5例胰腺内副脾表皮样囊肿影像学表现分析  

Imaging Features of Epidermoid Cyst of An Intrapancreatic Accessory Spleen:5 Case Reports

作　　者：刘义涛[1] 陈超[1] 亓昌珍[1] 邓丽萍[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院放射科,杭州310016

出　　处：《临床放射学杂志》2017年第4期586-589,共4页Journal of Clinical Radiology

摘　　要：目的回顾性分析胰腺内副脾表皮样囊肿(ECIPAS)的临床及影像学表现,提高对该病的认识及诊断水平。方法搜集经手术病理证实的5例胰腺内副脾表皮样囊肿的临床及影像学资料,分析其临床特征、CT及MRI表现,影像学特征包括:位置、大小、钙化、囊的特征、密度(信号)及强化特点。结果 5例患者均为女性,均为体检偶然发现,3例CA19-9升高。行CT检查者4例,行MRI检查者3例。5例均发生于胰尾内,其中1例与脾脏分界不清;病灶长径2.0~5.5 cm,平均为3.4 cm;3例表现为多囊,1例为单囊,1例呈囊实性;3例边缘显示为"厚壁"的实性成分,平扫密度/信号、多期动态增强表现与脾脏类似,给出了提示性诊断;2例壁菲薄,无明显周围副脾样组织,其中1例内部见部分实性成分,增强扫描轻度强化,术前分别诊断为胰腺囊腺瘤及实性假乳头状瘤。结论ECIPAS是一种非常少见的病变,发生在胰尾部的囊性或囊实性病变,应考虑到ECIPAS的可能,尤其在动态增强检查时发现类似于脾脏改变的囊壁。然而一些缺乏囊壁或囊壁菲薄的病变术前诊断困难,需要病理确诊。Objective To retrospectively analyze the clinical and imaging features of epidermoid cyst in intrapancreatic accessory spleen（ECIPAS）,in order to improve the recognition and diagnosis of the disease.Methods Five cases with pathologically confirmed ECIPAS were collected.The clinical features and imaging（CT and MRI） findings,including location,size,calcification,cyst features,density/signal,and enhancement pattern,were analyzed.Results All of the 5cases were female.All cases were asymptomatic and were incidentally detected.CA 19-9 level was elevated in three cases.Two cases received both CT and MR examination; the other three cases received either CT or MR examination.All lesions were situated in the pancreatic tail with a mean size of 3.4 cm in diameter,ranging from 2.0 to 5.5cm.The boundary between lesion and spleen was unclear in one case.Three lesions were presented as multilocular changes,one was unilocular,and one was cystic-solid,with three lesions having a thick wall and the other two had thin wall.For the three lesions with a thick wall,the density/signal and enhancement patterns were similar to that of the spleen.For the other two lesions,no enhancement was observed in one case and mild enhancement was observed inside the lesion in the other case,which was preoperatively misdiagnosed as pancreatic cystadenoma and solid pseudopapillary tumor,respectively.Conclusion ECIPAS is an extremely rare entity.The diagnosis of an ECIPAS should be considered when the cyst or cystic solid lesion is observed in the pancreatic tail,especially when the enhancement pattern of the cystic wall is similar to that of the spleen when performing dynamic enhanced CT or MR.However,the preoperative diagnosis was difficult in cases with a thin wall.

关 键 词：胰腺 胰腺内副脾 表皮样囊肿 体层摄影术 X线计算机 磁共振成像 

分 类 号：R576[医药卫生—消化系统] R816.5[医药卫生—内科学] R445.2[医药卫生—临床医学]