胰腺导管内乳头状黏液性腺瘤一例

患者男,57岁。无诱因出现皮肤巩膜黄染、尿色深黄、陶土样便伴上腹胀痛不适2月,于2013年9月8日入我院。实验室检查:天冬氨酸氨基转移酶117 U/L,丙氨酸氨基转移酶165 U/L,直接胆红素148.7 Umol/l,间接胆红素163.8 Umol/l,γ-谷氨酰转肽酶500 U/L,碱性磷酸酯酶586 U/L。有慢性胰腺炎病史4年。影像学检查及表现:2012年5月25日CT平扫显示胰头形态增大,密度不均,胰管局部明显扩张。2013年9月1日CT见胰腺形态饱满,胰腺主胰管明显扩张,最大径为1.3cm,可见分隔,呈轻度强化,扩张的主胰管管壁中度强化,胰     

胰腺导管内乳头状黏液瘤影像特征及误诊病例分析

目的 分析胰腺导管内乳头状黏液瘤(IPMN)影像学表现和误诊原因,减少误诊率.方法 回顾性分析术前影像诊断或怀疑为IPMN和术前影像误诊为胰腺其他疾病但是术后被确诊为IPMN患者的资料,共计130例.由2名高年资影像诊断医生统计资料,总结IPMN影像学表现,分析误诊原因,找出对策.结果 130例患者经病理确诊为IPMN有105例(80.7%),确诊为胰腺其他病变25例(19.2%);IPMN与慢性胰腺炎(CP)和浆液性囊腺瘤(SCN)间相互误诊病例最多.将IPMN按照病理级别分为轻至中度组和重度、浸润癌组,2组在囊肿直径、有无壁结节、有无分隔、主胰管直径、是否伴有肝内外胆管扩张组间有统计学差异(P<0.05).误诊的主要原因为影像科医生诊断时未完整结合患者的临床资料;对少见类型影像学表现认识不足;对于病变与胰管关系判断错误.结论 在诊断IPMN时需要结合病变临床特征,明确肿块与胰管之间的关系,全面掌握影像学表现;对于反复发作胰腺炎患者需考虑IPMN存在的可能;长期IPMN可以存在CP.     

胰腺导管内乳头状黏液瘤的影像分析

目的分析胰腺导管内乳头状黏液瘤的影像特征,以鉴别其良恶性。方法经手术和病理证实的5例胰腺导管内乳头状黏液瘤患者(男性3例,女性2例)均经CT平扫及增强扫描,4例经MRCP检查。对所有患者的影像表现进行回顾性分析。结果 5例中,主胰管型2例,分支型2例及混合型1例。肿瘤病灶位于胰头或钩突部2例,胰体尾部2例,胰尾部1例,在CT及MR像上表现为胰管扩张呈圆桶状的囊性或囊实性肿块,囊壁可见结节状突起,增强扫描壁结节呈轻中度强化或呈多囊状葡萄串样低密度影,MRCP清晰显示了扩张的胰管及分支的形态,胰管分支与主胰管相通。结论胰腺导管内乳头状黏液瘤有明确的影像特征,有助于良恶性鉴别,指导临床治疗及预后评估。     

胰腺导管内乳头状黏液瘤的CT诊断

胰腺导管内乳头状黏液瘤（intraductal papillary mucinous neoplasm,IPMN）是胰管内来源的肿瘤,可分泌大量黏液导致主胰管全程扩张,十二指肠乳头部开口由于黏液流过而扩大。1982年由日本Ohashi首先报道了4例。此后,随着影像设备的更新,国内不断有个案报道,但由于临床对本病认识不足,多误诊为慢性胰腺炎。     

胰腺导管内乳头状黏液样瘤的影像诊断

胰腺导管内乳头状黏液样瘤(IPMT)是胰腺较为少见的肿瘤,由胰腺导管内产生黏液的上皮细胞呈乳头状增殖形成的肿瘤,约占胰腺肿瘤的1％～2％.由于该肿瘤常常表现为胰腺炎症状,而且影像学检查多数仅表现为胰腺主导管扩张,因此临床上容易被忽视或误诊[1～3].随着医学影像检查技术的进步及诊断水平的提高,近年来逐渐被认识.本文收集了4家医院资料完整经病理证实IPMT病例19例,通过总结影像学表现,并结合复习文献,旨在提高对本病的进一步认识.     

胆管导管内乳头状黏液瘤一例

患者女,67岁.出现纳差、消瘦1个月,体重下降约10 kg,无发热、黄疸、腹痛、腹泻.CT显示肝内外胆管全程扩张,胆总管十二指肠开口处未见明显软组织肿块.扩张肝内胆管内可见多发乳头状结节影;增强后动脉期强化不明显,门静脉期中等程度强化(图1,2;箭).手术病理表现:术中见胆总管直径约3 cm,张力高.     

胰腺导管内乳头状黏液性癌1例

患者女,52岁。返酸并消瘦1年,上腹胀痛1月,加重1周。饮食睡眠可,大小便正常,无糖尿病、结核病史。血常规:白细胞9.28×109/L,中性粒细胞为80.2%;结核抗体阴性,血胰淀粉酶正常,血沉41 mm/h;血清学检查AFP1.75ng/ml,CEA 2.09ng/ml,CA12-5 22.80 U/ml,CA19-940.23 U/ml。外院胃镜示:十二指肠降段粘膜充血糜烂。外     

2型糖尿病患者中胰腺导管内乳头状黏液性肿瘤影像学分析

目的分析2型糖尿病患者中胰腺导管内乳头状黏液性肿瘤(IPMN)的影像学良恶性表现,提高影像学诊断水平。方法选取我院经手术病理证实的2型糖尿病患者伴胰腺IPMN患者20例。记录肿瘤分型、部位、大小、囊壁结节、胰管扩张等影像学表现。结果 20例IPMN中,头颈部9例,体尾部11例;混合型8例,多表现为主胰管不同程度扩张并周围分支胰管扩张,分支型6例,表现为单发单囊或多房囊性病灶;肿瘤平均直径约25.2 mm,主胰管型6例,表现为全程主胰管不同程度扩张,平均直径约15.9 mm;良性17例,恶性3例(2例为主胰管型均伴壁结节,1例混合型)。结论糖尿病患者的胰腺IPMN具有较为特征的影像学良性及恶性表现,临床上应严格把握手术和随访指征,结合患者的其他临床资料评估决定。     

胰腺分支胰管型导管内乳头状黏液瘤的MRI诊断与鉴别诊断

目的探讨胰腺分支胰管型导管内乳头状黏液瘤的MRI诊断及鉴别诊断。方法回顾性分析经手术病理证实的9例胰腺分支胰管型导管内乳头状黏液瘤的临床及MRI表现。结果 9例胰腺分支胰管型导管内乳头状黏液瘤患者年龄56~78岁,平均66.3岁,其中男性4例,女性5例,8例单发,1例多发。胰腺分支胰管型导管内乳头状黏液瘤的MRI表现呈多房囊样表现4例、呈分叶状3例、呈孤立单囊状2例;5例囊内见轻度强化壁结节。MRCP及薄层图像上能够显示胰腺分支胰管型导管内乳头状黏液瘤的囊与主胰管相通。结论 MRI在胰腺分支胰管型导管内乳头状黏液瘤的诊断与鉴别诊断中具有非常重要的价值。     

磁共振成像技术对胰腺导管内乳头状黏液瘤的诊断价值

目的探讨胰腺导管内乳头状黏液瘤的MRI影像学特点,以提高该病的诊断准确率。方法搜集12例经手术证实的胰腺导管内乳头状黏液瘤患者的临床及影像学资料,回顾性分析主胰管型和分支胰管型的MRI表现。结果研究证实,12例中有主胰管型3例和分支胰管型9例。主胰管型MRI表现为主胰管节段性或弥漫性扩张,可伴有胰腺实质的萎缩;分支胰管型MRI表现为单房或多房型囊性病变,并与主胰管相通。结论 MRI对胰腺导管内乳头状黏液瘤是一种无创、有效的诊断方法,有助于提高该病的诊断准确率。     

软骨黏液样纤维瘤2例误诊分析

软骨黏液样纤维瘤是一种少见的良性骨肿瘤,本院收治2例,现报告如下. 病例1 男,76岁.发现股骨粗隆间肿物1年余,近2月疼痛加重,以劳累后为著.骨盆正位片示(图1A):右股骨颈、股骨粗隆见不规则透亮区,周边见硬化边,其内见斑片状高密度影,考虑:骨囊肿.髋关节CT片示(图1B):右股骨颈呈轻度膨胀性改变,其内见不规则低密度区,病灶边缘见硬化边,病灶内见结节样及分隔样高密度影,考虑:内生软骨瘤.病理示(图1C):软骨黏液样纤维瘤.     

Pancreatic intraductal papillary mucinous neoplasm associated colloid carcinoma

Colloid carcinomas are rare pancreatic tumors characterized by the presence of mucin pools with scarce malignant cells. Most of these neoplasms arise from intestinal-type intraductal papillary mucinous neoplasms (IPMNs). We report a case of a 77-year-old male patient who presented with weight loss, asthenia, lumbar pain and diabetes. Imaging studies revealed a mixed-type IPMN with high-risk features and a possible invasive component. The patient underwent surgical resection and the histology confirmed an invasive colloid carcinoma of the pancreas associated with an intestinal-type IPMN. Although invasive ductal and colloid carcinomas may look similar on imaging studies, its distinction is important because the latter have a better prognosis.     

肝内胆管乳头状肿瘤的MRI表现

见明显肿块影.结论 MRI检查对IPNB与肝脏其他肿瘤鉴别具有一定价值.     

胰腺导管内乳头状黏液性肿瘤的影像学进展

胰腺导管内乳头状黏液性肿瘤(IPMNs)是胰腺最常见的囊性肿瘤[1].1982年由Ohhashi首次报道,定义为一种胰腺产生黏液的肿瘤[2].以后陆续有文献对该肿瘤进行不同的命名,如:产黏液癌、高分泌黏液癌、导管内乳头状肿瘤等.     

Correlation between CT patterns and pathological classification of intraductal papillary mucinous neoplasm

Objective

To examine CT patterns of intraductal papillary mucinous neoplasm (IPMN), analyze their correlation with pathologic classification, and discuss the value of CT in the diagnosis and differential diagnosis of IPMN.

Methods

CT patterns of 39 IPMN patients, whose clinical data were complete and whose diagnosis was confirmed by surgery and pathology, were classified into three types: (1) simple main pancreatic duct (MPD) dilation type, (2) MPD dilation with pancreatic cystic lesion type, and (3) simple pancreatic cystic lesion type. Correlations between the three CT types and Takada pathologic classification (MPD type, furcation type and mixture type) were analyzed. The 39 IPMN cases were pathologically classified as the benign group and the malignant/borderline group. CT characteristics including the presence or absence of mural nodules, intrafocal partitions, focal size and the degree of MPD and common bile duct (CBD) dilation were analyzed statistically.

Results

A correlation was found between the CT simple MPD dilation type and the pathological MPD type, between the MPD dilation with pancreatic cystic lesion type and the furcation and mixture types, and between the simple cystic lesion type and the furcation type (p < 0.001). The benign rate was 92% in patients without intrafocal mural nodules, and 42% in patients with intrafocal mural nodules. The difference between the two groups was statistically significant (p = 0.003). The presence or absence of intrafocal partitions was not correlated with benignancy or malignancy (p = 0.793). The maximum diameter of malignant/borderline lesions was bigger than that of benign ones (p = 0.016). There was no significant difference in MPD and CBD diameters between the benign and malignant/borderline groups. Regardless of pathological classification, the MPD diameter was larger than the CBD diameter in all cases (p = 0.02).

Conclusion

The three CT types of IPMN well correlated with the pathologic classification, which is helpful for analyzing CT manifestations and improving the accuracy of diagnosis. MPD dilation is usually larger than CBD dilation in IPMN patients, which is also helpful in the diagnosis and differential diagnosis of IPMN in the context of other related findings.     

多层螺旋CT对胰腺导管内乳头状黏液性肿瘤的诊断价值

目的探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的多层螺旋CT诊断价值。方法分析12例经手术病理证实的IPMN的临床资料及CT图像表现,包括胰管扩张的程度、范围,病灶的大小、形态、密度、边缘和强化方式等。采用曲面重建技术显示扩张的主胰管和分支胰管。结果12例IPMN中,男性8例,女性4例,年龄48~85岁。肿瘤位于钩突部7例,胰腺体部3例,胰腺头部和尾部各1例。分支胰管宽度>5 mm者10例,主胰管宽度>5 mm者4例,其中2例表现为胰腺弥漫性肿胀和胰腺实质内肿块。分支胰管型8例,主胰管型3例,混合型1例。病理结果显示腺瘤4例,交界性肿瘤5例,腺癌3例。结论多层螺旋CT对IPMN的诊断、分型具有重要的临床应用价值。     

An intraductal papillary mucinous neoplasm associated tubular adenocarcinoma with sarcomatoid component: A case report

Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a risk factor for the development of adenocarcinoma. However, the presence of a component of sarcomatoid carcinoma in the malignant tumor has rarely been described in the literature. A 30-year-old Chinese woman was admitted to our hospital with vague abdominal pain and a poor appetite for 2 months. Computed tomography revealed a huge, unilocular, solid-cystic mass in the pancreatic body, and tail. The patient underwent an en bloc resection of the distal pancreatic tumor with splenectomy and regional lymphadenectomy. Pathologic examination revealed an IPMN associated tubular adenocarcinoma containing a component of sarcomatoid (spindle-shaped cell) carcinoma. Immunohistochemical results revealed that the mononuclear spindle-shaped cells were positive for both pan-cytokeratin and vimentin. There was no evidence of perineural or vascular infiltration, lymph nodal metastasis, or positive surgical margins. The patient developed local recurrence 3 months after surgery for which she received chemoradiotherapy at another hospital. Distant metastases were detected 6 months after the surgery and the patient expired 9 months after surgical resection. We concluded that the presence of sarcomatoid change in IPMN-associated pancreatic adenocarcinoma may indicate poor prognosis.