胰腺实性假乳头状瘤的CT表现

目的分析胰腺实性假乳头状瘤(SPTP)的CT表现,提高正确诊断率。方法回顾分析经手术病理证实的21例胰腺实性假乳头状瘤,患者术前均经CT平扫及三期增强检查,复习CT影像表现并与病理结果对照。结果21例胰腺实性假乳头状瘤中13例位于胰头,8例位于体尾部,肿瘤直径2～15cm。19例与周围组织界限清,具有完整的包膜,以囊实性为主,囊最大直径4cm,囊壁厚0.2～3cm;仅2例为实性。位于胰头的肿瘤胰管及胆总管扩张不明显。CT平扫示肿瘤密度不均匀;CT增强扫描示动脉期实性部分轻度强化,门脉期及延迟期强化程度逐渐增加。结论CT对胰腺肿瘤的诊断具有一定的价值,病理变化是CT表现的基础。     

胰腺实性假乳头状瘤的 CT 表现与病理分析

目的：探讨胰腺实性假乳头状瘤（ SPTP）的CT特征及病理改变。方法：回顾性分析6例SPTP的临床资料,其中男1例、女5例,平均年龄24．5岁。所有患者均进行CT平扫及增强扫描。病灶位于胰头2例,胰体1例,胰尾3例;胰尾3例中,1例发生肝脾多发转移,1例发生肝脏多发转移。总结其CT表现及病理学表现特征。结果：CT平扫病灶大小约3 cm ×5 cm～11 cm ×10 cm,呈圆形、类圆形或分叶状囊实性肿块,均可见包膜;1例病灶周缘可见细条状及斑点状钙化,2例病灶内可见斑片状出血灶。增强扫描病灶实性部分呈渐进性持续强化,可见特征性表现“浮云”征。所有病例均未见胆管或胰管扩张。6例病变病理检查均显示肿瘤有完整或不完整的纤维包膜,瘤组织由实性区、假乳头区混合组成,瘤细胞形态较一致,部分区域有出血、坏死及退行性变。结论：SPTP好发于青年女性,其CT表现有一定特征性,多期增强扫描有助于诊断与鉴别诊断;肿瘤细胞以纤细的纤维血管为轴心形成特征性的分支状假乳头状结构是其组织病理学特征性改变。     

胰腺实性假乳头状瘤的CT表现与病理对照分析

为了分析胰腺实性假乳头状瘤(SPTP)的CT表现,并与病理结果对照,提高对该病的诊断率,回顾性分析23例经手术病理证实的SPTP患者的临床、CT及病理资料。23例患者中,女21例(91.3%),男2例(8.7%)。最常见症状为腹部不适伴钝痛12例(52.2%),其他包括体检发现胰腺包块9例(39.1%),恶心呕吐2例(8.7%)。1例女性患者共有2处病灶,24例肿瘤中,位于胰头6例(25.0%),胰颈3例(12.5%),胰体8例(33.3%),胰尾7例(29.2%);肿瘤最长径2.1~20.1cm,平均6.4cm;9例以实性成分为主(37.5%),10例囊、实性成分比例相仿(41.7%),5例以囊性成分为主(20.8%)。9例患者的病灶伴钙化(39.1%)。2例患者的病灶伴出血(8.7%)。1例患者伴肝内胆管扩张(4.3%)。1例患者出现肝转移(4.3%)。CT增强扫描24例肿瘤实性成分动脉期轻度强化,门脉期持续强化,其强化程度不及正常胰腺组织,囊性成分各期均未见强化。24例镜下见假乳头状结构以及出血、坏死或囊性变。总之,SPTP的CT表现具有一定的特征性,反映其病理特征,结合临床表现有助于做出正确的诊断及鉴别诊断。     

卵巢囊肿蒂扭转的CT和MRI诊断价值

目的 探讨CT与MRI对卵巢囊肿蒂扭转的诊断价值.方法 回顾性分析10例经手术病理证实为卵巢囊肿蒂扭转的CT或MRI影像学特征.结果 盆腔囊实性双肿块且实性肿块与一侧子宫角或输卵管相连10例(100％);增强扫描实性部分轻度强化或不强化;囊壁不均匀增厚8例(80％)、囊壁均匀增厚2例(20％);囊肿边界清楚光滑8例(80％);盆腔积血1例(10％).结论 卵巢囊肿蒂扭转的CT与MRI表现具有一定特征性,作为超声检查的一种补充检查方法,对卵巢囊肿蒂扭转的诊断和鉴别诊断具有一定的临床价值.     

盆部孤立性纤维性肿瘤的多层螺旋CT和磁共振成像表现特征及其病理学基础

为了探讨盆部孤立性纤维性肿瘤(SFT)的多层螺旋CT(MDCT)和磁共振成像(MRI)表现特征及其病理学基础,收集手术病理证实的13例患者的临床资料,回顾分析其MDCT和MRI表现特征。13例中,6例仅行CT检查,5例仅行MRI检查,2例同时行CT和MRI检查。MDCT和MRI图像显示,病灶最长径为4.0~25.2cm(平均11.8cm);6例分叶状,7例圆形或卵圆形;所有病灶边界清晰,且均不同程度地压迫、推挤邻近的器官结构。行MDCT扫描者,平扫时表现为以等密度为主的软组织肿块,其中5例病灶内见片状低密度区。在MRI图像上,T1WI相主要表现为等信号,其中3例病灶内见片状低信号区,3例病灶中心见放射状低信号区,1例呈均匀等信号;T2WI相主要表现为混杂高信号,其中3例为不均匀高信号,3例病灶中心见放射状低信号区,1例均匀高信号。增强扫描时,13例中4例患者见粗大的供血血管。强化程度:1例轻度均匀强化;12例中-重度强化,其中7例病灶内见片状无强化区,3例病灶中心见放射状进行性强化区,2例均匀强化。病理组织学检查证实,放射状进行性强化区为胶原纤维成分。术后随访发现,2例患者存在局部复发,1例存在肝转移。总之,盆部SFT常表现为实性、边界清晰的富血供肿块,常伴不同程度的坏死和囊变,并推挤邻近的器官结构。病灶中心的胶原纤维在T2WI相表现为放射状低信号,增强时呈进行性强化,是该病变的重要特征,对诊断有重要价值。     

原发性胰腺淋巴瘤CT特征及增强特点

目的分析原发性胰腺淋巴瘤的CT特征及增强特点,以提高对原发性胰腺淋巴瘤的认识。方法回顾性分析2009年7月至2015年11月于我院接受病理检查并确诊的7例原发性胰腺淋巴瘤患者的CT图像特点,并分析其相关病理检查结果。结果 7例患者均为原发性胰腺淋巴瘤,肿块体积较大,平均6.3 cm,与正常胰腺组织分界不清,CT扫描呈稍低密度影,病灶直径均大于5 cm,最大直径为8.3 cm,未出现胰管扩张,动、静脉期轻度强化、渐进性增强,出现类似"血管漂浮征"。结论原发性胰腺淋巴瘤的CT特征显示为病灶较大,密度均匀,边界与正常组织分界不清,未出现胰管扩张,动、静脉期轻度强化、渐进性增强,出现类似"血管漂浮征"特征,结合临床、实验室检查则可明确诊断。     

胰腺实性-假乳头状肿瘤内PTEN和nestin的表达

目的 探讨胰腺实体假乳头肿瘤（SPTP）细胞可能的组织学起源。方法 复习25例SPTP的临床病理特征,常规HE和超微结构观察,免疫组化EnVision法染色检测肿瘤细胞PTEN和nestin等的表达。结果 25例SPTP中女性22例,男性3例,中位年龄22．3岁。肿瘤主要位于胰腺内,1例位于后腹膜并与胰腺相连。1例伴有肝转移。肿瘤呈囊实性,出血、坏死明显。肿瘤细胞大小形态较一致,实性和假乳头状排列,部分似“室管膜样”菊形团。核卵圆形,有核沟,核仁不明显,核分裂象少见。肿瘤细胞均有PTEN阳性表达（18／18,100％）,44％（8／18）的病例有nestin的表达。超微结构观察细胞内可见酶原样分泌颗粒和神经内分泌颗粒。结论 胰腺实体假乳头肿瘤可能起源于胰腺多能干细胞。     

小肾透明细胞癌的CT表现与病理组织对照研究

目的分析小肾透明细胞癌的CT表现及其与病理组织的关系。方法选择小肾透明细胞癌患者42例,其中男性27例,女性15例;年龄34~68岁,平均年龄50.6岁。对42例经手术后病理组织证实的小肾透明细胞癌病例进行CT征象及病理组织结果对照分析。结果 CT平扫32例为低密度,8例为等密度,2例为高密度;增强CT扫描皮质期,肿瘤实性部分明显强化,强化峰值≥100 Hu,排泄期迅速下降,低于正常肾实质,呈快进快出特点;不均匀强化26例,均匀强化16例。病理组织36例可见出血、坏死,细胞呈实性排列,6例呈囊性排列;出现小泡样结构2例,出现不规则钙化2例,出现假包膜38例。结论小肾透明细胞癌的CT表现与病理组织类型及肿瘤结构有关,动态增强扫描对小肾透明细胞癌的诊断及制定手术方案有重要意义。     

胰腺导管内乳头状黏液肿瘤19例的病理学分析

目的 总结并分析胰腺导管内乳头状黏液肿瘤(IPMN)临床病理特征.方法 收集19例IPMN的临床及影像学资料,通过光镜观察及免疫组织化学EnVision法[抗体包括p53、c-erbB-2、Ki-67、p16、Fascin]分析其临床、病理学特征及免疫表型.结果 19例IPMN患者平均年龄59岁,中位年龄61岁,男女比例12:7,6例有长期吸烟史,1例合并结肠腺癌,临床表现为上腹部不适、腹痛、食欲减退、体重下降、脂肪泻等.腹部CT及B超检查多数病例表现为囊性占位性病变,囊内有分隔,囊壁有乳头状回声,个别病例表现为单发或多发实性占位,其中3例行十二指肠镜逆行胰管造影(ERCP)检查见十二指肠乳头处有胶冻样黏液分泌物.18例行肿物及部分胰腺切除术,1例行胰管内肿瘤摘除术,11例主要位于胰头,病理诊断1例为胰腺导管内乳头状黏液腺瘤,3例为交界性IPMN,15例为胰腺导管内乳头状黏液腺癌,其中12例伴有浸润,浸润癌中10例为乳头型和(或)管型,2例为黏液型合并管型,2例为原位癌.大体检杳17例为单发,2例为多发病灶,6例为实性占位,13例表现为囊性或囊实性占位,囊性区部分内肇光滑剑有乳头附着,部分囊腔内充满乳头状组织;镜下检查8例为肠型,7例为胰胆管上皮型,3例为胃型,1例为嗜酸细胞型;导管周围纤维组织均明显增生,16例周围胰腺组织伴有慢性胰腺炎,2例肠壁浸润,淋巴结均未发现转移;术后13例分别随访4～48个月,平均随访20个月,1例术后24个月死于其他原因,1例可疑肝转移,1例姑息手术后胰头占位,10例无复发.免疫组织化学6例p53阳性,5例p16阳性,8例Fascin阳性,c-erbB-2均阴性,Ki-67指数1%～80%,平均38%.结论 IPMN为一组少见的胰腺肿瘤,肿瘤主要位于胰管内,伴有胰管扩张,肿瘤细胞为黏液性,有乳头形成,乳头状黏液腺癌多见,约2/3病例伴有浸润.Ki-67指数超过15%应考虑恶性.肿瘤预后较胰腺导管癌明显要好,治疗主要是局部切除及相应化疗,应长期随访.影像学、ERCP及胰液细胞学检查有助于疾病的早期发现和诊断.     

自身免疫性胰腺炎的临床及影像学表现分析

目的：探讨自身免疫性胰腺炎的临床及CT、MRI表现。方法回顾性分析12例AIP患者的临床及影像学资料。结果12例患者实验室检查均有IgG4增高。8例表现为胰腺弥漫性肿大,呈"腊肠样",2例表现为体尾部局限性肿大,1例表现为胰头部局限性肿大。12例CT均表现为密度均匀减低,增强后强化减低,7例在MRI上表现为T1WI信号减低T2WI信号增高,增强后低强化。8例周围有假包膜样结构,6例合并肝内外胆管扩张。结论AIP影像学具有一定的特征性,影像学检查在AIP的诊断中起着重要的作用,结合临床特点有助于明确诊断,减少误诊。     

Solid-pseudopapillary tumor of the pancreas: a neoplasm with distinct and highly characteristic cytological features

The solid-pseudopapillary tumor of the pancreas (SPTP) is an unusual low-grade malignant epithelial tumor affecting predominantly adolescent girls and young women. Although approximately 500 cases of SPTP have been described in the last 40 yr, its pathogenesis remains uncertain. However, the clinical features of this neoplasm are very characteristic and SPTP must be suspected in any young woman with a cystic or partially cystic pancreatic mass. In this report, we describe the cytologic features of seven cases of SPTP investigated by preoperative fine-needle aspirates. The analysis of the cytologic features in these cases and in 43 cases collected from the literature reveals that they are highly characteristic and quite distinct from those of other cystic or solid tumors of the pancreas. On this basis, a cytologic diagnosis of SPTP may be rendered with great confidence, not only in clinically typical examples, but also in unusual presentations, such as in older patients, in males, in ectopic locations, and in metastatic sites.     

Adenocarcinoma of the minor duodenal papilla with intraepithelial spread to the pancreatic duct

It is extremely rare to encounter tumors arising exclusively in the minor duodenal papilla. We report a 60-year-old male patient with a polypoid type of adenocarcinoma of the minor papilla. Preoperative examinations, including computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), suggested pancreas divisum and showed a series of stones in the dorsal pancreatic duct. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). On histology, an adenocarcinoma was located in the minor papilla, which was limited to the mucosa, without invasion of the duodenum, sphincter muscles of the minor papilla, or the underlying pancreas. The carcinoma cells, together with dysplastic and hyperplastic epithelium of the pancreatic duct, extended peripherally within the pancreatic duct. No cystic dilatation of the pancreatic duct was observed. The ventral pancreatic duct was short and narrow; there was evidence of chronic pancreatitis in the dorsal pancreas, whereas the ventral pancreas was almost normal, suggesting the existence of pancreas divisum. Although it is well known that adenocarcinoma of the duodenal papilla is sometimes accompanied by intraepithelial spread in the pancreatic duct, an adenocarcinoma arising in the minor papilla in this case with pancreas divisum was more extended than our thoughts.     

胰腺囊性肿瘤92例临床病理分析

目的探讨胰腺囊性肿瘤的临床病理特征及免疫组织化学特点,以期提高对胰腺囊性肿瘤的认识。方法复习复旦大学附属中山医院1999—2005年间手术切除的92例胰腺囊性肿瘤的临床病理资料和影像资料,根据2002年WHO胰腺肿瘤分类标准将其分类。并采用免疫组织化学EnVision法,借助-组抗体进行鉴别诊断。结果在92例囊性肿瘤中,发病年龄16～80岁,男33例,女59例。其中,浆液性肿瘤18例,黏液性肿瘤14例,导管内乳头状黏液性肿瘤36例,实性假乳头状肿瘤18例,导管腺癌囊性变4例,胰腺内分泌肿瘤囊性变2例。免疫组织化学检测无特异性标记物可以完全区分各类型,常有交叉和重叠。浆液性囊腺瘤表达MUC-1,黏液性囊性肿瘤表达MUC-5AC为主,实性假乳头状肿瘤表达d-抗胰蛋白酶、d-抗胰糜蛋白酶、波形蛋白及孕激素受体,导管内乳头状黏液性腺瘤表达MUC-2,囊性恶性肿瘤主要表达MUC-1。结论胰腺各类囊性肿瘤在临床症状、影像学表现、组织形态及免疫表型上均有一定特征,但均无特异性,需结合起来综合判断,才能做出正确诊断,以指导临床治疗和预后判断。     

Pancreatic acinar cell carcinoma extending into the common bile and main pancreatic ducts

Acinar cell carcinoma (ACC) of the pancreas is relatively rare, accounting for only approximately 1% of all exocrine pancreatic tumors. A 69-year-old man was found to have a mass lesion measuring approximately 4 cm in diameter in the pancreatic head on ultrasound, abdominal dynamic CT, and percutaneous transhepatic cholangiography. Magnetic resonance cholangiopancreatography showed defect of the lower common bile duct (CBD) due to obstruction by the tumor cast. Histopathologically, the pancreatic head tumor invaded the main pancreatic duct (MPD) and CBD with extension into the CBD in a form of tumor cast. The tumor cells consisted of a solid proliferation with abundant eosinophilic cytoplasm and round nuclei in an acinar and trabecular fashion. A 55-year-old man with upper abdominal pain and nausea, had a cystic lesion approximately 3 cm in size in the pancreatic tail on CT. Histopathologically, the tumor was encapsulated by fibrous capsule and had extensive central necrosis with solid areas in the tumor periphery, and invaded with extension into the MPD in a form of tumor cast. The tumor cells resembled acinar cells in solid growths. Two resected cases of ACC with unusual tumor extension into the CBD and the MPD, respectively, are reported.     

A case of santorinicele without pancreas divisum: diagnosis with multi-detector row computed tomography

A santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla. Most cases reported previously were associated with pancreas divisum and a santorinicele without pancreas divisum is known to be rare. We recently experienced a typical case of a santorinicele without pancreas divisum in a 67-yr-old woman with abdominal pain and hematochezia, subsequently proven to be the result of an ischemic colitis. The santorinicele was diagnosed incidentally with multi-detector row computed tomography using a minimum intensity projection technique, which clearly showed a cystic dilatation of the terminal portion of the dorsal pancreatic duct and a communication between the ventral and dorsal pancreatic ducts. This finding was also confirmed by a magnetic resonance cholangiopancreatography.     

Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension

Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT) demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.     

Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal

Although cystic neoplasms and lesions of the pancreas are rare, they have attracted a great deal of attention because of their potential curability. Since, in recent years, several new entities have been identified, the relative frequency of the tumors and their classification need to be reevaluated. In a series of 1454 tumorous lesions of the pancreas collected between 1971 and 2003 in our surgical pathology files and consultation files, all cystic pancreatic neoplasms and tumor-like lesions were identified and typed both histologically and immunohistochemically. There were 418 cases (29%) showing cysts with a diameter ranging between 0.5 cm and 27 cm. Most common were solid pseudopapillary neoplasms (21%) and intraductal papillary-mucinous neoplasms (18%). When only the cystic neoplasms and lesions that had been resected in a single institution were considered, intraductal papillary mucinous neoplasms were the most frequent cystic neoplasms, while solid pseudopapillary neoplasms took fifth place behind ductal adenocarcinomas with cystic features, serous cystic neoplasms and mucinous cystic neoplasms. The most frequent cystic tumor-like lesions were pancreatitis-associated pseudocysts. New and rare entities that have recently been identified are mucinous nonneoplastic cysts, acinar cell cystadenomas and cystic hamartomas. Bearing in mind that figures from referral centers such as ours may be biased regarding the relative frequency of lesions, we concluded from our data that intraductal papillary-mucinous neoplasms are the most frequently occurring pancreatic cystic neoplasms, rather than solid pseudopapillary neoplasms. It was possible to classify all cystic lesions encountered in our files or described in the literature in a new system that distinguishes between neoplastic and nonneoplastic lesions, with further subdivisions into epithelial (adenomas, borderline neoplasms and carcinomas) and nonepithelial tumors. This classification is easy to handle and enables a distinction on the basis of clinical behavior and prognosis.     

Pancreatic ductal adenocarcinomas with cystic features: neither rare nor uniform.

Cystic tumors of the pancreas are uncommon but important because of their diverse pathology and biology. Their wide spectrum also includes cystic variants of otherwise solid tumors, such as cystic endocrine tumors, cystic acinar cell carcinomas and ductal adenocarcinomas with cystic changes. In this study, we screened pancreatic ductal adenocarcinomas and their variants for macrocystic changes and determined the nature of the cysts (neoplastic vs non-neoplastic). Of 483 tumors 38 (8%) had cystic features. The largest group consisted of 24 pancreatic ductal adenocarcinomas showing a large-gland pattern with small cysts whose diameter varied between 0.5 and 1.8 cm. The epithelial lining of these cysts was generally positive for CEA (83%) and/or MUC1 (71%) and MUC5AC (74%). p53 was positive in 57% of the cases. The second group of cystic tumors (8/483) showed degenerative cystic cavities with diameters ranging between 1 and 6 cm. This group consisted of poorly differentiated pancreatic ductal adenocarcinomas, undifferentiated carcinomas with or without osteoclast-like giant cells and one adenosquamous carcinoma. In the third group of cystic tumors there were four pancreatic ductal adenocarcinomas containing tumor-related retention cysts. Their epithelial cells were positive for MUC5AC, but negative for CEA, MUC1 and p53. The fourth group consisted of two pancreatic ductal adenocarcinomas showing closely attached pseudocysts caused by tumor-associated pancreatitis. The results indicate that a considerable number of pancreatic ductal adenocarcinomas and their variants display cystic features and must therefore be considered in the differential diagnosis of cystic neoplasms of the pancreas. Moreover, not all of the cystic structures we observed were neoplastic in nature. They may also represent non-neoplastic changes, such as retention cysts and inflammatory pseudocysts.     

Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid-pseudopapillary tumor of the pancreas: a rare neoplasm of elusive origin but characteristic cytomorphologic features

Clinical histories, endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) material, and immunohistochemical stains performed on cell block samples of 6 solid-pseudopapillary tumors of the pancreas (SPTPs) were reviewed in the cases of 5 females (13-58 years) and 1 man (57 years); all had abdominal pain. Preliminary cytologic diagnoses at endoscopy included 1 SPTP 2 low-grade neoplasms, and 3 pancreatic endocrine tumors. Variable numbers of branching fragments with central capillaries and myxoid stroma were seen in the smears of 5 of 6 cases but were more apparent in the cell block material of all cases. The cells had bland nuclear features and rare grooves. Extensive necrosis was noted in 1 case and rare mitotic figures in 1. SPTPs showed strong cellular immunoreactivity for vimentin and focal weak keratin reactivity. Neuron-specific enolase, alpha1-antitrypsin, and alpha1-antichymotrypsin stains performed in 2 cases were strongly positive. Subsequent surgical resection confirmed all diagnoses. EUS-guided FNA diagnosis of SPTP is accurate. The characteristic branching papillae with myxoid stroma are best seen in cell block slides. Clinical setting, cytomorphologic features, and immunostains of the cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma, and papillary mucinous carcinoma.