胰腺浆液性微囊性囊腺瘤1例报道并文献复习

目的探讨胰腺浆液性微囊性囊腺瘤的临床病理学特征及诊断、鉴别诊断要点。方法对1例胰腺浆液性微囊性囊腺瘤进行临床病理分析及免疫组化研究。结果胰腺浆液性微囊性囊腺瘤临床上可以表现为消瘦、乏力而体格检查阴性；镜下肿瘤由大小不等的囊腔组成，囊壁内衬单层立方上皮，胞质清亮，核小而圆、居中，核分裂象极少见，细胞无异型性，囊腔之间可见粗大的纤维结缔组织分隔。免疫组化瘤细胞keratin和EMA( )，S-100、vjmentir、actin、CGA、Syn、CEA、desmin和Ⅷ因子(-)。结论胰腺浆液性微囊性囊腺瘤是一种罕见肿瘤，其诊断和鉴别诊断主要依靠病理组织学和免疫组化，部分肿瘤的良恶性很难确定，需进行随访。     

胰腺假性囊肿、胰腺囊性肿瘤与胰腺癌的研究进展

胰腺占位性病变可分为良性及恶性。良性有胰腺囊肿、胰腺假性囊肿、黏液性囊腺瘤、浆液性囊腺瘤等。恶性有胰腺癌、黏液性囊腺癌、浆液性囊腺癌等。在美国,胰腺癌居恶性肿瘤死亡原因的第4位,消化道肿瘤死亡原因的第2位,在我国胰腺癌现已成为常见的恶性消化道肿瘤之一。胰腺癌早期症状、体征不典型,因而其早期诊断目前仍存在较大困难。     

胰腺囊性肿瘤的彩色多普勒血流显像与病理对照研究

目的：探讨胰腺囊性肿瘤的彩色多普勒血汉显像特点及病理基础。方法：对17例经手术病理证实的胰腺囊性肿瘤的声像图特点、血流情况及病理之间的关系进行分析研究。结果：浆液性囊腺瘤2例,粘液性囊腺瘤1例,囊腺癌14例。根据声像图特点将其分为三型：单房型、多房型和密集筛网型。粘液性囊腺瘤或囊腺癌过大时呈单房型,多房型是胰腺囊腺 癌的典型声像图表现,浆液性囊腺瘤呈密集筛网型改变,1例囊腺癌也呈类似改变。肿瘤内部不易探及血流,囊腺瘤与囊腺癌周边血流较丰富,且肿瘤越大血流越丰富,其来源为肿瘤血管以及因肿瘤挤压、牵拉移位的周围组织血管,因此频谱表现多样。结论：胰腺囊性肿瘤的声像图改变、血流分布、频谱表现与肿瘤的病理类型密切相关。     

胰腺浆液性及黏液性囊性肿瘤35例临床病理分析

目的探讨胰腺浆液性及黏液性囊性肿瘤的临床及病理学特点。方法回顾性分析35例胰腺浆液性及黏液性囊性肿瘤的临床及病理资料。结果 35例患者平均年龄为54岁,男女之比为1∶1.77。肿瘤位于胰头7例(20%),胰颈4例(11.4%),胰体尾24例(68.6%)。临床影像学表现均为胰腺囊性占位。所有患者均行手术治疗,其中浆液性囊腺瘤27例(77.1%)(微囊型20例、寡囊型7例),黏液性囊性肿瘤伴异型增生8例(22.9%)(伴低级别异型增生6例、伴中级别异型增生2例)。浆液性囊腺瘤为多房囊性,囊壁衬覆扁平或立方上皮,胞质透亮,核圆形或卵圆形,无明显异型和核分裂。黏液性囊性肿瘤伴低级别异型增生为多房囊性,囊壁衬覆柱状上皮,细胞核增大、位于基底部,胞质内含有黏液,囊壁内有富于细胞的卵巢样间质;伴中级别异型增生者可见乳头状突起及隐窝样凹陷形成,细胞排列呈假复层,核拥挤、增大,可见核分裂。30例经6个月至4年的随访未发现肿瘤复发或转移,5例术后痊愈,随访失联。结论胰腺浆液性及黏液性囊性肿瘤相对少见,掌握临床病理特征有助于准确的病理诊断。     

胰腺浆液性微囊性腺瘤2例临床病理观察

目的 探讨胰腺浆液性微囊性腺瘤的临床与病理学特点.方法 对2例胰腺浆液性微囊性腺瘤进行临床病理、特殊染色及免疫组化观察并随访.结果 2例均为中老年女性,均因上腹部不适或疼痛就诊.肿瘤均位于胰体近胰尾部,最大径分别为3 cm和2.6cm;切面呈蜂窝状,囊内含清亮液体或灰红色液体.镜下见瘤组织由多个小囊腔构成,似疏松的海绵状、蜂窝状,囊腔直径0.1 ～0.5 cm;囊壁内衬单层立方或扁平上皮细胞,胞质丰富,嗜酸性,部分胞质较透明;细胞核大小一致,无明显异型性,未见核分裂.免疫组化:CK7、CK20和CA19-9(+),CgA、Syn和CEA(-).结论 胰腺浆液性微囊性腺瘤为胰腺罕见的肿瘤,临床上多无明显症状,依据其特有的病理组织学形态及免疫组化染色可明确诊断.本病预后很好,恶性变的风险很小.治疗上目前仍以手术治疗为主,手术彻底切除可以根治.     

胰腺浆液性囊腺瘤MSCT表现与病理特征

目的:探讨胰腺浆液性囊腺瘤MSCT表现和病理特征。方法:回顾性分析经手术及病理证实的43例胰腺浆液性囊腺瘤的MSCT表现,观察病灶部位、大小、囊腔类型、中央瘢痕、钙化及强化特点等。结果:43例胰腺浆液性囊腺瘤中,浆液性微囊型囊腺瘤34例,浆液性寡囊型囊腺瘤9例。34例浆液性微囊型囊腺瘤的囊直径平均为(4.2±0.5)cm,其中多囊蜂窝型29例,囊内见多发厚薄不均的蜂窝状分隔,其囊隔厚度为0.03~0.2 cm;多囊海绵型5例,瘤内呈海绵状囊实混杂密度,囊隔显示不清。34例微囊型囊腺瘤内有中央星芒状纤维瘢痕14例,放射状或砂砾状和囊壁上斑点状钙化14例,上游胰管扩张4例。9例浆液性寡囊型囊腺瘤中单囊型4例,呈圆形或卵圆形,囊直径平均为(3.1±3)cm;多囊型5例,边缘呈分叶状,由数个小囊构成,囊壁薄而光滑、均匀,其囊壁厚度<0.1 cm。增强扫描表现:微囊型囊腺瘤中囊内分隔、中央星芒状纤维瘢痕及实性成分多呈轻中度强化,囊内分隔及实性成分越多,强化越明显,中央纤维瘢痕多呈延迟强化;寡囊型囊腺瘤囊内无强化,仅囊壁、囊隔呈轻度强化。结论:胰腺浆液性囊腺瘤CT表现具有一定特征性。微囊型囊腺瘤CT平扫呈蜂窝状或海绵状,瘤中央见星芒状纤维瘢痕及放射状钙化,增强扫描见囊壁、分隔及实性部分呈轻中度或显著强化,中央纤维瘢痕呈延迟强化;寡囊型囊腺瘤由单个或数个大囊组成,无中央纤维瘢痕及钙化,增强扫描见囊壁、囊隔呈轻度强化。     

VEGF及PCNA在卵巢上皮性肿瘤中的表达

目的探讨VEGF、PCNA表达在卵巢浆液性上皮性肿瘤进展中的作用。方法采用SP免疫组化染色法检测19例卵巢浆液性囊腺癌、15例交界性浆液性囊腺瘤和13例浆液性囊腺瘤中VEGF、PCNA的表达情况。结果浆液性囊腺癌中VEGF及PCNA显著高于交界性浆液性囊腺瘤和浆液性囊腺瘤，交界性浆液性囊腺瘤中VEGF、PCNA显著高于浆液性囊腺瘤；VEGF、PCNA在Ⅲ级卵巢浆液性囊腺癌中的表达显著高于Ⅰ-Ⅱ级；不同临床分期VEGF、PCNA表达没有显著差异。相关分析显示VEGF的表达与PCNA呈显著正相关。结论VEGF及PCNA在卵巢浆液性囊腺癌和交界性浆液性囊腺瘤中呈高表达，表明其与卵巢浆液性上皮性肿瘤的进展有关；随着癌组织分级的增高，VEGF、PCNA呈高表达，但与临床分期无关，显示其可能是评估卵巢浆液性上皮性肿瘤良、恶性程度的辅助指标。     

胰腺粘液性囊性肿瘤诊治体会

目的：探讨胰腺粘液性囊性肿瘤的诊断和治疗。方法：对2000年6月-2005年6月复旦大学附属中山医院收治的12例胰腺粘液性囊性肿瘤的临床资料进行回顾性分析。结果：胰腺粘液性囊性肿瘤好发于女性，无特征性，1名床表现。B超和CT对胰腺粘液性囊腺瘤的诊断正确率为89％（8／9），而囊腺癌的诊断正确率分别为33％（1／3）和67％（2／3）。本组9例粘液性囊腺瘤中，胰十二指肠切除术4例，远端胰腺切除术5例；3例囊腺癌中行扩大的胰十二指肠切除术1例，远端胰腺切除术2例。本组均获随访，1例囊腺癌因复发转移于术后11个月死亡，其余均存活，无复发。结论：B超和CT是胰腺粘液性囊性肿瘤主要的影像学检查方法。胰腺粘液性囊性肿瘤因有恶变倾向度临床不能鉴别其良恶性，需手术治疗。胰腺粘液性囊腺瘤手术切除后可获治愈，囊腺癌术后疗效也较满意。     

卵巢浆液性囊腺癌的螺旋CT表现

目的　探讨卵巢浆液性囊腺癌的CT表现及螺旋CT在卵巢恶性肿瘤诊断中的优越性。方法　回顾性分析 2 3例经手术病理证实的卵巢浆液性囊腺癌的CT表现 ,着重观察卵巢肿瘤的形态与结构 ,以及对周围结构的侵犯与远处转移、腹水。结果　 2 3例中 15例为双侧 ,共 3 8个肿瘤 ,2 2个表现为囊实混合性 ,9个以实性为主 ,7个表现为囊性。结论　浆液性囊腺癌双侧多见 ,发病年龄较高 ,肿块多表现为囊实混合性 ,常伴有周围侵犯、远处转移和大量腹水 ;囊壁及分隔不均匀增厚超过 3mm ,囊壁上有乳头状突起及肿瘤周围血管的异常增多是浆液性囊腺癌的特征。     

胰腺囊腺瘤囊性结构及实性成分的CT特点分析

目的 探讨胰腺浆液性囊腺瘤和胰腺黏液性囊性肿瘤囊性结构及实性成分的CT影像学特点及其诊断价值。方法 回顾性分析26例经病理证实为胰腺浆液性囊腺瘤和胰腺黏液性囊性肿瘤瘤患者CT影像资料。结果 胰腺浆液性囊腺瘤16例,单囊者7例,多囊且数目小于6个者2例,大于或等于6个者7例;最大囊直径小于2 cm者6例,大于或等于2 cm者10例;囊壁平均厚度1.5 mm(1.0~1.9 mm);有实性成分者14例,CT增强扫描动脉期轻度强化3例,中度强化7例,明显强化4例,门脉期轻度强化3例,中度强化3例,明显强化8例,动脉期与门脉期强化程度差异有统计学意义(P=0.001)。胰腺黏液性囊性肿瘤10例,单囊者7例,多囊且数目小于6个者2例,超过6个者1例;最大囊直径小于2cm者4例,大于或等于2 cm者6例;囊壁平均厚度2.2 mm(1.1~3.0 mm);有实性成分者8例,CT增强扫描动脉期轻度强化2例,中度强化5例,明显强化1例,门脉期无强化1例,轻度强化2例,中度强化2例,明显强化3例,动脉期与门脉期强化程度差异有统计学意义(P=0.001)。两组病例囊壁厚度的比较差异具有统计学意义(P=0.031),3例出现中央瘢痕钙化者均为浆液性囊腺瘤,两组病例实性成分双期增强的比较差异无统计学意义(P动脉期=0.521、P门脉期=0.301)。结论 胰腺浆液性囊腺瘤和胰腺黏液性囊性肿瘤囊壁厚度及囊内中央瘢痕钙化对此类疾病的诊断具有重要的临床价值,实性成分在CT双期增强中强化程度的比较无统计学意义。     

螺旋CT增强扫描对进展期胃癌的局部浸润和淋巴结转移的研究

目的:探讨螺旋CT增强扫描在判定进展期胃癌局部浸润和胃周淋巴结转移上的应用价值。材料与方法:对56例进展期胃癌的局部浸润和胃周淋巴结转移情况进行螺旋CT诊断,并与手术病理对照。结果:依据癌肿对应局部浆膜面征象、脂肪间隙征象、癌肿局部突出征象判定癌肿穿透浆膜的准确度分别为82.14%,60.71%和55.36%。动脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,52.17%和89.47%。静脉期癌肿线状强化、不均匀强化和团块状强化的穿透浆膜率分别为7.14%,53.85%和93.75%。螺旋CT增强扫描判定胰腺、横结肠及其系膜、脾受累的准确度分别为87.5%,87.5%和92.86%。支持以直径9mm作为螺旋CT增强扫描诊断胃周淋巴结转移的直径标准(P<0.05)。多种胃癌生物学行为CT影像特征与癌肿对应淋巴结转移率密切相关(P均<0.05)。结论:应用螺旋CT增强扫描检查进展期胃癌的局部浸润和淋巴结转移情况,对于指导手术和制定综合治疗方案具有重要意义。     

Macrocystic serous cystadenoma of the pancreas:CT and endosonographic features

Recently, the term ``serous cystadenoma' has been adopted in the pathological community to qualify the so-called microcystic adenoma of the pancreas. This change in terminology was based on the emergence of a new type of serous cystadenoma of the pancreas, i.e., the macrocystic variant. We report one case of pathologically proven macrocystic serous cystadenoma of the pancreas for which the diagnosis of mucinous cystadenoma was suggested preoperatively. This rare but benign macrocystic variant exhibits radiological features similar to those of mucinous cystadenoma. In addition, inflammatory changes and foci of hemorrhage within the tumor may simulate mucinous cystadenocarcinoma. RID="ID="<e5>Correspondence to:</e5> P. Soyer Received: 25 August 1997/Accepted: 8 October 1997     

Macrocystic serous cystadenoma of the pancreas: case report

We report a case of macrocystic serous cystadenoma of the pancreas. The lesion consisted of a large main cyst and several small cysts, and each cyst showed high intensity on T1-weighted and very high intensity on T2-weighted magnetic resonance images. High-intensity cyst contents may be a characteristic, if not a specific, finding of macrocystic serous cystadenoma of the pancreas. Received: 24 April 2000/Accepted: 31 May 2000     

Unusual imaging appearances of pancreatic serous cystadenoma: correlation with surgery and pathologic analysis

Background We describe imaging and pathologic features of serous cystadenoma of the pancreas on multislice helical computed tomography CT (MS-CT) and surgical resection. Methods Radiologic and pathologic features were analyzed in five patients. All patients underwent MS-CT and digital subtraction angiography (DSA), and four patients underwent magnetic resonance (MR) imaging. Preoperatively, three cases showed radiologic evidence of mainly solid appearance on MS-CT, and the suspected diagnoses were solid pancreatic tumors (patients 1–3). The other two cases showed radiologic evidence of macrocystic tumor of the pancreas, and the suspected diagnoses were mucinous cystic tumors (cases 4 and 5). All patients underwent surgery, and the diagnosis of serous cystadenoma was confirmed on pathologic examination. Results In three cases that showed a solid appearance on MS-CT, a microcystic appearance was identified on microscopic examination, and the tumors were found to be hypervascular lesions on multiphasic contrast-enhanced CT and DSA. In cases 1 and 2, the lesions showed high intensity with internal septation on T2-weighted MR images. In two cases, the tumors were classified as a macrocystic variant of serous cystadenoma, and no mural nodules, papillary projections, or calcifications were seen in the tumors. Conclusion Imaging appearance of serous cystadenoma on MS-CT is various and sometimes indistinguishable from that of solid tumor or mucinous cystic tumors of the pancreas. Imaging findings of hypervascularity and a well-marginated high-intensity lesion with internal septation on T2-weighted MR imaging may be crucial to identify serous cystadenoma that contains no visible cystic compartments on MS-CT.     

Nonmucinous cystic pancreatic neoplasms

This article discusses serous cystadenomas, the most common of the nonmucinous cystic lesions of the pancreas. These microcystic lesions were previously known as "glycogen-rich" cystadenomas because of the presence of glycogen within the cyst epithelium. A small percentage of these lesions are macrocystic, and it may be difficult to differentiate them from mucinous lesions; however, endoscopic ultrasound guided fine needle aspiration can provide diagnostic material from the cyst fluid. The second most common nonmucinous cyst, the islet cell tumor, is also discussed. These rare cystic tumors may or may not be accompanied by excess hormone production. The prognosis for the rare cystic tumors is good if they are resected successfully.     

Cystic Tumors of the Pancreas: Ultrasound, Computed Tomography, and Magnetic Resonance Imaging Features

Cystic tumors of the pancreas are a subset of rare pancreatic tumors that vary from benign to malignant. Many have specific imaging findings that allow them to be differentiated from each other. This article aims to review the histopathologic and imaging findings of the relatively common lesions (serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, and solid pseudopapillary tumor) and uncommon lesions (cystic endocrine tumors, cystic metastases, cystic teratomas, and lymphangiomas) in this group.     

胰腺常见囊性肿瘤的影像表现特征及其鉴别诊断

目的 探讨胰腺常见囊性肿瘤的MSCT和MRI表现特征及其鉴别诊断要点。 方法 回顾性分析经手术病理证实的41例胰腺囊性肿瘤 的MSCT和MRI表现。 结果 SCN中浆液性微囊性腺瘤7例,呈分叶状,囊小而多,多具有中心瘢痕;浆液性寡囊性腺瘤2例,1例单房、1例多房,囊大而少,边缘分叶;实性浆液性腺瘤1例,CT增强检查明显强化,但T2WI可显示其囊性特征。MCN囊大而少,边缘多光滑。IPMN与胰管相通,单房者多表现为杵状指样的囊,多房者囊常呈多种形态。IPMN胰管可出现远端、近端或全程扩张,而SCN和MCN仅近端扩张。 结论 胰腺常见囊性肿瘤中囊的不同形态对鉴别诊断有提示作用。全程或远端胰管扩张只见于IPMN。     

Incidental detection of a microcystic adenoma of the pancreas

Cystic neoplasms of the pancreas are uncommon. The two major types of cystic pancreatic neoplasms are microcystic (serous) cystadenoma and mucinous cystic lesions (mucinous cystadenoma and mucinous cystadenocarcinoma). The two types differ substantially in the long-term mortality. Symptoms and signs do not distinguish between the two types, and small lesions are often asymptomatic. The neoplasms may be discovered during imaging procedures for unrelated complaints. Computerized tomography may suggest the diagnosis of microcystic adenoma or mucinous cystic neoplasm when the features are typical, but the final diagnosis must be established by surgical biopsy. Characteristic gross findings, light microscopic findings, and immunohistochemical staining patterns distinguish between the two types. When preliminary open biopsy confirms microcystic adenoma, extensive unnecessary surgery can be avoided.