胰腺导管内管状乳头状肿瘤的超声内镜特征分析  

Endoscopic ultrasonography features of intraductal tubulopapillary neoplasm of the pancreas

作　　者：沈聪强 田新宇 米热阿依·努尔麦麦提 庄宇航 张松[1] 彭春艳[1] 黄淑玲[1] 沈珊珊[1] 张玮[1] 吕瑛[1] Shen Congqiang;Tian Xinyu;Mireayi·Nuermaimait;Zhuang Yuhang;Zhang Song;Peng Chunyan;Huang Shuling;Shen Shanshan;Zhang Wei;Lu Ying(Department of Gastroenterology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Department of Gastroenterology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008 [2]南京医科大学鼓楼临床医学院消化内科,南京210008

出　　处：《中华胃肠内镜电子杂志》2024年第3期153-158,共6页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

基　　金：南京鼓楼医院临床研究专项资金项目(2021-LCYJ-DBZ-03)

摘　　要：目的分析胰腺导管内管状乳头状肿瘤(ITPN)在超声内镜(EUS)中的影像学特征。方法回顾性收集2019年1月1日至2023年12月31日南京大学医学院附属鼓楼医院经术后病理诊断为ITPN患者的资料,对术前常规EUS、超声弹性成像、谐波造影增强EUS(CH-EUS)及超声内镜引导下细针穿刺活检(EUS-FNA)结果进行描述分析。结果共纳入5例患者,术后病理均为ITPN伴浸润性癌。所有患者术前均行常规EUS及超声弹性成像检查,3例行CH-EUS、2例行EUS-FNA。常规EUS图像中,病灶均表现为低回声肿块,4例可见"双色征",2例可见"酒瓶塞征"。超声弹性评分3~5分。CH-EUS表现为中-低增强、等增强、稍高增强。2例行EUS-FNA,活检病理诊断为中-低分化腺癌、高度上皮内瘤变或浸润性腺癌。结论ITPN在EUS中表现为低回声肿块,双色征及酒瓶塞征是其特征性征象,伴浸润性癌的ITPN在超声弹性成像上表现为中等以上硬度,在CH-EUS中表现为中高增强,EUS-FNA对伴浸润性癌的ITPN有一定的诊断价值。Objective To analyze the endoscopic ultrasound(EUS)features of the intraductal tubulopapillary neoplasm(ITPN)of the pancreas.Methods The data of patients with pancreatic ITPN diagnosed by postoperative pathology in Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 1,2019 to December 31,2023 were retrospectively collected.The results of EUS,ultrasound elastography,contrast-enhanced harmonic endoscopic ultrasonography(CH-EUS)and endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)were described and analyzed.Results A total of 5 patients were enrolled in the study,the postoperative pathology of all patients was ITPN with invasive carcinoma.All patients underwent EUS and ultrasound elastography,3 patients underwent CH-EUS,and 2 patients underwent EUS-FNA.On EUS images,all lesions appeared as hypoechoic masses,4 patients had two-tone duct sign,and 2 patients had cork-of-wine-bottle sign.In ultrasound elastography,the elasticity scores of 5 patients were 3-5.On CH-EUS,3 patients showed moderate-low enhancement,isoenhancement,and slightly hyperenhancement.Two patients underwent EUS-FNA,1 patient was diagnosed as moderately to poorly differentiated adenocarcinoma,and the other was diagnosed as high-grade intraepithelial neoplasia or invasive adenocarcinoma.Conclusion The ITPN presents as a hypoechoic mass on EUS,with the characteristic signs being the presence of the two-tone duct sign and cork-of-wine-bottle sign.ITPN with invasive carcinoma shows moderate to higher stiffness on ultrasound elastography,and moderate to high enhancement on CH-EUS.EUS-FNA has certain diagnostic value for ITPN with invasive carcinoma.

关 键 词：胰腺导管内管状乳头状肿瘤 超声内镜 双色征 酒瓶塞征 

分 类 号：R735.9[医药卫生—肿瘤]