胰腺实性假乳头状瘤33例临床病理特点及诊治分析

目的 探讨胰腺实性假乳头状瘤临床病理特点、免疫组化特征、生物学行为及诊治经验.方法 回顾性分析2001年5月至2010年7月收治的33例胰腺实性假乳头状瘤患者的临床及病理资料,其中男性7例,女性26例;年龄13 ～ 66岁,平均34.3岁.结果 肿瘤位于胰头10例,胰颈部5例,胰体尾部18例.8例行单纯胰腺肿瘤切除,6例行胰十二指肠切除,3例行胰腺肿物切除加胰肠吻合,1例行胰腺肿物切除加胰胃吻合,11例行胰腺体尾切除,4例行胰腺体尾切除加脾切除(其中1例因合并肝转移加行肝中叶切除);其中16例为经腹腔镜手术.3例证实有胰腺和血管浸润,其中1例合并肝转移.免疫组化显示α1抗胰蛋白酶、α1抗胰凝乳蛋白酶、β-连环蛋白、CD56、CD10和波形蛋白均阳性;神经元特异性烯醇化酶阳性3例,突触素阳性6例,嗜铬粒素A阳性4例,孕激素受体阳性28例,雌激素受体阳性3例,S-100阳性6例.33例均获随访,中位随访时间49个月,肿瘤无复发.结论胰腺实性假乳头状瘤多发生在年轻女性,肿瘤可位于胰腺任何部位,免疫组化对诊断和鉴别诊断有比较重要的价值,选择适当患者行胰腺远端切除或肿瘤切除安全、可行.

Clinicopathologic features, diagnosis and treatment with solid-pseudopapillary tumor of the pancreas: a report of 33 cases

Objective To study the clinicopathologic and immunohistochemical features,biological behavior,diagnosis and treatment of solid pseudopapillary tumor of the pancreas ( SPTP).Methods A retrospective clinical and clinicopathologic analysis was made on 33 cases of SPTP admitted from May 2001to 2010 July.There were 7 male and 26 female patients,aging from 13 to 66 years with a mean of 34.3years.Results The tumor was located in pancreatic head of 10 patients,in pancreatic neck of 5 patients,in pancreatic body and tail of 18 patients.Of the 33 patients treated with surgery,8 underwent simple resection of pancreatic tumor, 6 underwent pancreaticoduodenectomy, 3 underwent tumor resection plus pancreaticojejunostomy,1 underwent tumor resection plus pancreaticogastrostomy, 11 underwent distal pancreatectomy,4 underwent distal pancreatectomy plus spleen resection ( 1 underwent mesohepatectomy for hepatic metastasis).Sixteen of the 33 operations were completed by laparoscopy.Histologically,tumors were composed of papillary and microcystic solid structures,with uniformed population of cells.The pancreas and blood vessels invasion were identified in 3 cases,one of them was combined with liver metastasis,and they are male.Immunohistogically,the tumors were positive for α1-antitypsin,o1-antichymotrypsin,β-catenin,CD10,CD56 and vimentin (all cases),neuron-specific enolase (3 cases ),synaptophysin (6 cases),chromogranin A ( 4 cases),progesterone receptor ( 28 cases),estrogen receptor ( 3 cases),S-100 ( 6 cases) Totally 33 cases were followed up with a median period of 49 months without tumor recurrence.Condusions SPTP is of low graded malignancy.It primarily affects young women.It may be located in any part of pancreas.Immunohistochemistry is very important for the diagnosis and differential diagnosis of SPTP.Surgical resection is recommended as the treatment of choice.Laparoscopic distal pancreatectomy or tumor resection is feasible and safe for some selected patients,and the prognosis is good.