伴破骨样巨细胞胰腺未分化癌的临床病理特征与治疗策略  

Clinicopathological characteristics and treatment strategies of undifferentiated carcinoma with osteoclast-like giant cells of pancreas

作　　者：马永蔌[1] 赵旭东[1] 张继新[2] 柳萍[2] 郭小超[3] 田孝东[1] 杨尹默[1] Ma Yongsu;Zhao Xudong;Zhang Jixin;Liu Ping;Guo Xiaochao;Tian Xiaodong;Yang Yinmo(Department of Surgery,Peking University First Hospital,Beijing 100034,China;Department of Pathology,Peking University First Hospital,Beijing 100034,China;Department of Imaging,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院外科,100034 [2]北京大学第一医院病理科,100034 [3]北京大学第一医院影像科,100034

出　　处：《中华消化外科杂志》2021年第4期437-444,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81672353,81871954);北京大学第一医院青年临床研究基金(2019CR18)。

摘　　要：目的探讨伴破骨样巨细胞胰腺未分化癌(UCOGCP)的临床病理特征与治疗策略。方法采用回顾性描述性研究方法。收集2004年1月至2019年1月北京大学第一医院收治的5例UCOGCP病人的临床病理资料;男1例,女4例;中位年龄为56岁,年龄范围为33~71岁。病人术前行实验室检查、影像学检查及活组织病理学检查。胰头部肿瘤行胰十二指肠切除术,胰体尾部肿瘤行胰体尾+脾切除术,均行标准范围淋巴结清扫。术后辅助治疗方案依据多学科讨论结果个体化制订。观察指标:(1)术前检查结果与治疗情况。(2)术后组织病理学检查情况。(3)随访情况。采用门诊和电话方式进行随访,了解病人肿瘤复发情况。随访时间截至2020年1月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)术前检查结果与治疗情况:5例病人中,1例术前CA19-9升高为65.43 U/mL,4例肿瘤标志物水平均为正常值。5例病人术前增强CT检查结果显示:4例为囊实性肿瘤,1例实性肿瘤边缘延迟强化伴中心坏死。5例病人磁共振成像检查T1序列、T2序列及加权弥散序列均表现为低信号。5例病人影像学检查评估结果显示:3例为可切除肿瘤;1例为局部进展期肿瘤,侵犯结肠、胃及部分小肠且伴门静脉癌栓;1例为胰头肿瘤伴同时性肝左外叶长径为0.4 cm孤立转移灶。PET-CT检查结果示肝左外叶高代谢病灶,术前经内镜超声引导下细针穿刺活组织病理学检查结果示UCOGCP。5例病人均行根治性手术治疗。3例可切除肿瘤病人中,2例行胰十二指肠切除术,1例行胰体尾+脾切除术;1例局部进展期胰体尾部肿瘤病人行胰体尾+脾+横结肠+胃部分切除+门静脉瘤栓取出术;1例胰头部肿瘤伴肝转移病人行胰十二指肠切除+肝左外叶切除术。5例病人中,2例术后行吉西他滨单药辅助化疗,1例行白蛋白结合型紫杉醇+吉�Objective To investigate the clinicopathological characteristics and treatment strategies of undifferentiated carcinoma with osteoclast-like giant cells of pancreas(UCOGCP).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 5 patients with UCOGCP who were admitted to Peking University First Hospital from January 2004 to January 2019 were collected.There were 1 male and 4 females,aged from 33 to 71 years,with a median age of 56 years.Patients underwent preoperative laboratory test,imaging and histopatho-logical examinations.Patients with pancreatic head tumors underwent pancreaticoduodenectomy,and those with tumors in the body or tail of pancreas underwent distal pancreatectomy combined with splenectomy.All patients underwent standard lymph node dissection.Postoperative adjuvant therapy was individually decided by a multidisciplinary team.Observation indicators:(1)preopera-tive examination and treatment;(2)postoperative histopathological situations;(3)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence of patients up to January 2020.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were described as M(range).Count data were described as absolute numbers.Results(1)Preoperative examination and treatment:of the 5 UCOGCP patients,CA19-9 was elevated as 65.43 U/mL in only 1 patient preoperatively,while the CA19-9 was normal in other 4 patients.Four patients showed a solid cystic mass on preoperative contrast-enhanced computed tomography(CT)scan,and 1 patient showed a delayed peripheral enhancement of the solid tumor with central necrosis.The magnetic resonance imaging(MRI)scan showed hypointense signals on T1,T2 and weighted diffusion sequences in all 5 patients.Three of the 5 patients were resectable according to imaging data,1 patient had locally advanced tumor,infiltrating the transverse colon,stomach,and partial small intestine,with the portal vein t

关 键 词：胰腺肿瘤 未分化癌 破骨样巨细胞 外科手术 组织病理学检查 

分 类 号：R735.9[医药卫生—肿瘤]