意义

目的检测神经前体细胞表达下调蛋白(NEDD)9在胰腺癌和癌旁组织的表达情况,分析其与胰腺癌进展、预后的关系。方法收集2005年8月-2010年12月于无锡市第三人民医院治疗的98例胰腺癌患者的癌和癌旁组织样本,应用免疫组化技术检测患者胰腺癌和癌旁组织中NEDD9的表达,并对NEDD9表达与胰腺癌临床病理特征的关系进行分析。计数资料组间比较采用χ2检验。结果胰腺癌组织中NEDD9的高表达率明显高于癌旁组织(57.1%vs 41.8%,χ2=4.592,P=0.032)。胰腺癌组织NEDD9的表达与患者TNM分期、分化程度及有无淋巴结转移相关(χ2值分别为45.02、20.41、36.21,P值均<0.001);与性别、年龄、肿瘤部位、有无肝转移无相关性(P值均>0.05)。结论 NEDD9可能在胰腺癌的发展和侵袭转移中起着一定的作用,有可能作为评估胰腺癌预后的分子指标和治疗靶点。

CT能谱成像鉴别诊断胰腺癌与肿块型胰腺炎

目的探讨CT能谱成像在鉴别胰腺癌与肿块型胰腺炎中的价值,提高术前鉴别诊断准确率。资料与方法回顾性分析经能谱CT检查并经手术病理证实的62例胰腺癌患者(胰腺癌组)和30例肿块型胰腺炎患者(胰腺炎组)的临床资料,在动脉期和门静脉期40~140 ke V单能量下(间隔10 ke V),分别测量和比较两组病灶的平均CT值、碘浓度以及能谱曲线的差异。结果在动脉期和门静脉期的40~140 ke V单能量下,胰腺炎组的平均CT值均大于胰腺癌组,差异均有统计学意义(t动脉期=-7.349^-4.810,P<0.05;t门静脉期=-6.760^-5.496,P<0.05)。胰腺炎组与胰腺癌组的能谱曲线有明显的差别,在40~70 ke V低能量之间差异明显。胰腺癌组在动脉期和门静脉期的碘浓度均低于胰腺炎组,差异有统计学意义(t动脉期=-28.577,P<0.05;t门静脉期=-28.451,P<0.05)。结论通过CT能谱成像技术测量不同单能量下CT值、能谱曲线以及碘浓度可以鉴别胰腺癌和肿块型胰腺炎。

HIF-1α、VEGF在胰腺癌组织中的表达及其与血管新生的关系

目的 探讨HIF -1α和VEGF在胰腺癌组织中的表达及其与肿瘤血管新生的关系。方法 应用免疫组化检测了41 例根治性切除的胰腺癌组织HIF- 1α、VEGF表达和微血管密度,分析HIF- 1α表达与肿瘤血管生存和临床病理分期的关系。结果 HIF -1α、VEGF在胰腺癌组织中高表达,阳性率分别为63.4%和75.6%,明显高于正常胰腺组织(P<0.001)。胰腺癌组织中的MVD也高于正常胰腺组织(P<0.01)。HIF- 1α表达与VEGF表达呈正相关,MVD与HIF- 1α表达有关。HIF- 1α表达随着胰腺癌的临床分期进展而增高。结论 HIF- 1α在胰腺癌组织中呈高表达,HIF- 1α可通过上调VEGF的表达促进胰腺癌组织中的微血管形成,可能在胰腺癌的发生和发展中起重要作用,HIF 1α可作为评价胰腺癌预后的指标。

24例胰腺实性-假乳头状瘤的螺旋CT征象与临床病理分析

目的:分析胰腺实性-假乳头状瘤的螺旋CT征象及病理特点,提高术前诊断水平。方法:回顾性分析24例胰腺SPT的螺旋CT征象,包括肿瘤的部位、大小、形态、边界、密度、强化方式、强化程度、囊实比例、钙化、临近组织器官侵犯及淋巴结转移等,并与手术结果及病理对照分析。结果:1)肿瘤发生于胰头部10例,体部7例,尾部6例,体尾部1例,大部分呈圆形或类圆形,部分有分叶,边界清楚,有完整包膜。2)肿瘤内部可见实性及囊性成分,实性部CT平扫呈稍低或等密度,增强扫描动脉期轻至中度强化,门脉期进一步强化,与胰腺实质最大密度差出现在动脉期,囊性部分平扫及增强扫描均呈低密度。3)囊性为主型6例,实性为主型8例,囊实相仿型10例。4)8例肿瘤内部可见钙化,其中一例呈蛋壳状钙化,6例胰管轻度扩张,1例胆总管、肝内胆管可见扩张。5)9例患者CT征象见恶性倾向,1例呈弥漫性生长,5例推压、包绕脾血管,2例与肠系膜血管粘连,1例肿瘤包绕右肾静脉,其余15例CT表现为良性,包膜完整,与周围器官、组织分界清楚,术中所见有一定差异。结论:胰腺SPT病理学特点明显,螺旋CT征象有一定特征,肿瘤呈囊实性两部分,血供较为丰富,呈逐渐强化改变,与大多数胰腺癌缺乏血供有较大差别,血浆CEA阴性也有较大的参考价值,CT检查对胰腺SPT的术前诊断、良恶性判断、治疗方法的选择均有重要意义。

胰腺乳头状囊实性肿瘤的病理与临床特点

目的：探讨胰腺乳头状囊性实性肿瘤（solid cystic papillary tumor,SCPT）的病理与临床特点。方法：回顾性分析在小儿外科手术及病理确诊的8例患儿,同时分析同期在成人外科手术及病理确诊的7例患者的临床资料。结果：15例患者中,男1例,女14例。10-20岁8例,20-30岁4例,30-40岁3例。平均年龄15.8岁,中位年龄16岁。该肿瘤多以腹胀、腹痛和腹部包块为首发症状,多数肿瘤位于胰头或胰尾。3例行肿瘤切除术,8例行远端胰腺切除术,3例行胰十二指肠切除术,1例仅取病理行活检术。随访3个月-4年,15例患者生存至今,2例复发。镜下观察15例肿瘤均以实性区、囊性区及乳头状突起为其特征。α抗胰蛋白酶免疫组化阳性率100%（15/15）,波形蛋白80%（12/15）,神经元特异性烯醇化酶53.3%（8/15）。15例均诊断为胰腺囊性实性乳头状瘤。结论：胰腺乳头状囊性实性肿瘤多见于青春期女性和年轻妇女,组织病理来源不清,属低度恶性,具有良性临床病程,手术治愈率高,预后良好。