胰腺实性假乳头状瘤诊治分析(附8例报道)

目的总结胰腺实性假乳头状瘤的临床特点及诊治体会。方法回顾性分析2000年5月至2010年5月期间在我科手术治疗并经病理检查证实的8例胰腺实性假乳头状瘤患者的临床资料。结果 3例肿瘤位于胰头部者行胰十二指肠切除术;2例肿瘤位于胰颈部者行单纯肿瘤摘除术;1例肿瘤位于胰体部者行胰腺中段切除、近端闭合、远端与空肠行吻合术;2例位于胰尾部者行胰体尾切除联合脾脏切除术。术中未见腹腔脏器转移。8例患者术后经病理检查均证实为胰腺实性假乳头状瘤。术后均未行放、化疗。本组患者随访1~10年(平均5.5年),除2例失访外,其余均健在。结论 胰腺实性假乳头状瘤临床少见,属低度恶性肿瘤,女性多见;CT及MRI是其主要的影像学检查手段;手术切除预后较好。     

胰腺实性假乳头状瘤的诊治(附4例)

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent.     

胰腺实性假乳头状瘤的诊治(附4例)

Objective To discuss the management of solid-pseudopapillary tumor of the pancreas. Methods Four patients of solid-pseudopapillary tumor of the pancreas (SPT) were diagnosed by pathology. One patient was underwent magnetic resonance and two enhanced computer tomography scan. The mass was located in tuberculum (1 case), neck (1 case), and body-tail (2 cases) of pancreases respectively. Four cases were underwent duodenopancreatectomy, local resection of mass, resection of body-tail of pancreases respectively. The maximal diameter of tumor ranged from 5 cm to 16cm, averaged 10.3cm. The blood regular test and biochemistry were normal, and the tumor markers including AFP,CA19-9,CA125,CEA also were normal. The specimens were examined by pathology and immunohistochemistry. Results Four cases all were diagnosed solid-pseudopapillary tumor of the pancreas by pathology. At histologic analysis, the tumor was composed of uniform polygonal cells with moderate to abundant amphophilic cytoplasm and arranged in solid nests with areas of degeneration characterized by separation of the cells into pseudopapillary aggregates with intervening accumulation of mucopolysaccharide rich ground substance. The expressions of Vimentin, α-ACT, α-AAT were positive, and CgA negative. Four cases were followed up for six months and norecurred. Conclusions SPT of pancreases was a kind of tumor of low potential malignancy, and the magnetic resonance and computer tomography were often to be used. The effective therapy was thoroughly resection, and the prognosis in most patients is excellent.     

胰腺实性假乳头状瘤的诊治分析

目的 回顾18例胰腺实性假乳头状瘤(SPPT)的临床病理特点及治疗,以求建立最佳诊断方法及手术治疗方案.方法 回顾近12年18例SPPT患者的术前、手术、术后资料,包括年龄、性别、症状体征、实验室检查、手术、病理及复发和预后情况.结果 18例患者中女性16例,男性2例,平均年龄30.9岁.所有患者均没有特异的实验室检查阳性结果,肿瘤标记物均基本正常.17例患者均获得手术切除肿瘤.平均术后住院日10.7 d,(随访时间3～113个月).切除患者均无复发.术前影像学中肿瘤的大小、包膜、囊实性比例同胰腺实性假乳头状瘤的良恶性无明显关系.结论 该研究证实SPPT是多发于青年女性的少见肿瘤.手术切除是治愈该疾病的治疗方式.     

胰腺实性-假乳头状瘤4例报告

对4例胰腺实性假乳头状瘤（SPT）的临床病理资料进行回顾性分析。 4例中3例为女性,年龄15～63（平均23）岁。2例以腹部肿块就诊;1例体检时偶然发现胰腺肿物;1例以腰背部隐痛为主诉入院。肿瘤位于胰头部2例,胰颈体部1例,胰体部1例。肿瘤直径4.5～8.0（平均7）㎝,均有包膜,囊实相间。镜检示,肿瘤由假乳头和囊实区混合组成,瘤细胞围绕纤维血管轴心形成特征性假乳头结构。免疫组化检查,4例Vim,AT阳性,2例NSE阳性。均行手术切除,术后随访0.5~4年,均无复发。提示SPT好发于青少年女性,有独特的临床病理表现,免疫组化提示SPT可能起源于胰腺多潜能干细胞。应视为低度恶性肿瘤。切除率高,预后好。     

胰腺实性假乳头状瘤16例诊治分析

目的 总结胰腺实性假乳头状瘤（SPTP）的诊断和治疗经验。方法 对2000年8月至2010年10月我院收治的16例SPTP病例进行回顾性研究。结果 16例SPTP患者11～44岁,平均32.4岁,其中女12例,男4例。肿瘤位于胰头6例,胰颈部2例,胰体尾部8例。无特异性临床表现。B超显示胰腺低回声实性或囊实性占位。CT或MRI检查显示胰腺低密度占位病变,血清肿瘤标记物均为阴性。4例行胰十二指肠切除术,2例行肿块切除及胰管空肠吻合术,2例行胰腺节段切除及远端胰管空肠吻合术,6例行胰体尾切除术,2例行胰体尾切除联合脾切除术。对14例患者进行随访,平均随访时间24.3个月,均未发现肿瘤复发转移。结论 SPTP是一种少见的低度恶性肿瘤,多发于青年女性,切除肿瘤后能获得良好的预后。     

胰腺实性假乳头状瘤16例诊治分析

目的 总结胰腺实性假乳头状瘤的诊治经验.方法 对2005年1月-2009年12月收治的16例胰腺实性假乳头状瘤病例的临床表现、影像学特征、病理结果、治疗和预后进行回顾性分析.结果 肿瘤位于胰腺头部及钩突部者5例,位于颈体部者5例,位于尾部者6例.首发症状表现为间断性上腹部隐痛不适者7例,体重下降者2例,查体时发现腹部肿块者3例,体检发现胰腺肿瘤者4例.B超表现为回声不均的囊实性病变或低回声实性病变;SCT表现为胰腺实性或囊实性占位病变,低密度、不均匀、边界清楚、形态规则,增强扫描时呈高血供表现.肿瘤标记物无异常.行胰体尾切除加脾切除术者9例,其中1例因侵犯横结肠加行左半结肠切除术.4例行肿瘤局部切除术.3例患者行保留十二指肠及部分胰头、肿瘤切除,胰体空肠Roux-en-Y吻合术.随访时间3～48个月,未发现肿瘤复发或转移.结论 胰腺实性假乳头状瘤好发于年轻女性,可位于胰腺的任何部位,临床表现无特异性,手术切除是治疗的有效途径,预后良好.     

胰腺实性假乳头状瘤的诊治进展

目的 总结胰腺实性假乳头状瘤的诊治进展.方法 分析近年来有关胰腺实性假乳头状瘤诊治进展的文献报道. 结果 胰腺实性假乳头状瘤是一种少见的胰腺低度恶性肿瘤,有其特殊的临床、影像学及病理特征.手术切除是其主要的治疗方法 且预后良好.结论 熟悉并掌握胰腺实性假乳头状瘤的特征有助于临床准确诊断与治疗,但对其深入认识尚需更多的病例积累与基础研究.     

胰腺实性假乳头状瘤：附17例报告

胰腺实性假乳头状瘤（solid-pseudopapillary tumor,SPT）是一种少见胰腺的低度恶性肿瘤,仅占胰腺肿瘤的0.13%-2.7%,多见于年轻女性[1]。因临床症状不典型,影像学特征不明显,临床诊断较为困难。本文回顾性分析我院收治的17例患者的资料,     

胰腺实性假乳头状瘤临床诊治分析（附69例报告）

目的：总结胰腺实性假乳头状瘤（SPT）的临床特点及其治疗、预后。方法：回顾性分析69例SPT患者的临床表现、手术治疗、术后并发症及预后情况。结果：SPT位于胰头部24例（占34.8%）、胰颈部15例（占20.3%）、胰体尾部30例（占45.0%）。69例患者均行手术切除,无手术死亡。术后药物性肝功能衰竭1例、胰瘘9例、胃潴留3例,均保守治疗治愈。术后病理明显恶性者3例,其中1例术后26个月死于肿瘤脑转移,1例术后1年肝内及腹腔淋巴结复发、带瘤生存14个月,1例术后40个月无肿瘤复发。结论：SPT是一种低度恶性的胰腺肿瘤,预后相对良好,胰瘘是术后的主要并发症。     

胰腺实性-假乳头状瘤22例诊疗体会

目的：探讨胰腺实性-假乳头状瘤（solid pseudopapillary tumor of the pancreas,SPTP）的临床表现特点和治疗方法。方法：回顾性分析2004年1月—2010年11月山东省立医院收治的22例经手术治疗,且术后病理证实为SPTP的患者的临床资料。结果：患者包括21例女性及1例男性,平均年龄为23.4岁。首诊原因多为查体发现胰腺包块而无明显临床症状,另可伴有腹痛、腹胀。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病变,CT强化扫描示肿瘤实性部分呈轻、中度强化,囊性部分无明显改变。手术方式包括局部肿瘤切除术8例,胰腺节段切除术2例,胰体尾联合脾脏切除术6例,胰尾部肿瘤切除合并保留脾脏4例,保留十二指肠胰头切除1例,1例发生肝脏转移者行肿瘤局部切除联合肝脏转移瘤切除。术中发现肿瘤分界清楚。除1例发生肝转移外,余患者肿瘤未发现周围器官、血管明显浸润。术后随访无复发及转移。结论：SPTP是一种低度恶性肿瘤,手术是首选治疗方法,尽量首选肿瘤局部切除术,以减少手术创伤。     

胰腺实性假乳头状肿瘤的诊断及外科治疗分析

目的 探讨胰腺实性假乳头状肿瘤(SPN)的诊治方法,以期为临床提供参考、避免误诊,并采取正确治疗SPN的措施.方法 收集2001年2月至2009年12月收治的24例手术治疗SPN患者的临床资料,回顾性分析其临床表现、实验室检查、影像学、病理学及手术治疗特征.结果 本组24例中,23例为女性,平均发病年龄31岁.SPN最常见的临床表现是腹痛和腹部肿块.影像学检查显示胰腺的实性或囊-实性占位病变,大部分肿瘤位于胰腺头部和尾部.24例均行肿瘤切除,22例获得根治性切除,术后获得长期生存,无复发征象;1例R1切除患者死于术后42个月,另1例R1切除患者术后复发,再次手术后获得长期生存.结论 SPN是一种低度恶性的肿瘤.SPN的正确诊断需要综合分析其临床特征、影像学检查及病理组织学特点.根治性切除能够阻止术后复发,减瘤切除手术对提高患者生存是有益的.     

胰腺实性假乳头状瘤的诊断与治疗

目的 总结胰腺实性假乳头状瘤的诊断与治疗经验.方法 回顾性分析天津医科大学附属肿瘤医院2006年1月至2011年10月收治的24例胰腺实性假乳头状瘤患者的临床病理资料.结果 本组患者中男2例、女22例,中位年龄27.5岁(12～51岁).24例患者中11例肿瘤位于胰头,5例位于胰体,4例位于胰尾,3例位于胰体尾,1例位于胰颈体部.肿瘤直径平均为6.4cm(2.0～12.0 cm).该病无特异性临床表现,术前诊断主要依赖于彩超、CT、MR等影像学检查.所有患者均行手术切除治疗,经术后病理证实为胰腺实性假乳头状瘤.术后随访时间为2～55个月,中位随访时间27.2个月,23例患者无瘤生存,l例患者术后复发,带瘤生存. 结论 胰腺实性假乳头状瘤是一种少见的低度恶性胰腺肿瘤,多发于青年女性,完整手术切除可获得较好的预后.     

胰腺实性假乳头状瘤的临床特征和外科治疗

目的 总结胰腺实性假乳头状瘤的临床特征和手术疗效.方法 回顾性分析安徽医科大学附属省立医院2000年1月-2011年2月经病理证实的18例胰腺实性假乳头状瘤患者的临床资料.结果 患者发病年龄15 ～46岁,平均27.8岁;其中男性3例,女性15例.肿瘤直径为4.0～15.0 cm,平均7.1 cm;11例肿瘤(61.1％)有界限清楚的囊,5例(27.8％)侵及胰腺外组织;9例(50.0％)含有囊性成分,3例(16.7％)有钙化.静脉侵犯、淋巴侵犯、神经侵犯的频率分别为16.7％(3/18)、0、0.未见淋巴结侵犯和肝转移.胰体尾+脾切除术5例,保脾胰体尾切除术3例,胰十二指肠切除术1例,中段胰腺切除术1例,单纯肿瘤切除术8例.18例患者中15例进行了随访,平均随访47.5个月,所有患者存活未见复发或转移.结论 胰腺实性假乳头状瘤好发于年轻女性,经手术治疗(包括单纯肿瘤切除术)的胰腺实性假乳头状瘤患者有良好的疗效.     

Renal cell carcinoma with concomitant solid pseudopapillary tumor of the pancreas: A case report

INTRODUCTIONSolid pseudopapillary tumor (SPT) of pancreas is an unusual low-grade malignant epithelial tumor that usually occurs in young women and can be treated with surgical resection. Renal cell carcinoma (RCC) is the most common solid lesion of the kidney and primarily a disease of the elderly patient.PRESENTATION OF CASEIn this article we present a case of RCC with concomitant SPT of the pancreas who was treated successfully with a radical nephrectomy and distal pancreatectomy.DISCUSSIONRCC with concomitant SPT may associated in β-catenin gene mutation. But no prior reports have described RCC with concomitant SPT of the pancreas in the same patient.CONCLUSIONTo the best of our knowledge, this is the first report of RCC with concomitant SPT of the pancreas in the same patient.     

胰头部胰腺实性假乳头状瘤的手术治疗

目的 评价胰头部胰腺实性假乳头状瘤(SPTs)的手术方法及其疗效.方法 总结1999年1月-2009年6月收治的24例胰头部SPTs病例,手术分为肿瘤剜除组(12例)及行胰十二指肠切除或保留幽门胰十二指肠切除术(PD/HPPD)组(12例),回顾性对比分析研究两组的一般资料、手术治疗、术后并发症及预后情况.结果 两组的年龄及肿瘤大小无差异;剜除组手术时间及术中出血量明显少于PD组(P<0.05,P<0.01);剜除组术后并发症略多于PD组,但二者之间无显著性差异.PD/HPPD组明显恶性1例,局部浸润性生长1例.除1例恶性者术后1年复发外,其余患者目前无肿瘤复发.结论 对包膜完整、无明显恶性表现的胰头部SPTs,宜尽量行肿瘤剜除手术治疗.对怀疑恶变的胰头部SPTs,应行标准的胰十二指肠切除术或扩大的胰十二指肠切除术.     

Solid pseudopapillary tumor of the pancreas: a case series of 26 consecutive patients

Objective

Solid pseudopapillary tumor (SPT) of the pancreas, which predominantly affects young women, is a relatively indolent entity with favorable prognosis. The aim of this study is to describe the clinicopathologic features and surgical management of this disease in our institution.

Methods

A retrospective study of clinical data from 26 consecutive patients with SPT managed in a tertiary academic center between January 2002 and December 2007 was performed. Clinicopathologic factors were compared between benign and malignant cases to determine what features of the tumor could suggest malignant potential.

Results

The 26 cases included 22 female and 4 male patients, and the average age was 32.3 years (range 15 to 64). Clinical symptoms were nonspecific and included upper abdominal pain or discomfort, abdominal distention, and back pain. The neoplasm was localized in the pancreatic head/neck in 14 patients and in the body/tail in 12 patients. The median diameter of these lesions was 6.25 cm (range 2 to 15). All of the tumors-including 8 pancreaticoduodenectomies, 10 distal pancreatectomies, 6 local resections, 1 total pancreatectomy, and 1 central pancreatectomy-were resected successfully. No patient received chemotherapy or radiotherapy after surgery. All of the patients except 1 were alive at a median follow-up of 32.5 months (range 3 to 69). One of the 2 patients with malignant SPT, in whom Ki-67 immunoreactivity was >25%, developed local recurrence with liver metastasis 4 months and died 6 months after surgery. There were no significant associations between clinicopathologic factors and malignancy.

Conclusions

SPT is a rare neoplasm with low malignant potential. Characteristic computed axial tomography and magnetic resonance imaging scans combined with age and sex profile should be sufficient for the decision to operate. Patients with malignant SPT should have careful follow-up. The high proliferative index assessed by immunohistochemical staining for Ki-67 may predict poor outcome of malignant SPT.     

两种不同机器人手术方式治疗胰头部实性假乳头状瘤的对比研究

目的对比研究机器人肿瘤剜除术(robotic enucleation,REN)及机器人胰十二指肠切除术(robotic pancreaticoduodenectomy, RPD)在治疗胰头部胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas, SPT)的可行性及术后短期、长期结果。 方法选取2016年1月至2019年4月解放军总医院第一医学中心肝胆外二科收治的28例胰头部SPT患者,其中10例患者进行REN,18例患者接受RPD。回顾性分析两组患者的一般资料、手术情况、术后随访等数据,对两组进行比较和评估。 结果28例患者的中位年龄为29岁,男∶女比例为1∶8.33。REN组体质量指数值较低(P＝0.046)。两组患者均无围手术期死亡及二次手术。与RPD组相比,REN组的手术时间更短(P<0.001)、出血量更少(P＝0.009)。但两组的术后并发症率、胰瘘率、术后住院时间比较,差异均无统计学意义(P>0.05)。随访期内两组均无复发病例,REN组术后外分泌功能不全的发生率更低(P＝0.039)。 结论机器人胰头部SPT肿瘤剜除术安全可行,保留器官及功能的优势明显,不会增加术后胰瘘及其他严重并发症。对于适合的胰头部SPT患者建议首选REN治疗。