胰腺实性假乳头状瘤的病理特点及诊治体会  

Clinicopathologic features, diagnosis and treatment of solid-pseudopapillary tumor of the pancreas

作　　者：魏志新[1] 宝荣[2] 孙智勇[1] 孙自友 

机构地区：[1]山东菏泽市立医院普外科,274031 [2]山东菏泽市立医院病理科,274031 [3]山东郓城县人民医院普外科

出　　处：《中华普通外科杂志》2007年第2期96-98,共3页Chinese Journal of General Surgery

摘　　要：目的总结胰腺实性假乳头状瘤临床病理特点及诊治经验。方法回顾性分析1996年6月至2005年9月收治的13例胰腺实性假乳头状瘤患者的临床病理资料。结果所有患者均为女性，平均年龄29．2岁。上腹疼痛10例，腹部肿块9例。影像学检查均能发现腹部肿块但未能明确诊断。肿块平均直径10．5cm，包膜完整者9例，包膜不完整4例，质地呈实性5例，呈囊实性8例。术中快速冰冻病理6例，5例获得确诊。病理特征为肿瘤细胞围绕纤细血管轴心形成特征性的假乳头状结构，细胞形态一致，异型不明显。2例证实有胰腺和血管浸润。8例免疫组化结果均为波形蛋白（Vimentin）、神经元特异性烯醇化酶（NSE）、α1抗胰蛋白酶（α1-AT）、突触素（Syn）、孕激素（PR）阳性，上皮膜抗原（EMA）、雌激素（ER）、嗜铬颗粒素A（CgA）、S-100蛋白阴性。4例行胰十二指肠切除术，4例行肿瘤局部切除术。4例行胰体尾加脾切除术，1例胰体部肿瘤行胰腺节段切除术。12例获随访，中位随访时间41（2—103）个月，肿瘤无复发，除1例出现营养不良外，余患者生存满意。结论胰腺实性假乳头状瘤为低度恶性肿瘤，确诊需依赖病理组织学检查。手术切除是治疗本病的良好方法。Objective To study the clinicopathologic features, diagnosis and treatment of solidpseudopapillary tumor of the pancreas. Methods A retrospective clinicopathologic analysis was made on 13 cases of solid-pseudopapillary tumor of the pancreas admitted from June 1996 to September 2005. Results All 13 patients were female, the mean age was 29. 2 years. The main complains included abdominal pain in 10 cases and abdominal mass in 9 cases. Imaging examination was not suggestive of tumor differentiation. The mean diameter of tumor was 10. 3 cm with complete capsule in 9 cases. Tumor was solid in 5 cases and cysto-solid in 8 cases. Frozen pathology was definite in 3 out of 6 cases. Histologically, tumors were composed of papillary and microcystic solid structures, with uniformed population of cells without atypia. Pseudopapilla with fibro-vascular core was remarkable. The pancreas and blood vessels invasion were identified in 2 cases. Enzyme labeling examinations （8 cases） were positive for Vimention, NSE,α1-AT,Syn,PR but negative for EMA,ER,CgA,S-100. Four cases underwent Whipple＇s procedure, 4 cases underwent body and tail resection of the pancreas plus splenectomy, 4 cases underwent tumor enucleations, one case underwent body resection of the pancreas. 12 cases were followed up with a median period of 41 （2 - 103） months without tumor recurrence. Conclusions Solid-pseudopapillary tumor of the pancreas is a tumor of low-grade malignancy. The correct diagnosis depends on histopathology examination. Surgical resection is a therapy of cure for these patients.

关 键 词：胰腺肿瘤 病理学 临床 诊断 外科手术 

分 类 号：R686[医药卫生—骨科学]