胰腺浆液性囊腺瘤误诊病例的MSCT影像特征与病理分析  

Analysis of MSCT Imaging Features and Pathological Features of Misdiagnosed Pancreatic Serous Cystadenoma

作　　者：王朋 李云 王晓艳[2] 周静[3] 姬广海 WANG Peng;LI Yun;WANG Xiaoyan;ZHOU Jing;JI Guanghai(Department of Radiology,the First Affiliated Hospital of Yangtze University,Jingzhou,Hubei 434000,China;Department of Pathology,the First Affiliated Hospital of Yangtze University,Jingzhou,Hubei 434000,China;Department of Anesthesiology,the First Affiliated Hospital of Yangtze University,Jingzhou,Hubei 434000,China)

机构地区：[1]长江大学附属第一医院放射科,湖北荆州434000 [2]长江大学附属第一医院病理科,湖北荆州434000 [3]长江大学附属第一医院麻醉科,湖北荆州434000

出　　处：《临床误诊误治》2024年第5期14-18,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨胰腺浆液性囊腺瘤(PSC)的影像特征及病理基础,分析误诊原因,总结防范措施。方法回顾性分析2017—2023年经手术病理证实为PSC且术前多层螺旋CT误诊为其他病变22例的临床资料及CT影像特征,并与病理HE染色对照分析。结果本组22例中因腹痛就诊7例,恶心呕吐就诊1例,其余14例均为体检发现,其中微囊型10例,大囊型8例,混合型3例,实质型1例;8例位于胰腺头颈部,14例位于体尾部;分叶状13例,中央瘢痕2例,钙化5例,上游胰管扩张5例;增强后明显强化3例,中度强化5例,轻度强化6例,无强化8例。13例PSC呈分叶状轮廓、边界清晰、呈蜂窝或多囊状结构、与胰管不相通,2例PSC可见内部纤维瘢痕,5例可见钙化等特征性影像表现。误诊为黏液性囊腺瘤和神经内分泌瘤各5例,实性假乳头状瘤4例,未定性3例,假性囊肿2例,潴留囊肿、胰腺导管内乳头状瘤、胰腺癌各1例。误诊时间7~180 d。均手术治疗并经术后病理学检查确诊。随访均无复发。结论不同类型PSC影像表现存在一定差异,但同时存在一些共同影像特征,对于非典型病例,CT诊断困难,误诊率高,需提高对于本病的认知,同时密切结合临床病史,可提高其诊断准确率。Objective To investigate the imaging features and pathological basis of pancreatic serous cystadenoma(PSC),to analyze the causes of misdiagnosis,and to summarize the preventive measures.Methods The clinical data and CT image features of 22 patients with PSC confirmed by surgical pathology and misdiagnosed as other lesions by multi-slice spiral CT before surgery from 2017 to 2023 were retrospectively analyzed,and compared with pathological HE staining.Methods Among the 22 patients,7 presented with abdominal pain,1 presented with nausea and vomiting,and the other 14 patients were accidentally found during physical examination,including 10 cases of microcystic type,8 cases of oligocystic type,3 cases of mixed type,and 1 case of parenchymal type.The lesion was located in the head and neck of the pancreas in 8 patients and in the tail of the body in 14 patients,including lobulation in 13 patients,central scar in 2 patients,calcification in 5 patients,and upper pancreatic duct dilatation in 5 patients.After enhancement,3 cases were significantly strengthened,5 cases were moderately strengthened,6 cases were mildly strengthened,and 8 cases were not strengthened.In 13 cases,PSC showed lobulated contour,clear boundary,honeycomb or polycystic structure,and no communication with pancreatic duct.Two patients with PSC showed internal fiber scar,and 5 patients showed calcification and other characteristic image manifestations.There was misdiagnosis as mucinous cystadenoma in 5 patients,neuroendocrine tumor in 5 patients,solid pseudopapilloma in 4 patients,indeterminable tumor in 3 patients,pseudocyst in 2 patients,retention cyst in 1 patients,intraductal papilloma in pancreas in 1 patient,and pancreatic cancer in 1 patient.Misdiagnosis lasted from 7 to 180 d.All patients were treated with surgery and confirmed by postoperative pathological examination.There was no recurrence during follow-up.Conclusion There are several differences in the imaging manifestations of different types of PSC,but in the meantime,there are some commo

关 键 词：囊腺瘤 浆液 误诊 囊腺瘤 黏液 神经内分泌瘤 实性假乳头状瘤 胰腺导管内乳头状瘤 胰腺肿瘤 

分 类 号：R730.269[医药卫生—肿瘤]