MRI对胰腺囊性肿瘤的诊断价值

目的探讨MRI对胰腺囊性肿瘤的诊断价值.方法回顾分析23例经手术病理证实的胰腺囊性肿瘤资料,总结其影像表现.结果黏液性囊性肿瘤10例,囊性肿块较大,肿块平均直径超过10 cm,由较厚的纤维壁分隔成多房囊肿,外壁光滑,边界清楚.浆液性囊腺瘤6例,病灶较小,囊内有分隔而呈放射状排列,中心瘢痕为其特征性表现.胰腺囊性转移瘤3例,均有肿瘤病史,表现不典型,需结合肿瘤病史定性.胰胚细胞瘤2例,幼儿发病,肿块巨大,肿瘤坏死囊变,形成假-假性囊肿.胰腺乳头状囊实性肿瘤1例,表现为边界清楚的囊实性肿块,囊壁上有壁结节.胰腺毛细血管瘤1例,表现与浆液性囊腺瘤相似,难以术前诊断.结论 MRI对胰腺囊性肿瘤具有高度敏感性,不同病变有一定的特征性表现,对术前定性极有价值.     

多层螺旋CT对胰腺囊性肿瘤的诊断价值

目的探讨多层螺旋CT对胰腺囊性肿瘤的表现和诊断价值,以提高对该类疾病的认识。方法回顾性分析谷城县人民医院2010年1月-2013年1月18例经手术或穿刺活检标本病理证实的胰腺囊性肿瘤患者的CT资料。结果浆液性囊腺瘤8例,7例小囊型,1例大囊型,小囊型病灶较小,囊内有分隔,强化是呈海绵状,1例可见中央星状瘢痕伴钙化,大囊型病灶呈薄壁大囊,无囊壁结节及分隔,增强扫描囊壁轻度强化;黏液性腺瘤6例,2例表现为单房囊性病灶,4例表现为多房分隔囊性病灶,增强后壁有强化;黏液性囊腺癌2例,1例伴有肝转移;实性假乳头状瘤2例,均为囊实混合型。结论多层螺旋CT对胰腺囊性肿瘤具有高度敏感性,不同病变有其特征表现,对术前诊断有一定价值。     

胰腺浆液性囊腺瘤15例影像学分析

目的提高胰腺浆液性囊腺瘤的诊断水平。方法回顾性分析经手术病理证实的15例浆液性囊腺瘤的CT(10例)和MRI(5例)特点。结果肿瘤最大径2.1～7.2 cm,平均4.6 cm;微囊型10例,由大量微囊(直径<2 cm)组成伴纤维间隔,呈蜂窝状或海绵状外观;寡囊型2例,由少数(个数<6)和大囊(直径>2 cm)构成,伴少许纤维间隔;混合型3例,内部表现同微囊型,伴周围大囊(直径>2 cm)。15例肿瘤均呈分叶状,边界清楚,5例中央见星芒状瘢痕组织,1例伴钙化。肿瘤囊壁薄(厚度<2 mm),囊内纤维间隔(厚度<3 mm)及中央瘢痕呈延迟强化。结论胰腺浆液性囊腺瘤CT和MRI表现具有一定特征性。分叶状、边界清楚的分房状肿物伴间隔延迟强化为其影像学特征性表现。     

不典型胰腺实性假乳头状瘤的影像学诊断及病理对照分析

目的分析不典型胰腺实性假乳头状瘤的影像学表现并与病理对照,探讨其诊断价值,就类似影像学表现的疾病进行鉴别诊断。方法选取77例胰腺实性假乳头状瘤患者,均行手术治疗,并经病理学和免疫组化分析。术前诊断为胰腺实性假乳头状瘤47例,胰腺囊肿7例,假性囊肿4例,胰腺脓肿5例,胰腺浆液性囊腺瘤7例,胰腺癌5例,胰腺血肿2例。对77例患者临床资料进行回顾性分析,比较其影像和病理学特点。结果 77例患者中男性29例,女性48例,年龄2~79岁,平均41.5岁。18例因触及上腹部包块就诊,12例有腹胀,47例无症状。查体：影像学检查发现胰腺或胰周占位性病变,44例为囊实性肿块,16例为单个囊性肿块,10例为实性肿块,7例为多个囊性肿块（囊〈3个）。肿瘤位于胰腺头部29个,体部25个,尾部17个,难以确定的部位6个（以胰尾部周围为主）。有或无完整包膜,不伴有胆总管和胰管扩张。病理特点为肿瘤实性部分由实性区、假乳头区及两者过渡区以不同比例混合而成。囊性区由坏死、液化组织及陈旧性出血组成。结论胰腺实性假乳头状瘤典型影像学表现为较大囊实性肿块,诊断比较容易,但对于表现为单个或多个囊性或单纯实性者,诊断需与有类似表现的胰腺其他疾病鉴别,特别对于老年患者需要与胰腺癌进行鉴别。影像学表现和病理学有一定特征,有助于诊断。     

胰腺囊腺瘤与囊腺癌39例的CT影像学特征

目的 探讨胰腺囊腺瘤与囊腺癌的CT影像学特征.方法 回顾性分析经过病理证实的21例浆液性囊腺瘤、12例黏液性囊腺瘤、6例黏液性囊腺癌的CT影像学资料,分析肿瘤部位、单(多)囊、最大囊直径、囊壁特征、囊内分隔、肿瘤边界、肿瘤与胰管关系等影像学征象.结果 21例浆液性囊腺瘤中17例位于胰头颈部,5例位于胰体尾部,其中1例为多发;均为多囊,平均最大囊直径为1.8 cm;4例囊壁或分隔有钙化,7例分隔可见软组织成分;10例胰管轻度增宽.12例黏液性囊腺瘤中6例位于胰头颈部,6例位于胰体尾部;4例为多囊,平均最大囊直径为4.5 cm;1例分隔可见钙化,6例囊壁可见软组织成分;2例胰管扩张,3例胰管轻度增宽.6例黏液性囊腺癌中5例位于胰体尾部,1例位于胰头颈部;4例为多囊,平均最大囊直径为5.1 cm;1例分隔可见钙化,5例囊壁可见软组织成分;1例胰管扩张,1例胰管轻度增宽.所有病灶与胰管均不相通,增强后病灶软组织成分及分隔均有不同程度强化.结论 胰腺囊腺瘤与囊腺癌的CT表现具有一定的特征性,但对于少数不典型表现病例,诊断仍存在困难.     

胰腺囊性肿瘤患者MSCT影像学表现及病理诊断对比分析

目的探讨多层螺旋CT(MSCT)在胰腺囊性肿瘤诊断中的价值及不同病变影像学表现。方法79例胰腺囊性肿瘤患者,入院后均接受MSCT检查,并进行手术或穿刺活检标本病理检查,以病理诊断结果为金标准,评估MSCT诊断价值。结果病理检查结果显示,79例胰腺囊性肿瘤患者分别为浆液性囊腺瘤29例,黏液性囊腺瘤31例,黏液性囊腺癌10例,实性假乳头状瘤9例;MSCT诊断浆液性囊腺瘤29例,黏液性囊腺瘤32例,黏液性囊腺癌9例,实性假乳头状瘤9例,与病理诊断符合率为92.41%。结论MSCT检查在胰腺囊性肿瘤诊断中有较高敏感性,且不同病变有其影像学表现特征,能为鉴别诊断提供参考。     

胰腺囊性及囊实性病变应用超声诊断的临床分析

目的分析并研究超声诊断在胰腺囊性及囊实性病变中的临床应用价值。方法随机选择2015年1月—2016年12月期间陕西省西安市第八医院收治的40例胰腺囊性及囊实性病变患者为研究对象,所有患者的病症经手术病理证实,记录比较不同病变下患者的超声诊断结果。结果本研究中,出现胰腺囊腺瘤及囊腺癌患者12例,患者的超声影像图主要表现为境界清洗的囊实性包块,或者呈现囊实混合性结构,其实质部分质地较为疏松,显示为"豆腐渣"样的改变。出现胰腺癌患者共10例,其超声诊断结果主要表现为实质低回声为主的不规则肿块,其内回声不均匀,存在小片状液性暗区。出现胰腺单纯性囊肿患者1例,其超声影像诊断结果表现为存在边界清晰的囊状暗区,壁光整,暗区较为清晰,无明显分隔。出现胰岛细胞瘤患者1例,经超声诊断,其表现为囊实性混合包块,边界较为清晰,内部有不规则液性暗区及较多的中低光点,有明显的分隔光带。共出现胰腺假性囊肿16例,主要表现为大小不一的囊实性包块,部分显示为囊实混合结构,部分包块暗区较为清晰,部分包块中存在内回声混杂。结论临床诊断中,应用超声进行胰腺囊性及囊实性病变的诊断具有较高的额应用价值,值得推广应用。     

多层螺旋CT对胰腺囊腺瘤及囊腺癌的诊断价值

目的分析胰腺囊腺瘤及囊腺癌的MSCT表现,提高其诊断水平。方法分析经手术病理证实的18例胰腺囊腺瘤及囊腺癌患者的MSCT表现。结果浆液性囊腺瘤8例,表现为多房2例：中央可见星芒状钙化,增强后分隔强化;表现为单房囊性病灶6例：边缘分叶,增强后病变无强化。黏液性囊腺瘤5例,2例表现为圆形或椭圆形单房囊性病灶,3例呈多房分隔囊性病灶,增强后壁有强化。5例囊腺癌患者肿瘤呈多房分隔囊性病灶,增强后壁结节及分隔强化,其中4例伴肝脏转移及1例伴邻近血管受侵征象。结论MSCT能很好显示胰腺囊腺瘤及囊腺癌内部结构及邻近脏器、血管受累改变,对其诊断及鉴别诊断具有重要价值。     

肝脏肿瘤囊实性病变的CT及MR特点分析

目的：探讨肝脏肿瘤囊实性病变的影像学特点,为其诊断及鉴别诊断提供依据。方法分析49例肝脏肿瘤（原发性肝细胞癌26例,肝内胆管癌3例,肝脏恶性纤维组织细胞瘤2例,炎性肌纤维母细胞瘤2例,肝脏囊腺瘤1例,肝脏转移瘤15例）患者的CT和MR影像学表现,总结其特点。结果肝细胞癌囊变区CT主要表现为形态不规则水样低密度,MR主要表现不规则长T1长T2混杂信号;CT及MR增强检查实性区具有“快进快出”强化特点。肝内胆管细胞癌CT表现为肿瘤中心部分不规则低密度囊变区,肿瘤周围可见迂曲扩张的胆管,MR表现为囊变区呈不规则长T1长T2混杂信号;CT及MR增强检查实性区均可见延时强化。肝脏恶性纤维组织细胞瘤CT表现为花环状或中心囊变。炎性肌纤维母细胞瘤CT表现为分隔状囊变,囊壁及分隔厚薄不均。肝脏胆管囊腺瘤CT表现为分隔状囊实性肿块,其内见壁结节。肝转移瘤表现为肝内多发病灶,具有边缘环形强化特点。结论 CT和MR为诊断肝脏肿瘤囊实性病变的较好方法。     

脑实质室管膜瘤核磁共振成像征象分析

目的分析颅内脑实质室管膜瘤核磁共振成像(MRI)表现,旨在提高幕上及幕下脑实质室管膜瘤影像诊断的准确率。方法回顾性分析经手术病理证实的12例脑实质内室管膜瘤MRI表现;重点分析肿瘤好发部位、形态特征、与脑室的关系、增强扫描特征等。结果位于幕上脑实质者10例,其中7例表现为囊实性,且实性成分信号不均匀,明显强化;3例表现为囊性,囊壁较薄,增强扫描囊壁明显环形或不规则形强化。幕下脑实质内室管膜瘤2例,均位于小脑半球,表现为实性肿块。结论脑实质内室管膜瘤多发生于幕上大脑半球,且与脑室关系密切,多表现为囊实性,MRI表现有一定的特征性,但仍与其他中枢神经系统肿瘤及部分脑外肿瘤鉴别困难,仅依靠影像表现无法做出明确诊断。     

Serous cystic neoplasm of the pancreas-indications for surgery

BACKGROUND/AIMS: Serous cystic neoplasm is a rare pancreatic tumor. Almost all of these tumors are benign and only 9 cases of serous cystadenocarcinoma have been reported. Although serous cystic neoplasm is typically a microcystic lesion, there is a wide range of cyst sizes from micro to macro and even unilocular cysts have been reported. Thus, the diagnosis is difficult and indications for surgery are controversial. We aimed to elucidate the clinicopathological and imaging features of serous cystic neoplasm of the pancreas. METHODOLOGY: We investigated 15 cases of resected and 6 cases of nonresected cases of serous cystic neoplasm, evaluating the symptoms, imaging findings, preoperative diagnosis, macroscopic morphology, microscopic findings, and results of follow-up. RESULTS: Imaging diagnosis of serous cystic neoplasm was not easy, because not so many tumors had the typical microcystic pattern. Most of the resected serous cystic neoplasms were non-microcystic or were small tumors, which could not be precisely evaluated. CONCLUSIONS: Small serous cystic neoplasms, which can be diagnosed by imaging, do not need to be resected because serous cystadenocarcinoma is rare. Tumors of the pancreas that cannot be confirmed to be serous cystic neoplasm should be resected because of the possibility of pancreatic cancer, mucinous cystadenocarcinoma, or mucinous cystadenoma with malignant potential.     

Serous cystadenoma of the pancreas communicating with a pancreatic duct

Summary Conclusion To differentiate serous cystadenoma from other cystic lesions communicating with the pancreatic duct, careful radiological examination is necessary. Background Communication between the cystic cavity and the pancreatic duct in an ordinary serous cystadenoma is uncommon, although it is not uncommon in other cystic lesions, such as pseudocyst, mucinous cystadenoma/adenocarcinoma, and intraductal papillary tumor. Methods A serous cystadenoma of the pancreas communicating with main pancreatic duct in a 76-yr-old male is reported. Results The communication was preoperatively demonstrated by endoscopic retrograde cholangiopancreatography and confirmed by histopathological examination of the resected specimen.     

Operative indications for cystic lesions of the pancreas with malignant potential--our experience

BACKGROUND/AIMS: There are still many important but unclear points regarding the differential diagnosis and operative indications of cystic lesions of the pancreas with malignant potential. Studies of the clinicopathological and molecular biological characteristics of such diseases are necessary. In this paper, we discuss operative indications for this condition based on a review of the literature and our own experience. METHODOLOGY: Seven cases of serous cystadenoma and 9 cases of mucinous cystadenoma or cystadenocarcinoma of the pancreas that were operated on or autopsied in our department from 1980 to 1996 were analyzed clinicopathologically. Small cystic lesions incidentally found in 300 autopsied cases were also studied. Finally, mucin-producing tumors described in several reports were reviewed, and the branch type of this tumor was especially investigated. RESULTS: A marked disappearance of pancreatic acini in the upstream pancreas was found when serous cystadenoma became large. Papillary projection was histologically found in all of the cases. Tumorous invasion to the interstitium was suspected in tumors more than 5 cm in diameter, and malignancy was reported when tumors were larger than 6 cm. As for mucinous cystadenocarcinoma, the patients had a poor prognosis. In 2 of 42 cases with a pseudocyst, small duct cell carcinoma was incidentally found adjacent to the pseudocyst on the duodenal side. With regard to branch-type intraductal papillary neoplasm, 80% of the tumors larger than 4 cm were malignant. Most of the small cystic lesions found in elderly autopsy cases were accompanied by hyperplastic epithelia without evidence of malignancy. CONCLUSIONS: Based on our experience, an operation should be considered and resection is recommended under the following circumstances: 1) cystic lesions in the body and tail of the pancreas in middle-aged women; 2) typical serous cystadenoma larger than 4 cm; 3) mucinous cystadenoma of any size; 4) branch-type intraductal papillary neoplasm larger than about 3 cm; and, 5) pseudocysts of unknown cause. Small cystic lesions in elderly patients should not necessarily be operated on, but should be followed-up carefully.     

Macrocystic type of serous cystadenoma with a communication between the cyst and pancreatic duct

A 42-year-old woman with a cystic lesion in the head of the pancreas was evaluated by using abdominal ultrasonography, a computed tomographic scan, magnetic resonance imaging and endoscopic retrograde pancreatography. Multiple cystic lesions, 5 cm in diameter, which had papillary protrusion inside the cyst in the head of the pancreas and had the communication between the cysts and pancreatic duct, were determined. Pylorus-preserving pancreaticoduodenectomy was performed under the diagnosis of mucinous cystic neoplasm of the pancreas. Although the cut surface of the tumor showed a macrocystic tumor of 3 cm in diameter, part of the cyst wall was cavernous. A histopathological examination showed single-layered cuboidal cells, which lead to the diagnosis as being serous cystadenoma of the pancreas. Serous cystadenoma is a rare, almost benign pancreatic tumor. The macrocystic subtype of serous cystadenoma is even more rare. We describe a patient who had this macrocystic subtype of serous cystadenoma with a communication between the cyst and pancreatic duct. This case illustrates the difficulty in the diagnosis of cystic lesions in the pancreas, and might support the single category of cystic lesions of the pancreas.     

Risk of malignancy in serous cystic neoplasms of the pancreas

BACKGROUND: In contrast to mucinous cystic neoplasms of the pancreas, which are known to have considerable malignant potential, the serous variant is generally thought to be benign. There are, however, several reports of malignancy in serous cystic neoplasms of the pancreas. AIMS: To assess the risk of malignancy of serous cystic tumors of the pancreas and to investigate specific clinical and histological features. METHODS: Clinical and pathological characteristics of benign and malignant serous cystic neoplasms of the pancreas were investigated by a review of the literature and documented by a case of a serous cystadenocarcinoma and immunohistochemical analysis of a series of serous cystadenomas. Reviewing the literature prevalence, age and sex distribution of serous cystic neoplasms were analyzed. RESULTS: The prevalence of cancer among serous cystic neoplasms reported since 1989 was 3%. Serous cystadenoma of the pancreas present at an earlier age (61 years) than serous cystadenocarcinoma (66 years; p = 0.056) and are symptomatic in the majority of patients.Pathological examination of the primary tumor was not able to distinguish cystadenoma from cystadenocarcinoma in 38% of cases. In 25% the diagnosis of cancer was established only after growth of metachronous metastases. In the present case, nuclear atypia, papillary structures, proliferation marker Ki-67 and p53 protein were increased in the primary tumor and/or metachronous metastasis. CONCLUSION: Serous cystic neoplasms of the pancreas do have malignant potential with a risk of malignancy of 3% and should be surgically treated if the operative risk is acceptable. Routine analysis of genetic and proliferation markers may improve diagnosis of malignancy in these tumors.     

Surgical Management of Pancreatic Cysts: A Shifting Paradigm Toward Selective Resection

Due to the widespread use of high-quality cross-sectional imaging, pancreatic cystic neoplasms are being diagnosed with increasing frequency. Clinicians are therefore asked to counsel a growing number of patients with pancreatic cysts diagnosed incidentally at an early, asymptomatic stage. Over the last two decades, accumulating knowledge on the biologic behavior of these neoplasms along with improved diagnostics through imaging and endoscopic cyst fluid analysis have allowed for a selective therapeutic approach toward these neoplasms. On one end of the management spectrum, observation is recommended for typically benign lesions (serous cystadenoma), and on the other end, upfront resection is recommended for likely malignant lesions (main duct IPMN, mucinous cystadenoma, solid pseudopapillary tumor, and cystic pancreatic neuroendocrine tumors). In between, management of premalignant lesions (branch duct IPMN) is dictated by the presence of high-risk features. In general, resection should be considered whenever the risk of malignancy is higher than the risk of the operation. This review aims to describe the evolution and current status of evidence guiding the selection of patients with pancreatic cystic neoplasms for surgical resection, along with a specific discussion on the type of resection required and expected outcomes.     

Cystic pancreatic lesions: current evidence for diagnosis and treatment

Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use and quality of abdominal imaging. There are well known differential diagnostic difficulties concerning these lesions. The aim is to review current literature on the diagnostic options and the following treatment for cystic lesions in the pancreas focusing on serous cystadenomas, primary mucinous neoplasm of the pancreas and mucinous cystadenocarcinomas, as well as intraductal papillary mucinous neoplasms, starting with excluding pseudocysts. A conservative approach is feasible in patients with a clinical presentation suggestive of an asymptomatic serous cystadenoma. Surgical management, as well as follow-up, is discussed for each of the types of neoplastic lesions, including an uncharacterized cyst, based on patient data, symptoms, serum analysis, cyst fluid analysis and morphological features. Aspects for future diagnostics and management of these neoplasia are commented upon.     

Endoscopic ultrasound characteristics of mucinous cystic neoplasms of the pancreas

OBJECTIVE: Mucinous cystic neoplasms of the pancreas have a more favorable prognosis than ductal adenocarcinoma. Management of a subgroup, intraductal papillary-mucinous neoplasms, is controversial. Endoscopic ultrasound (EUS) with fine-needle aspiration biopsy may emerge as the imaging modality of choice. There are few studies describing the EUS features of these tumors. METHODS: A total of 35 consecutive cases of cystic tumors of the pancreas with an established pathological diagnosis were analyzed for characteristic EUS features. RESULTS: Mucinous cystadenocarcinomas (n = 14) were more likely to be characterized by hypoechoic cystic/solid mass or complex cyst and were frequently associated with a dilated main pancreatic duct. Benign mucinous duct ectasia (n = 6) were characterized by a dilated main pancreatic duct in conjunction with hyperechoic thickening of the duct wall. The two cases of intraductal mucinous hyperplasia additionally showed a hypoechoic mass. Intraductal papillary carcinoma (n = 11) had features in common with mucinous cystadenocarcinoma but also had echogenic foci in the mass and intraductal hyperechoic lesions. The two cases of microcystic cystadenoma showed either a mixed hypoechoic solid/cystic mass or a complex cyst without the additional features seen in mucinous cystadenocarcinoma. CONCLUSIONS: EUS features seem to exist that may help to differentiate cystic neoplasms from adenocarcinoma of the pancreas and, thus, to establish the preoperative diagnosis of cystic tumors of the pancreas.     

Cystic pancreatic lesions: Current evidence for diagnosis and treatment

Abstract

Pancreatic cystic neoplasms are detected at an increasing frequency due to an increased use and quality of abdominal imaging. There are well known differential diagnostic difficulties concerning these lesions. The aim is to review current literature on the diagnostic options and the following treatment for cystic lesions in the pancreas focusing on serous cystadenomas, primary mucinous neoplasm of the pancreas and mucinous cystadenocarcinomas, as well as intraductal papillary mucinous neoplasms, starting with excluding pseudocysts. A conservative approach is feasible in patients with a clinical presentation suggestive of an asymptomatic serous cystadenoma. Surgical management, as well as follow-up, is discussed for each of the types of neoplastic lesions, including an uncharacterized cyst, based on patient data, symptoms, serum analysis, cyst fluid analysis and morphological features. Aspects for future diagnostics and management of these neoplasia are commented upon.