临床罕见的胰腺实性假乳头状瘤误诊原因分析

目的:分析胰腺实性假乳头状瘤(SPT)的误诊原因,总结SPT的诊断经验。方法:收集2000年2月～2007年3月间解放军总医院收治9例SPT临床资料,并进行回顾分析误诊原因。结果:9例均为女性,平均26岁。首诊临床表现为腹部肿物4例,腹痛1例,无任何临床症状4例。血清肿瘤标志物检查均正常。影像学检查均提示胰腺或腹腔内边界清楚的实性或囊实性占位。1例行超声引导下肿瘤活组织检查,3例行术中快速冰冻病理检查。影像学检查、术前穿刺及术中冰冻病理检查均出现误诊,9例经术后病理确诊SPT。结论:SPT临床症状不典型,实验室及影像学检查均无特异性,病理学特点不被医师所熟悉,临床易误诊。熟悉SPT的临床特点和影像学特征,提高病理确诊率,是避免误诊的关键。

Analysis of Nine Misdiagnosed Cases with Solid Pseudopapillary Tumor of Pancreas

Objective:To summarize the experience of diagnosis of solid pseudopapillary tumor of pancreas(SPT).Methods:Clinical data of all patients with SPT admitted in our hospital from February 2000 to March 2007 were collected,and the misdiagnosed cases were retrospectively analyzed.Results:Nine misdiagnosed cases were female and the mean age was 26 years.Clinical presentation included palpable abdominal mass(4/9),abdominal pain(1/9),and 4 patients were asymptom.Abdominal imaging showed solid and solid cystic masses in pancreas or abdominal cavity.Tumor markers in all patients were negative.One case received preoperative needle biopsy and three underwent freezing pathology during surgery.Misdiagnosis was made sometimes by imageology examination,preoperative neendle biopsy and freezing pathology during surgery.Conclusion:SPT can be misdiagnosed due to atypical clinical presentation and poor specificity of laboratory test and imaging.It is crucial to master clinical and image feature and increase the final diagnosis rate of pathology.