12例胰腺实性假乳头状瘤的诊治分析

背景:胰腺实性假乳头状瘤(SPTP)是一种罕见的胰腺交界性肿瘤,临床表现缺乏特异性,早期易误诊。目的:探讨SPTP的临床诊治特点。方法:收集2002年10月～2009年9月大连医科大学附属第二医院12例确诊SPTP患者的病例资料,对其临床表现、病理特点、治疗以及预后进行回顾性分析。结果:本组12例患者均为女性,年龄11～30岁,均为单发肿瘤,肿瘤直径1.30～10.80 cm,中位直径6.05 cm。患者无特异性临床表现,主要表现为上腹部疼痛、恶心、呕吐等。患者均行B超、CT、MRI检查,肿瘤位于胰头部3例、胰颈部2例、胰体尾部7例,B超诊断为SPTP 8例,CT诊断为SPTP 10例,MRI诊断为SPTP 10例。所有患者均接受手术治疗,术后由组织病理学检查确诊为SPTP。患者术后均未出现肿瘤复发、转移。结论:SPTP是一种交界性胰腺肿瘤,好发于年轻女性,确诊需依靠组织病理学检查,手术是SPTP的有效治疗方法。     

胰腺实性假乳头状瘤的临床特征及手术治疗

目的:总结胰腺实性假乳头状瘤(SPTP)的临床特点及手术治疗方法.方法:回顾性分析聊城市人民医院自2001-01/2008-04收治的11例SPTP患者的临床资料,主要包括临床表现、B超及CT检查、手术方式、病理检查结果及出院后随访情况.结果:除2例患者表现为急性腹痛外其余患者均无特异性临床表现.肿瘤多位于胰体尾部.B超检查表现为实性或囊实性低回声肿物:CT平扫表现为胰腺低密度肿物,增强CT扫描则表现为肿瘤周边不均匀增强.除1例患者外其余病例肿瘤标志物均正常.11例患者均采用手术治疗且10例患者获得随访资料,平均随访23.7 mo,所有患者均未发现复发转移.结论:SPTP是一种罕见的胰腺低度恶性肿瘤,多发于青年女性,手术治疗能取得良好的疗效.     

胰腺实性假乳头状瘤的国内文献荟萃分析

目的 总结分析国内胰腺实性假乳头状瘤(SPT)的临床诊治现状及其预后.方法 检索1992年1月至2009年4月中国期刊全文数据库文献,获得临床资料完备的42篇文献共439例SPT,对其临床资料进行分析总结.结果 439例SPT中男性38例(8.7%),女性401例(91.3%),男:女=1:10.6,平均年龄28岁(8～76岁).377例有临床表现描述,主要为腹痛(35.3%)、腹部包块(31.3%)、腹胀不适(7.7%),101例(26.8%)无任何症状,为体检时偶然发现.术前诊断有记载者246例,误诊161例,误诊率65.4%.439例SPT均行手术治疗,手术根治性切除率高达97.3%(427/439).平均肿瘤直径7.8 cm(1.5～25.0 cm).394例对肿瘤侵犯转移有记载,80例(20.3%)有恶性表现.418例(95.2%)获得术后随访,平均随访时间34个月(1月～25年).随访期间403例(96.4%)无瘤存活,4例局部复发,6例发生肝转移,4例因本病病死.结论 SPT是一种少见的潜在低度恶性肿瘤,好发于年轻女性,确诊依赖于病理组织学检查.手术是SPT唯一有效的治疗手段,预后良好.     

胰腺实性假乳头状瘤的诊断和治疗

目的:总结胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)的诊断和治疗经验.方法:回顾性分析中国人民解放军总医院2002-02/2013-07诊治的134例SPTP病例的临床资料.结果:女116例,男18例,中位年龄29岁;肿瘤位于胰头40例(占29.85%),胰体尾及胰尾部64例(47.76%),颈部17例(12.69%);肿瘤体积较大,中位长径6.0 cm;21例(15.67%)因触及上腹包块就诊,上腹部隐痛不适50例(37.31%),49例无症状(36.57%).超声表现为胰腺低回声实性或囊实性占位.计算机断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)发现胰腺低密度占位性病变,增强扫描实性部分渐进性强化,强化程度低于正常胰腺,囊性成分不强化.126例行手术治疗.随访89例,4例复发转移死亡,1例未行手术治疗的患者病情较前进展,其余均未发现肿瘤复发转移.结论:SPTP好发于年轻女性,具有恶性潜能,其临床表现缺乏特异性,术前诊断主要依赖影像学检查,手术切除是首选治疗方法,预后好.     

胰腺实性假乳头状肿瘤

胰腺实性假乳头状瘤（SPTP）是一种罕见的低度恶性胰腺肿瘤,其组织来源尚不清楚。近年来,随着对其认识的提高,临床诊断病例逐渐增多,但术前容易误诊为无功能胰岛细胞瘤、腺泡细胞癌和胰母细胞瘤等。该肿瘤最早由Frantz描述,故又称Frantz肿瘤。其他名称还包括乳头状囊性肿瘤、胰腺乳头状上皮肿瘤、胰腺实性和囊性肿瘤等。1996年WHO对其重新分类命名为胰腺实性假乳头状瘤。SPTP患病率低,在胰腺肿瘤中占0．31％～2．7％。大多数SPTP患者就诊时无症状,部分因为体检发现腹部肿块后就诊,有症状者主要表现为上腹部胀痛、食欲不振等（有报道可表现为腹腔内出血）,可能与肿瘤压迫有关,缺乏特异性,因此常延误诊断。就诊时肿瘤体积往往较大。     

胰腺实性假乳头状瘤的诊断与治疗

胰腺实性假乳头状瘤（SPT）是一种罕见的低度恶性的胰腺肿瘤，术前容易误诊。2000-2005年，我们收治6例SPT患者。现作回顾性分析，并总结诊治经验。     

胰腺实性假乳头状瘤的临床病理分析

背景：胰腺实性假乳头状瘤（SPNP）是一种并非罕见的低度恶性胰腺肿瘤,近年报道的例数明显增多。目的：总结SPNP的临床病理特点,探讨其生物学行为。方法：回顾性分析2003年1月～2007年6月上海瑞金医院收治的13例SPNP患者的临床病理资料,并采用免疫组化方法检测肿瘤细胞α1-抗胰蛋白酶（AT）、α1-抗胰凝乳蛋白酶（ACT）、神经元特异性烯醇化酶（NSE）、波形蛋白、CD56、CD10、胰岛素、胰高血糖素、胃泌素、生长抑素等的表达。结果：526例胰腺肿瘤患者中,13例（2.5%）诊断为SPNP,男女比例为1∶5.5,平均年龄31.5岁,瘤体平均直径8.0cm。术前影像学诊断SPNP者6例（46.2%）。组织形态学显示瘤细胞大小一致,排列成实性片状区和假乳头结构。影像学显示4例浸润血管和周围组织,其中1例发生肝转移。免疫组化示α1-AT、α1-ACT、波形蛋白均呈阳性,11例NSE阳性,无胰岛素和胃泌素阳性者。所有患者均行手术完整切除肿瘤,术后平均随访24个月,均无复发或转移。结论：SPNP好发于年轻女性,具有低度恶性潜能,免疫组化检测对其诊断和鉴别诊断具有较重要的价值,手术治疗对SPNP的疗效较好。     

胰腺实性假乳头状肿瘤的外科治疗

胰腺实性假乳头状肿瘤(SPTP)是一种交界恶性的胰腺实体肿瘤,治疗方法以手术切除为主,目前主要采用肿瘤局部切除术、胰腺节段切除术、肿瘤扩大切除术,手术方式的选择取决于对肿瘤恶性程度的判断,术后并发症以胰瘘为主,保守治疗有效,完整切除肿瘤后,患者可获得长期生存。放射、化学治疗等辅助治疗效果尚不明确。     

胰腺实性假乳头状瘤293例临床荟萃分析

背景：胰腺实性假乳头状瘤（SPNP）是一种低度恶性的胰腺肿瘤,近年报道的例数明显增多。目的：总结SPNP的临床特征。方法：对以“囊实性肿瘤／胰腺”、“实性假乳头状瘤／胰腺”为关键词,在中国医院知识仓库医学专题全文数据库（CHKD）检索得到的1997年10月～2008年8月发表的32篇文献中293例SPNP患者的临床特征进行分析。结果：人组SPNP患者的男女比例为1：8．2,平均年龄27．3岁,临床表现无特异性。SPNP影像学表现为由不同比例的囊实性成分组成,术前影像学检查的诊断率为41．0％。所有患者均为单发性肿块,平均最大径7．6cm。218例患者的包膜完整,75例不完整。共196例患者接受治疗,根治性手术切除率94．9％。220例患者平均随访33_3个月,6例复发．3例死亡。结论：SPNP是一种并非罕见的低度恶性肿瘤,好发于年轻女性。手术切除对SPNP的疗效较好．患者预后佳。     

国内胰腺实性假乳头状瘤1180例临床荟萃分析

目的 汇总分析国内报道的胰腺实性假乳头状瘤(SPTP)病例,探讨国人SPTP的流行病学、临床特点及诊治策略.方法 以“胰腺实性假乳头状瘤”、“胰腺乳头状囊性肿瘤”、“胰腺乳头状上皮肿瘤”、“胰腺实质性囊性肿瘤”、“Frantz瘤”等为检索词,电子检索2001年1月至2011年12月间中国生物医学期刊文献数据库和中国生物医学文献数据库,总结分析纳入文献的临床资料.结果 共纳入117篇文献1180例患者,其中女性1054例,男性126例,男女比例为1∶8.37.发病年龄9～ 83岁,平均29岁.有详细临床资料者1172例,临床表现以腹部不适(526例,44.9％)、体检发现肿瘤就诊(464例,39.6％)、扪及腹部肿物(131例,11.2％)为主.实验室及影像学检查无特异性.肿瘤直径1.3～30 cm,平均7.84 em,位于胰头407例(36.8％),胰颈96例(8.7％),胰体尾部587例(53.1％).1116例患者接受治疗,其中1107例(99.2％)行手术切除.病理检查628例(57.0％)为良性,306例(27.8％)表现为恶性行为,浸润性生长侵及周围器官及组织.随访977例,随访时间为1个月至13年,42例(4.3％)复发或转移,其中24例病死.结论 SPTP是一种少见的低度恶性肿瘤,部分呈恶性表现,多发于年轻女性,临床表现、实验室及影像学检查无特异性,病理检查可确诊,手术治疗为首选,预后好.     

Solid pseudopapillary tumor of the pancreas in male patients: Report of 16 cases

AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.     

Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas: A single institution experience with 97 cases

Background/objectivesWe evaluated the diagnoses and surgical management of solid pseudopapillary tumors of the pancreas (SPTP) in a single center setting.MethodsDemographic details, clinical presentations, imaging features, surgical strategies, and pathological findings of 97 consecutive patients who underwent surgery for pathologically confirmed SPTP between 2008 and 2016 were analyzed retrospectively.ResultsA total of 97 patients with SPTP accounted for 2.15% of total pancreatic surgeries (N = 4508). The mean age at diagnosis was 31.6 ± 13.92 years (range: 7–83 years), and males:females were 85:12. Chief complaints were abdominal pain or discomfort (n = 50). The mean transverse tumor diameter was 53.2 ± 2.76 mm (range: 14–170 mm). Tumors were localized to the pancreatic head (38.1%; 37/97), neck (12.4%; 12/97), body and tail (49.5%; 48/97). There were no significant differences in age of onset, presenting symptoms, and sites between males and females. A significant difference was found in the maximum diameter of SPTP across different age groups. Partial pancreatectomy was performed for patient with tumor ≥ 5 cm, and enucleation was performed when tumor was smaller than 5 cm. Pancreatic fistula was the main complication. Immunohistochemical markers for endocrine, exocrine and epithelial factors were used for a final diagnosis. During a median follow-up of 54 months (range: 7–121 months), 84 patients were alive without evidence of recurrence, and 13 patients were lost to follow-up.ConclusionSPTP surgical resection is a safe procedure with low morbidity and mortality, which is also effective even in the presence of invasiveness and metastases. Accurate initial diagnoses and follow up are essential.     

Solid pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasms are rare. This article reviews the clinical and pathologic features of solid pseudopapillary neoplasm of the pancreas, including the epidemiology, cytology, molecular pathology, differential diagnosis, treatment, and prognosis. Solid pseudopapillary neoplasms are low-grade malignant tumours of the pancreas characterized by poorly cohesive epithelial cells with solid and pseudopapillary patterns. Solid pseudopapillary neoplasms occur predominantly in young women. Although solid pseudopapillary neoplasms can occur throughout the pancreas, they arise slightly more frequently in the tail of the pancreas. The aetiology is unknown. Extremely rare cases have been reported in the setting of familial adenomatous polyposis. There are no symptoms unique to solid pseudopapillary neoplasms, however, the most common symptom is abdominal pain or discomfort. The features of solid pseudopapillary neoplasms on computed tomography imaging are indicative of the pathologic changes within the tumour. Typically, well-demarcated masses with variably solid and cystic appearances. Microscopically, these tumours are composed of epithelial cells forming solid and pseudopapillary structures, frequently undergoing haemorrhagic cystic degeneration. Typically, these tumours express nuclear and/or cytoplasmic β-catenin. Almost all solid pseudopapillary neoplasms harbour mutations in exon 3 of CTNNB1, the gene encoding β-catenin. The overall prognosis is excellent, and most patients are cured by complete surgical resection.     

胰腺双部位实性假乳头肿瘤1例

目的:总结1例胰腺双部位实性假乳头肿瘤(SPT)的临床病理特点,探讨其可能起源.方法:手术行标准胰十二指肠切除术和胰体尾及脾切除术,分析该病例SPT的临床病理特点,并行多个抗体的免疫组织化学检查.结果:患者术后血糖5.5-8.9 mmol/L,第5天开始恢复饮食.未发生胰漏、胆漏及腹腔感染等并发症.大体形态的囊实性比例不尽相同,但镜下肿瘤细胞形态学一致,均确诊为SPT,对各个免疫表型的表达具有异质性,其中VIM、S100、AAT、CyclinD1、PR及Nestin 均呈阳性.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,由干细胞发育过程中分化不成熟所致.     

Solid pseudopapillary neoplasm of the pancreas: a single institution experience of 14 cases

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity; therefore proper diagnosis, evaluation and formulation of treatment protocols is difficult. A total of 14 cases were diagnosed and treated at our institute over a 10-year period (1992-2002). A retrospective study of all these cases was performed with respect to age group most frequently affected, sex ratio, common presenting symptoms and signs, investigative protocols, pathological features, treatment offered, outcome and prognosis. All the 14 patients were females, with a median age of 20 years (range 13-45 years). The commonest presenting symptom was abdominal pain. All these patients underwent surgical exploration; 13 patients underwent resection of the tumour. The average length of postoperative hospital stay was 10.3 days. Significant postoperative morbidity was seen in only one case. There was no postoperative mortality. All these patients who underwent resection were disease-free on follow-up ranging from 6 to 96 months (median 36 months).     

Solid pseudopapillary tumor of the pancreas:A review of 553 cases in Chinese literature

AIM:To sum up the clinical and pathological characte- ristics of solid pseudopapillary tumor (SPT) and the experience with it.METHODS: A total of 553 SPT patients reported in Chinese literature between January 1996 and January 2009 were retrospectively reviewed and analyzed. RESULTS: The mean age of the 553 SPT patients included in this review was 27.2 years, and the male to female ratio was 1:8.37. Their symptoms were non-specific, and nearly one third of the patients were asymptomatic. Computed tomography...     

Laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor of the pancreas

AIM:To compare short-and long-term outcomes of laparoscopic vs open distal pancreatectomy for solid pseudopapillary tumor(SPT)of the pancreas.METHODS:This retrospective study included 28 patients who underwent distal pancreatectomy for SPT of the pancreas between 1998 and 2012.The patients were divided into two groups based on the surgical approach:the laparoscopic surgery group and the open surgery group.The patients’demographic data,operative results,pathological reports,hospital courses,morbidity and mortality,and follow-up data were compared between the two groups.RESULTS:Fifteen patients with SPT of the pancreas underwent laparoscopic distal pancreatectomy(LDP),and 13 underwent open distal pancreatectomy(ODP).Baseline characteristics were similar between the two groups except for a female predominance in the LDP group(100.0%vs 69.2%,P=0.035).Mortality,morbidity(33.3%vs 38.5%,P=1.000),pancreatic fistula rates(26.7%vs 30.8%,P=0.728),and reoperation rates(0.0%vs 7.7%,P=0.464)were similar in the two groups.There were no significant differences in the operating time(171 min vs 178 min,P=0.755)between the two groups.The intraoperative blood loss(149 mL vs 580 mL,P=0.002),transfusion requirement(6.7%vs 46.2%,P=0.029),first flatus time(1.9d vs 3.5 d,P=0.000),diet start time(2.3 d vs 4.9 d,P=0.000),and postoperative hospital stay(8.1 d vs 12.8d,P=0.029)were significantly less in the LDP group than in the ODP group.All patients had negative surgical margins at final pathology.There were no significant differences in number of lymph nodes harvested(4.6 vs6.4,P=0.549)between the two groups.The median follow-up was 33(3-100)mo for the LDP group and 45(17-127)mo for the ODP group.All patients were alive with one recurrence.CONCLUSION:LDP for SPT has short-term benefits compared with ODP.Long-term outcomes of LDP are similar to those of ODP.