胰腺实性-假乳头状肿瘤43例临床病理观察  

Solid Pseudopapillary Tumor of Pancreas:Clinicopathological Analyses of 43 Cases

作　　者：晏菲 孙建海 马燕凌 

机构地区：[1]湖北省中山医院肿瘤内科,湖北武汉430033

出　　处：《武汉大学学报（医学版）》2015年第6期913-917,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨胰腺实性-假乳头状肿瘤(SPN)的临床病理学特点、诊断与鉴别诊断及临床生物学行为特点。方法:回顾性分析43例SPN临床病理特征、免疫组化及随访资料。结果:43例SPN中,女性35例,男性8例,年龄9-69岁,平均年龄36.25岁。肿瘤位于胰头10例,胰体尾部24例,胰腺周围9例;肿瘤大小直径3-17cm,平均为6.5cm,切面囊实性。组织学特点:肿瘤细胞围绕纤维血管轴心形成假乳头状结构或实体片状结构。瘤细胞大小较为一致,核圆或卵圆,异型不明显,核分裂象罕见。免疫组化:Vimentin、β-Catenin(核)、CD10、Cyclin D1和PR多为弥漫阳性,而CK-Pan、Syn多为灶性阳性,Ki-67大部分病例示增殖标记<5%,仅1例为30%。随访40例,中位随访时间61个月,均无瘤生存。结论:SPN是一种较为少见的胰腺外分泌肿瘤,好发于年轻女性,临床生物学行为表现缓慢发展过程。组织学上具有相对特异性的表现,免疫组化联合应用Vimentin,β-Catenin,CD10,Cyclin D1和PR等有助于该肿瘤的诊断和鉴别诊断。Objective：To investigate the clinical-pathologic features,diagnosis,differential diagnosis,biological behavior and prognosis of solid pseudopapillary neoplasm（SPN）of the pancreas.Methods：Forty-three cases of SPN were analyzed based on clinical-pathological features,immunohistochemical results and follow-up data.Results：There were 35 female and 8 male patients with a wide range of 9-69years（mean age 36.5years）.Ten cases of the tumors were located in the head,24 cases in the body and tail and 9cases in the adjacent sites of the pancreas.The tumors size ranged from 3to 17 cm in diameter with an average size of 6.5cm.The cut surface was solid-cyst appearance.Histologically,the solid portions contain sheets,cords,and nests of uniform,rather small,with fairly round cells around the vessels to form pseudorosette or pseudopapillary patterns.The cytoplasm was eosinophilic or vacuolated,which nuclei appeared round to oval and had finely dispersed chromatin and inconspicuous nucleoli.Mitoses were rarely identified.By immunohistochemistry,majority of cases stained strongly for vimentin,beta-catenin（nuclear）,CD10,CycinD1 and progesterone receptor（PR）and variably with pan-keratin and synaptophysin（Syn）.The proliferation index（Ki-67）was 5%in most cases except one casewith 30%.After a median follow-up of 61months（range：24-168months）in 40 cases,all patients were alive with no evidence of recurrence or metastatic disease.Conclusion：SPN possesses a low malignant potential rare tumor of pancreas,particularly in young females.SPN should be considered in the differential diagnosis of any solid and partly cystic pancreatic mass with histological features combined immunoprofile（vimentin,β-Catenin,CD10,CyclinD1,and PR）.

关 键 词：胰腺肿瘤 实性-假乳头状肿瘤 免疫组化 鉴别诊断 

分 类 号：R735.9[医药卫生—肿瘤]