胰腺实性假乳头状肿瘤临床病理学与恶性转移潜能相关性研究  

Study on clinicopathologic features and metastasizing potential of solid pseudopapillary tumor of pancreas

作　　者：杨博[1] 谭云山[1] 纪元[1] 刘弢[1] 曾海英[1] 

机构地区：[1]复旦大学附属中山医院病理科,上海200032

出　　处：《中华病理学杂志》2010年第1期25-30,共6页Chinese Journal of Pathology

摘　　要：目的探讨胰腺实性假乳头状肿瘤（SPT）临床病理学特征和恶性转移潜能相关性。方法收集45例SPT标本，利用光镜观察其形态学特征并依据形态学综合评分，免疫组织化学EnVision法检测波形蛋白、α-1-抗胰蛋白酶、α-1-抗胰糜蛋白酶、CD10、神经元特异性烯醇化酶、PR、嗜铬粒素A、突触素、AE1／AE3、β—catenin、p53、cyclinD1、CD34、Ki-67表达，将以上结果同临床随访资料（分为非转移组和转移组）进行综合比较分析。结果非转移组和转移组的年龄、性别、肿瘤部位、肿瘤平均直径和大体包膜情况比较，没有明显差异。单独形态参数（核分级、核分裂象、细胞异型性、血管内瘤栓、渐进性坏死巢、凝固性坏死）并不能区分非转移组和转移组，但核分裂象、血管内瘤栓和渐进性坏死巢在转移组较非转移组更为常见。依据形态学综合评分，非转移组41例中，39例（95．1％）综合得分〈5分，转移组综合得分全部〉t5分。免疫组织化学非转移组与转移组比较，β—catenin、p53、cyclinD1、CD34差异无统计学意义；核增殖指数Ki-67差异有统计学意义。45例SPT患者中，平均随访37．4个月，8例失访，33例无瘤生存，4例发生不同程度的肝转移，目前无死亡。结论SPT的核分裂象、血管内瘤栓和渐进性坏死巢对于预测肿瘤的恶性转移潜能具有一定的参考意义；形态学综合评分对于预测SPT的恶性转移潜能具有重要价值；核增殖指数Ki-67也具有一定参考价值。Objective To study the clinicopathologic features and metastasizing potential of solid pseudopapillary tumor of the pancreas （SPT）. Methods Forty-five cases of SPT were retrieved from the archival file and subdivided into metastasizing group （ MG, n = 4 ） , and non-metastasizing group （ NMG, n=41）, according to the follow-up clinical information. The histological features were reviewed and immunohistochemieal study for vimentin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, CD10, neuronspecific enolase, progesterone receptor, chromogranin A, synaptophysin, AE1/AE3, beta-eatenin, p53, cyclin D1, CD34 and Ki-67 was carried out. The results were correlated with follow-up data. Results There was no statistically significant difference between MG and NMG, in terms of age and gender of the patients, site, size and capsular status of the tumor. No single morphologie parameter could distinguish MG from NMG. In general, increased mitotic activity, tumor emboli in vessels and necrotic loci were more conspicuous in MG than in NMG. According to a morphologic scoring system, all cases of MG had score 〉!5, in contrast to 〈 5 in 95. 1% （39 cases） of NMG. Immunohistochemically, there was no statistically significant difference between MG and NMG for beta-catenin, p53, cyclin D1 and CD34 staining. Ki-67 positivity however was significantly higher in MG. Amongst the 37 cases with follow-up information available, the average duration of follow up was 37.4 months. Thirty-three patients were alive and diseasefree. Four suffered from liver metastases ; and none of them died of the tumor. Conclusions Mitotic activity, presence of tumor emboli and necrotic foci represent as the useful parameters in predicting metastasizing potential of SPT, especially with application of morphologie scoring system. Immunostaining for Ki-67 can also serve as an additional prognostic indicator.

关 键 词：胰腺肿瘤 肿瘤转移 诊断 鉴别 

分 类 号：R735.9[医药卫生—肿瘤] R737.9[医药卫生—临床医学]