胰腺实性假乳头肿瘤组织起源分析

目的：总结胰腺实性假乳头肿瘤（solid-pseudopapillary tumor，SPT）的组织病理学特点，并分析该肿瘤组织细胞的起源。方法：回顾性分析我院43例SPT的组织病理学特点，其中30例标本经与代表不同组织来源的抗体进行免疫组化反应．由SPSS11．5软件进行数据分析。结果：SPT肿瘤的组织病理特点为假乳头结构形成和区域性坏死，无腺泡结构。SPT细胞对神经内分泌细胞来源的神经元特异性烯醇化酶蛋白（NSE）、CD56和CD10的阳性高表达率甚高，均超过90％，但对SYN的高表达率仅为16．7％；SPT细胞对神经干细胞来源的神经巢蛋白（NES）和波形蛋白（VIM）的阳性高表达率分别为70％和90％；对神经软组织来源的S-100蛋白的高表达率为86．7％；对间叶组织细胞来源的仪1抗糜蛋白酶（α1-AT）、仅1抗胰蛋白酶（α1-ACT）和溶菌酶（LYS）的高表达率达80．0％～86．7％；而SPT细胞对上皮细胞来源的抗体标记物很少呈阳性反应，多为低表达。结论：SPT可能起源于胰腺干细胞及与其发育密切相关的胚胎神经嵴的神经前体细胞，在干细胞发育过程中发生分化不成熟所致。

The solid-pseudopapillary tumor of pancreas: the pathological characteristics and genesis

Objective To summarize the pathological characteristics of solid-pseudopapillary tumor （SPT） of pancreas, and to discuss the genesis of SPT. Methods The clinical data from 43 patients with SPT admitted were analyzed retrospectively. The immunohistochemical localization of different tissue origin markers was performed on 30 cases, and the data were analyzed by using statistical software 11.5 SPSS. Results The pathological features of SPT included a combination of solid components with pseudopapillae formation and degenerative regions without glands. Tumor cells of SPT were positive to the markers originated from neuroendocrine cells （NSE, CD56 and CD10） with a high percentage over 90%, except the SYN marker （16.7% positive）. SPT cells were also positive to the markers originated from nerve stem cells with a high percentage （NES 70%, VIM 90%） and to those from parenehyma tissnes（αl-AT, αl-ACT and LYS 80%-86.7%）, but only a low percentage of cases were positive to the markers from the epithelium. Conclusions SPT may be originated from pancreatic embryonic stem cells, resulting from immature differentiation of the pluripotential stem cells during pancreatic genesis.