胰腺混合性腺泡-神经内分泌癌的临床病理特征分析  

Clinicopathologic features of mixed acinar-endocrine carcinoma of the pancreas

作　　者：余春开[1] 杜雪梅[1] 张颖[1] 张建英[1] 昌红[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院病理科,北京100038

出　　处：《诊断病理学杂志》2017年第1期19-22,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨胰腺混合性腺泡-神经内分泌癌(MAEC)的临床病理特征。方法分析1例胰腺混合性腺泡-神经内分泌癌的临床表现、病理形态学特征及免疫组化特点,并结合文献进行讨论。结果患者男性,54岁。无明显诱因出现乏力,伴纳差,偶有反酸嗳气、腹胀。CT及MRI检查提示胰尾部、脾门区及脾实质内占位性病变,边界不清。行胰腺体尾部、脾及部分胃切除术。肿瘤组织由腺泡细胞癌及神经内分泌肿瘤两种组织学形态组成,两种成分穿插混合生长。神经内分泌肿瘤CD56、Cg A和Syn(+);腺泡细胞癌亦CD56和Syn(+);但仅散在个别细胞Cg A(+)。腺泡状区域bcl-10和CAM5.2弥漫性强(+),而梁索状区域弱(+)。Ki-67增殖指数均为3%。术后给予化疗,8个月后出现肝转移,目前随访15个月,患者一般状态良好。结论胰腺混合性腺泡-神经内分泌癌非常罕见,易与胰腺腺泡细胞癌、神经内分泌肿瘤、胰腺实性假乳头状肿瘤及胰母细胞瘤等混淆。Objective To study the clinicopathologic features, diagnosis, and differential diagnosis of mixed acinar endocrine carcinoma of the pancreas. Methods One case of mixed acinar-endocrine carcinoma of the pancreas was investigated by clinical findings, histopathology and immunohistochemistry, and related literatures were reviewed. Results A 54-year-old man presented with weak, poor appetite, occasionally with acid gas, bloating. CT and MRI examination revealed an irregular tumor located within the pancreatic tail, splenic hilus and spleen parenchyma. The pancreatic tail, spleen and partial gastreetomy were performed. Microscopic examination revealed that the tumor was composed of two kinds of histological morphology, acinar cell carcinoma and neuroendocrine tumor, with mixed growth. Immunohistochemically, neuroendocrine tumor was positive for CD56, CgA and Syn. Acinar cell carcinoma was also positive for CD56 and Syn, but individual cells positive for CgA. BCL-10 and CAM5.2 were diffuse strong positive in acinar cell carcinoma, but weakly positive in neuroendocrine tumor. Ki-67 proliferation index was both 3% in acinar cell carcinoma and neuroendocrine tumor. The patient received chemotherapy after surgery, and presented liver metastases 8 months later after operation. At present the patient general condition was good for 15 months of follow-up. Conclusions Mixed acinar-endocrine carcinoma of the pancreas is a very rare neoplasm. This tumor should be different from pancreatic aeinar cell carcinoma, neuroendoerine tumor, solid-pseudopapillary tumor and pancreatoblastoma.

关 键 词：混合性腺泡-神经内分泌癌 腺泡细胞癌 神经内分泌肿瘤 临床病理特征 

分 类 号：R735.9[医药卫生—肿瘤]