胰腺实性假乳头状瘤影像学表现

目的 探讨胰腺实性假乳头状瘤的CT及磁共振成像(MRI)表现,提高该疾病的影像正确诊断率.方法 回顾性分析9例经本院手术病理证实的胰腺实性假乳头状瘤的影像表现,术前1例仅接受CT检查,6例仅接受MRI检查,2例同时接受CT及MRI检查.结果 本组9例病例均为单发病灶,大多数类圆形、椭圆形.胰头颈部2例,胰体尾部7例.直...     

Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients

Objective:

To describe multidetector CT imaging features of solid pseudopapillary tumours (SPTs) in male patients and to compare these imaging features with those found in female patients.

Methods:

The institutional review board approved this retrospective study. We included the CT images of 72 patients (M:F = 12:60; mean age, 35.0 years) diagnosed with SPT by histology. CT images were reviewed on the following: location of the tumour, maximal diameter, shape, margin and the fraction of the tumour composition. Statistical differences in CT imaging features were analysed.

Results:

Male patients with SPTs were significantly older than female patients (42.4 years vs 33.4 years, p = 0.0408) and the mean size of the SPTs in male patients was larger (6.3 cm vs 4.6 cm, p = 0.0413) than that of SPTs in female patients. Lobulated shape of the SPTs was most frequent in male patients, whereas oval shape was most frequent in female patients (p = 0.0133). SPTs in male patients tended to have a solid component (p = 0.0434). Progressive enhancement in the solid portion of the tumour was seen in 9 (81.8%) of 11 SPTs in male patients and in 30 (79.0%) of 38 SPTs in female patients on multiphasic CT.

Conclusion:

The imaging features of SPTs in male patients usually appeared as a somewhat large-sized solid mass with a lobulated margin and progressive enhancement. These imaging features may help to differentiate SPTs from other pancreatic tumours for their proper management.

Advances in knowledge:

SPTs in male patients appear as somewhat large-sized solid masses with lobulated margins, and this form occurs more frequently in older male patients than in female patients.Solid pseudopapillary tumour (SPT) of the pancreas is a rare low-grade malignant neoplasm accounting for only 1–2% of all pancreatic tumours.^1–3 Synonyms for this neoplasm include solid and cystic tumours, solid and papillary epithelial neoplasms, solid cystic papillary tumour, papillary cystic neoplasm, papillary cystic epithelial neoplasm, papillary cystic tumour or Frantz''s tumour.^3,4SPT is known to occur preferentially in young females and has a favourable prognosis. The characteristic imaging features of SPTs include encapsulation, solid and cystic components and peripheral calcification.^1,3,4 Although the imaging characteristics of SPTs have been well described in recent years,^3,5 it remains uncertain if the features of SPT occurring in males differ from those in females.Machado et al⁶ and Takahashi et al⁷ described distinctive clinicopathological characteristics of SPTs occurring in males. The purpose of this study was to describe multidetector CT (MDCT) imaging features of SPTs in male patients and to compare these features with those of female patients.     

Solid pseudopapillary tumor of the pancreas: clinical features and imaging findings

This study aimed to report clinical features and CT, MRI, PET/CT findings of solid pseudopapillary tumor (SPT) of the pancreas. Thirty-four patients with pathologically proven SPT were retrospectively reviewed. Most patients were asymptomatic. SPTs in male patients mainly appeared as solid and near solid tumors. Mixed tumors and cystic tumors had larger size than solid and near solid tumors. Solid tumors and solid part of mixed tumors were T2 hyperintense and T1 hypointense and had progressive enhancement. Four tumors (80%) showed markedly even or uneven ¹⁸F-FDG uptake. These characteristic features can help differentiate SPT from other pancreatic neoplasms.     

胰腺实性假乳头状瘤的CT诊断（附8例报告）

胰腺实性假乳头状瘤（solid pseudopapillary tumor of pancreas,SPTP）是一种较少见的胰腺肿瘤,具有独特的病理学特点及生物学行为,不同于其他胰腺上皮性肿瘤。本文对8例经手术病理证实的SPTP螺旋CT征象进行回顾性分析,旨在提高对该病的术前诊断能力。     

MR imaging features of solid-pseudopapillary tumor of the pancreas.

Solid-pseudopapillary tumor (SPT) of the pancreas is characterized as cystic, necrotic, and hemorrhagic degeneration. In this study, magnetic resonance (MR) findings of 4 cases were reviewed. Patchy or spotty areas of high intensity that suggested hemorrhagic degeneration were constantly detected on fat-suppressed T(1)-weighted images. Dynamic contrast-enhanced MR imaging revealed mild and gradual increase of contrast enhancement in solid portions. Multi-contrast MR imaging that included fat-suppressed T(1)-weighted imaging and dynamic contrast-enhanced imaging allowed accurate diagnosis of SPT and its differentiation from other tumors.     

胰腺实性-假乳头状瘤的CT诊断价值

目的:探讨CT对胰腺实性-假乳头状瘤的诊断价值.方法:回顾分析经手术、病理证实的6例胰腺实性-假乳头状瘤的CT表现和诊断.结果:6例肿瘤位于胰头2例,胰体尾部4例.6例瘤体均为囊、实混合性,增强后实质部分均有强化,囊性部分无强化.结论:胰腺实性-假乳头状瘤CT表现有一定特征,CT检查对其诊断与鉴别诊断具有重要价值.     

胰腺实性假乳头状瘤的CT征象分析

目的：探讨胰腺实性假乳头状瘤（SPTP）的CT征象,提高对本病的诊断能力。方法：回顾性分析经手术和病理证实的10例SPTP患者的CT资料,其中女8例,男2例,年龄12-54岁,平均27.2岁。10例患者术前均行螺旋CT胰腺平扫与增强扫描。结果：10例SPTP均表现为孤立肿物,其中5例位于胰头,4例位于胰尾,1例位于胰体。3例肿块呈类圆形,4例呈卵圆形,3例呈不规则形,肿块最大径2.1-8.6 cm,平均6.5 cm。肿瘤全部由实性和囊性成分构成,以实性组织为主者5例,囊、实结构比例相近3例,以囊性结构为主者2例。动态增强扫描实性部分呈渐进性强化,囊性部分无强化。5例肿瘤的实体部分可见线形、小结节或斑块状钙化。1例肿瘤内可见液体-碎屑平面及＂浮云征＂。1例囊性为主肿瘤CT平扫囊性成分中见片状高密度影,术后病理证实为陈旧性出血。7例肿瘤有完整包膜,增强后强化明显,3例包膜不完整,手术见与周围组织有粘连,其中1例镜下可见侵犯邻近下腔静脉旁脂肪组织及十二指肠壁。肿瘤引起胰管增宽与肝管扩张各1例。所有病例均未见腹腔淋巴结肿大及远处脏器转移。结论：胰腺实性假乳头状瘤主要见于青年女性,具有相对特征的CT表现,即胰腺较大囊实性肿物,边缘清晰,实性部分呈渐近性强化,少数伴出血、钙化。     

胰腺实性假乳头状瘤的CT诊断

目的分析胰腺实性假乳头状瘤的CT诊断价值,以提高对该病的认识及诊断水平。方法回顾性分析6例经手术及病理证实的胰腺实性假乳头状瘤的临床资料及CT表现。结果胰腺实性假乳头状瘤好发于13～45岁年轻女性。6例肿瘤,位于胰头2例,胰尾4例,肿瘤体积较大,6例瘤体均为囊、实混合性,实性为主4例,囊性为主2例,2例肿瘤见线条状及斑点状钙化,增强扫描实性成分呈中度强化,囊性成分无强化,瘤体包膜较完整,边缘清楚。不伴有胆总管及胰管扩张。结论胰腺实性假乳头状瘤具有特征性的CT表现及临床表现。     

胰腺实性假乳头状瘤的诊断和外科治疗

目的 探讨胰腺实性假乳头状瘤(SPT)的诊断和治疗经验.方法 对2000年3月～2006年5月收治的21例SPT病例进行回顾性研究.结果 病例中,男2例,女19例,年龄25.6±13.4岁(9～52岁),肿瘤局部切除7例(其中1例为腹腔镜局部切除),减瘤体负荷手术2例,肿瘤扩大切除12例(包括Whipple手术2例,保留十二指肠的胰头切除1例,单纯胰体尾部切除3例,胰腺体尾部切除加脾脏切除5例,胰腺中段切除加胰尾空肠吻合术1例).术后胰瘘4例,切口裂开1例.对21例患者进行随访,平均随访时间24.4月,无死亡病例.结论 SPT是一种少见的低度恶性胰腺肿瘤,多发于青年女性,外科治疗后预后良好.     

胰腺实性假乳头状瘤MSCT双期扫描的诊断价值

目的:探讨胰腺实性假乳头状瘤(SPTP)的CT表现,提高对该病的诊断水平。方法:回顾性分析12例经手术及病理证实的SPTP。12例患者均行CT平扫及增强扫描。扫描参数为120kV,220mA,层厚5mm。动脉期延迟25～28s,实质期45～50s,门脉期80～85s。结果:10例为年轻女性,1例中年女性,1例男性,均无黄疸。12例表现为胰腺囊实性肿块,CT平扫表现为圆形、类圆形低密度或混杂密度肿块影,增强扫描后肿瘤实性部分及包膜可见强化,囊性部分无强化。结论:SPTP的CT表现有一定特征性。     

CT对胰腺实性假乳头状瘤的诊断价值

目的:研究胰腺实性假乳头状瘤的CT表现,提高CT对该病的诊断水平。方法:回顾分析7例经病理证实的胰腺实性假乳头状瘤的CT表现。结果:7例患者均为女性。CT表现为囊实性肿块,边界清楚,5例位于胰头部,1例位于胰体,1例位于胰腺尾部;其中2例肿块内可见钙化;所有病例胰管、胆管均未见扩张。增强后肿块囊壁及实性部分明显强化,无局部浸润或淋巴结转移。结论:胰腺实性假乳头状瘤好发于年轻女性,CT表现具特征性,结合临床特征可在术前作出诊断。     

胰腺实性假乳头状瘤的CT和MRI诊断价值

胰腺实性假乳头状瘤（solid pseudopapillary tumor of the pancreas,SPTP）是一种少见的良性或低度恶性胰腺肿瘤,作者收集6例经手术病理证实的SPTP患者的CT、MRI资料进行回顾性分析,观察其CT、MRI表现,以期提高对本病的影像认识和诊断水平。     

Differentiation between benign and malignant solid pseudopapillary tumor of the pancreas by MDCT

Purpose

The purpose of this study was to determine if characteristic features on computed tomographic and (or) magnetic resonance imaging can differentiate benign and malignant solid pseudopapillary neoplasms (SPN).

Materials and methods

A total of 82 pathologically diagnosed SPN patients were included. CT and MRI were reviewed by 3 radiologists. Each tumor was analyzed through the clinical and imaging features.

Results

The highest occurrence of malignant SPN was observed in the group of patients (11–19 years old) followed by the group of patients (50–65 years old). When the tumor was located in the tail and the size was equal or larger than 6.0 cm, the positive and predictive value, the predictive value, sensitivity and specificity for a malignant SPN were 61.5%, 100%, 100% and 78.6%, respectively. Presence of complete encapsulation was more frequent in benign SPNs, but focal discontinuity in the malignant SPNs. Amorphous or scattered calcifications, all near-solid tumors and presence of upstream pancreatic ductal was found in the benign SPNs.

Conclusion

A focal discontinuity of the capsule, large tumor size (>6.0 cm) and a pancreatic tail location may suggest malignancy of SPN. In contrast, tumors with amorphous or scattered calcifications, and all near-solid tumors may be indicative of benignancy. Age (less than 20 or more than 50 years old) is a possible risk factor of SPN. In comparison to other pancreatic neoplasms, such as ductal adenocarcinoma, a complete/incomplete pseudo-capsule, without upstream pancreatic duct dilatation and lymph nodes metastasis, and the presence of internal calcification and hemorrhage are more likely SPN.     

胰腺实性假乳头状瘤的超声诊断价值

目的：探讨超声对胰腺实性假乳头状瘤（SPTP）的诊断价值。方法：回顾性分析37例经病理证实的SPTP患者手术所见和大体标本特点以及其中的18例超声检查结果。结果：超声正确诊断10例为胰腺来源，仅占55．6％（10／18），其中只有1例诊断为良性可能性大，而且，也未能就对肿瘤包膜、与周围界限及其与邻近大血管或脏器的关系做出比较明确的描述。只有6例胆总管轻至中度扩张，3例伴有主胰管扩张，1例伴有肝内转移。结论：SPTP的临床及病理特点均具有一定的特征性，如果进一步提高对该病的认知程度，超声检查对SPTP的诊断会有重要的应用价值。     

Solid-pseudopapillary tumor of the pancreas: MR imaging findings in 21 patients

PurposeSolid-pseudopapillary tumor (SPT) of the pancreas is a rare, low-grade malignancy, which mostly occurs in adolescent and young adult females. The goal of this study was to retrospectively analyze the magnetic resonance (MR) imaging presentation of SPT of the pancreas.MethodsWe retrospectively reviewed the preoperative MR imaging examinations and the medical, surgical and histopathological records of 21 patients who underwent surgery for SPT of the pancreas. MR imaging included T1-weighted, T2-weighted, and gadolinium chelate-enhanced MR imaging. In addition, 10 patients had diffusion-weighted (DW) MR imaging. MR examinations were retrospectively reviewed for location, size, morphological features and signal intensity of the tumors.ResultsNineteen women and 2 men (median age, 23 years; range, 14–59) were included. Seven patients (7/21; 33%) presented with abdominal symptoms. The median largest tumor diameter was 53mm (range, 32–141 mm). SPTs were located in the pancreatic head, body, and tail in 9 (9/21; 43%), 5 (5/21; 24%) and 7 (7/21, 33%) patients, respectively. All patients (21/21; 100%) had a single SPT. SPTs were more frequently oval (12/21; 57%), predominantly solid (12/21; 57%), fully encapsulated (16/21; 76%), larger than 30 mm (21/21; 100%), hypointense on T1-weighted MR images (21/21, 100%), hyperintense on T2-weighted MR images (21/21; 100%) and with an enhancing capsule after gadolinium-chelate administration (21/21; 100%).ConclusionsThere is trend of appearance for SPT of the pancreas on MR imaging but that variations may be observed in a number of cases. SPT uniformly presents as a single, well-demarcated and encapsulated pancreatic mass.     

Gd-DTPA-enhanced MR imaging in pediatric patients after brain tumor resection

A prospective study was conducted in 15 pediatric patients who had undergone resection of intracranial tumors. The object of the study was to determine the safety and efficacy of magnetic resonance (MR) imaging performed after the administration of gadolinium diethylenetriamine-pentaacetic acid (Gd-DTPA) in evaluating residual or recurrent tumor. Precontrast T1-weighted, intermediate, and T2-weighted images were obtained at a field strength of 1.5 T. Gd-DTPA was then injected intravenously in a dose of 0.1 mmol per kilogram of body weight. T1-weighted images were obtained within 5 minutes after the injection, intermediate and T2-weighted images were obtained 10 minutes after the injection, and T1-weighted images were obtained approximately 20 minutes after the injection. None of the patients experienced allergic reactions or other side effects. Physical examination findings and laboratory values were unchanged after the Gd-DTPA-enhanced examination. In six patients, contrast-enhanced images depicted tumor not suspected on nonenhanced images. In four other patients, enhanced images provided better definition of the tumor core. The images of one patient with a brain stem tumor showed no evidence of enhancement. Pre- and postcontrast images of three previously treated patients showed no evidence of tumor. Gd-DTPA appears to be a safe and effective contrast agent for MR imaging and provides a more accurate method of imaging in the follow-up of brain tumors in pediatric patients.     

F-18 fluorodeoxyglucose uptake in a solid pseudopapillary tumor of the pancreas mimicking malignancy

Solid pseudopapillary tumors (SPTs), predominantly affecting young women, are rare pancreatic tumors. It is reported that imaging features of SPT are solid and cystic components, and there is intratumoral hemorrhage and calcification. However, findings of positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) with pathologic correlation have not been fully evaluated. We present a case of SPT that mimicked malignancy on FDG-PET.     

超声检查对胰腺实性假乳头状瘤诊断价值

胰腺实性假乳头状瘤（SPTP）是一种罕见且多为良性和低度恶性的肿瘤．发病率极低．占胰腺原发肿瘤的0．17％～3％左右。但据有关文献报告．该病的误诊率极高,为提高临床诊治水平．本文对B超对胰腺实性假乳头状瘤的临床诊治进行分析。     

Four cases of solid pseudopapillary tumors of pancreas: imaging findings and pathological correlations

OBJECTIVE: Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. SUBJECTS AND METHODS: The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resection and that a SPTP had been pathologically proved. RESULTS: Four cases of solid pseudopapillary tumor of the pancreas were diagnosed and treated in our institution in the study period. Two of the patients, developed on follow-up liver metastases, and peritoneal, hepatic, and nodal metastases, respectively. CONCLUSION: Solid pseudopapillary tumors are well-encapsulated neoplasms that usually have a good prognosis after surgical excision. A malignant behavior is uncommon and in this case lymph node involvement, hepatic metastases and occasionally peritoneal invasion may also occur. Resection of liver metastases can prolong the long-term survival of the patients.