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。     

儿童胰腺实性假乳头状瘤多排螺旋CT表现

目的:探讨儿童胰腺实性假乳头状瘤（SPTP）的多排螺旋CT（MDCT）表现。 方法:回顾性分析经手术病理证实为SPTP的10例患儿临床及MDCT资料,分析总结其特征表现。 结果:10例患儿均为女性,SPTP均为单发病灶,位于胰腺头颈部3例,胰腺体尾部7例。肿瘤最大径为2.5~13.8 cm,平均值为5.94 cm。8例呈类圆形,2例呈分叶状。10例均边界清晰,8例有完整包膜。平扫1例肿瘤呈均匀低密度,增强无明显强化;其余9例呈囊实性,8例以实性为主,1例囊实性比例相当,其中1例可见包膜下弧形钙化,实性成分动脉期呈轻度强化,强化程度低于正常胰腺组织,门脉期呈渐进性不均匀强化,囊性成分无强化。1例肿瘤出现肝内胆管和主胰管轻度扩张,1例出现主胰管轻度扩张。所有肿瘤均未见肝脏及淋巴结转移。 结论:儿童SPTP好发于女性,其CT表现具有一定的特征性,对诊断和鉴别诊断具有一定意义。     

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。     

肝局灶性结节增生的CT表现

目的 研究肝局灶性结节增生（FNH）在螺旋CT上的表现,提高CT诊断准确性。方法 回顾性分析10例患者的临床、病理及影像学资料。5例行多层螺旋CT扫描;5例行单层螺旋CT扫描,其中3例只行增强扫描,2例只行平扫。结果 CT共发现18个病灶,2例患者为多发。平扫CT上15个病灶中10个为低密度,5个是等密度;增强扫描动脉期,除了中央瘢痕和纤维分隔外,所有病灶都明显均匀强化;门脉期和延迟期大部分病灶变为等密度或略高密度,2个病灶变为略低密度。2个FNH病灶中发现中央瘢痕,1个病灶于动脉期中央及外周发现异常增粗、扭曲的动脉,于延迟期可见强化的假包膜。结论 FNH在螺旋CT扫描上表现具有特征性,螺旋CT诊断FNH具有重要价值。     

胰腺实性-假乳头状肿瘤的超微结构研究

目的探讨胰腺实性-假乳头状肿瘤(SPTP)的超微病理特征、鉴别诊断及组织起源。方法对3例SPTP进行了电镜观察。结果电镜观察见肿瘤细胞大小形态较一致,核圆形或卵圆形,异型不明显,可见核沟,核分裂象罕见.瘤细胞有丰富的线粒体及粗面内质网,可见到神经分泌颗粒,酶原样颗粒及特征性的环状板层体。结论SPTP可能起源于胰腺原始多潜能干细胞,诊断上须与胰腺其它良恶性肿瘤相鉴别.     

肾上腺神经节瘤的CT表现

目的探讨肾上腺神经节瘤的CT表现特点及其诊断价值。方法回顾性分析16例患者的临床病理及影像学资料。7例患者行CT平扫,9例行CT平扫加增强;15例经手术病理证实,1例经穿刺活检证实为肾上腺神经节瘤。结果16例患者CT扫描可见2例肿物为囊实性,14例为实性;5例肿物内伴有钙化;平扫CT值介于20～40 HU左右;9例增强扫描后,5例轻度延迟强化,4例强化不明显。结论肾上腺节细胞神经瘤CT扫描具有特征性,CT扫描对正确诊断肾上腺神经节瘤具有重要价值。     

胰腺实性—假乳头状肿瘤8例临床病理学分析

目的探讨胰腺实性-假乳头状肿瘤(solid-pseudopapillary tumor of pancreas,SPTP)的临床病理学特点、诊断和鉴别诊断、治疗及其预后。方法对8例SPTP患者的临床、病理学特点及免疫组化结果进行研究,并复习相关文献。结果 8例均为女性,年龄19～38岁,平均28岁。肿块直径3～15 cm。镜下肿瘤由乳头区和囊实区混合组成,瘤细胞围绕纤维血管轴心形成特征性假乳头结构。免疫表型:CK(3/8)、vimentin(8/8)、NSE(8/8)、CD56(8/8)、ER(0/8)、PR(5/8)、α-AT(8/8)、CgA(1/8)、Syn(8/8)、E-cadherin(0/8)、β-连环蛋白(8/8)和cyclinD1的核阳性率均大于40%。随访6例患者17～131个月,均无肿瘤复发及转移,并存活至今。结论 SPTP是一种好发于年轻女性,具有低度恶性潜能的少见胰腺肿瘤,其病理形态特征和免疫组化标记对SPTP的诊断和鉴别诊断具有重要价值。     

≤3cm乳头状肾细胞癌与肾透明细胞癌的CT鉴别诊断

目的分析直径≤3cm的乳头状肾细胞癌(PRCC)与直径≤3cm肾透明细胞癌(CCRCC)的CT表现,旨在提高二者的CT鉴别诊断水平。方法分析经手术病理证实的11例乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)患者(直径≤3cm)及44例CCRCC患者(直径≤3cm)的CT扫描图像,包括CT征象、病灶密度值及增强程度值,对相应资料进行统计学分析。结果PRCC瘤内坏死或囊变少见(0/11),平扫边界清楚多见(11/11),增强后多表现为均匀强化(6/11);CCRCC瘤内坏死或囊变较PRCC多见(17/44),平扫边界不清较PRCC多见(20/44),增强后多表现为明显的不均匀强化(35/44)。PRCC两期增强密度值及病灶增强程度值均低于CCRCC。结论瘤内坏死或囊变、平扫边界、增强均匀性、病灶增强密度值及增强程度值有助于直径≤3cm PRCC与CCRCC的CT鉴别诊断。     

胰腺实性假乳头状瘤临床病理学与术后复发/转移的相关性分析

目的探讨胰腺实性假乳头状瘤(solid-pseudopapillary neoplasms,SPN)的临床病理学特征与术后复发/转移的相关性。方法收集具有完整临床及预后资料的73例手术切除的SPN标本,分析其临床病理学特征与复发/转移的相关性。结果 73例SPN,女性57例,男性16例,发病年龄7~68岁,平均28岁,中位年龄27岁。肿瘤平均直径6.47 cm(0.13~14 cm)。30例SPN位于胰头、9例位于胰体、33例位于胰尾,1例为多发病灶,分别位于胰头及胰尾。所有患者平均随访34.8个月(12~99个月)。坏死、钙化、胆固醇结晶、泡沫细胞、细胞核异型性、浸润性生长、神经侵犯在非复发/转移组与复发/转移组间差异无统计学意义,而胰外侵犯、脉管瘤栓形成及增殖指数Ki-67在两组之间差异有统计学意义。结论 SPN胰外侵犯、脉管瘤栓形成和Ki-67增殖指数≥4%,对于预测SPN复发/转移具有一定的参考意义。     

胰腺实性-假乳头状瘤8例临床病理分析

目的 探讨胰腺实性-假乳头状瘤(SPT)的临床病理学及免疫组化特点。方法 8例SPT作HE、PAN、免疫组织化学(SP法)染色观察。结果 8例SPT中7例为女性，1例男性，年龄16～63岁，平均33．1岁。术后均无复发。肿瘤体积较大，平均直径7．9cm。有包膜，囊实性相间。镜检：肿瘤由乳头和囊实区混合组成，细胞形态一致，核圆或卵圆，异型不明显，核分裂象罕见。瘤细胞围绕纤维血管轴心形成特征性假乳头结构。2例侵犯胰腺组织。8例Vim、α1-AT、α1-ACT和NSE均阳性，4例Syn、CgA和AE1／AE3阳性，5例CD56阳性，5例PR阳性；Glu、Ins、Pol、EMA、p53、Ki-67、ER均阴性。结论 胰腺SPT好发年轻女性，具有独特的临床病理特点，手术切除治愈率高，应视为低度恶性肿瘤，免疫组化提示可能起源于胰腺多能干细胞。     

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.     

颅内非典型畸胎瘤样／横纹肌样瘤的影像学表现（附4例报道和文献复习）

目的：探讨颅内非典型畸胎瘤样/横纹肌样瘤（ AT/RT）的影像学特征,提高对其认识水平。方法：收集我科1997年1月～2011年12月经病理和免疫组化诊断为AT/RT的4例患者的临床资料,对其影像学表现进行回顾性分析,并进行相关文献复习。结果：4例中,病灶位于额叶2例,颞叶1例,桥脑小脑角区（CPA）1例;最大径3．6～6．5 cm。肿瘤边界清楚,3例轻度瘤周水肿,1例无瘤周水肿;4例轻度占位效应,位于CPA的1例可见同侧内听道扩大。肿瘤实质在CT上呈等密度,MRI T1WI呈低信号、T2 WI呈高低混杂信号。4例肿瘤内均见出血,2例见囊变。增强后肿瘤实质呈斑片状强化,囊壁和分隔亦见强化。结论：AT/RT的影像学表现有一定的特征性,但缺乏特异性;提高对本病的认识是诊断的关键。     

孤立性纤维性肿瘤 MSCT 表现

目的：探讨孤立性纤维性肿瘤（ SFT）的多层螺旋CT（ MSCT）表现。方法：收集我院经手术病理证实的9例孤立性纤维性肿瘤患者的临床资料,对其MSCT表现进行回顾性分析。结果：9例孤立性纤维性肿瘤中,位于胸部6例,腹腔2例,盆腔1例。 MSCT检查见：较小病灶边缘规则,较大病灶呈分叶样;6例边界清晰,3例边界不清;7例密度较均匀,2例见不规则坏死区,1例见点状钙化;增强扫描动脉期呈轻到中度强化,静脉期持续性强化。结论：SFT的MSCT表现具有一定特征性,正确认识其MSCT的影像学特点,可有助于提高该病术前诊断的准确率。     

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.     

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.     

Neuroendocrine tumor of the pancreas in a patient with tuberous sclerosis: a case report and review of the literature

A rare case of pancreatic neuroendocrine neoplasm in a patient with tuberous sclerosis complex is described. The patient was a 31-year-old man who had multiple congenital subependymal nodules, bilateral cortical tubers, and seizures of difficult control. A 2.3 cm × 2 cm well-delimitated solid tumor in the tail of the pancreas was discovered during a monitoring abdominal computed tomography. A distal pancreatectomy was performed. Histologically, the tumor was formed by uniform cells with moderated cytoplasm arranged in a combined trabecular and nested pattern. The nuclear features were bland, and mitosis was infrequent. There was no vascular invasion. Immunoreactivity for cytokeratine AE1/AE3, chromogranin A, and synaptophysin confirmed the neuroendocrine nature of this neoplasia. Pancreatic hormones were negatives. One of the 5 lymph nodes isolated from the peripancreatic adipose tissue was positive for metastases. Small series and case reports have documented that in tuberous sclerosis many endocrine system alterations might occur, affecting the function of the pituitary, parathyroid, and other neuroendocrine tissue, including islet cells of the pancreas. However, the true association of these pathological conditions remains uncertain. As far as we know, there are 10 cases reported of pancreatic neuroendocrine tumors in a setting of tuberous sclerosis complex, in which 2 cases resulted in malignant, nonfunctioning pancreatic neuroendocrine tumors.     

原发性腹膜后肿瘤影像学特点分析

目的：探讨腹膜后肿瘤影像学特点与病理表现关系,提高腹膜后肿瘤诊断及鉴别诊断水平。方法：回顾分析我院2001年～2008年9月临床资料完整并行手术切除的36例腹膜后肿瘤CT和MRI表现,并与临床资料及病理检查结果进行对比分析。结果：36例术前影像检查均显示腹膜后占位性病变,肿瘤最大径2．5—53cm（中位数6．3em）。11例压迫邻近器官,其中良性8例、恶性3例;7例侵犯邻近器官,其中良性l例、恶性6例。影像学诊断与术后病理诊断对比差异无统计学意义（P〉0．05）。CT／MR见13例发生囊变,3例可见钙化,4例见瘤内脂肪结构,5例显示坏死结构,3例见瘤内出血。增强扫描22例（22／27）有不同程度强化,间叶组织源性、神经源性肿瘤为中度-明显不均匀强化,淋巴类肿瘤不强化或轻度强化。结论：CT结合三维重建技术及MRI成像显示腹膜后肿瘤特征与病理检查结果具有相关性,有助于临床诊断及鉴别,并可显示肿瘤范围、邻近器官受累情况,对于术前评估具有重要价值。     

肾嗜酸细胞腺瘤CT及MRI特征分析

目的 探讨肾嗜酸细胞腺瘤(RO)CT及MRI的表现特点,为RO的临床诊断提供参考。方法 回顾性分析2011年2月—2017年7月解放军福州总医院经术后病理检查确诊为RO的24例患者的临床资料,其中男12例、女12例,年龄36~71(55.2±10.4)岁。患者术前行CT平扫及增强三期扫描,或行MRI平扫及增强扫描,观察病灶的部位、大小、形态、边界,坏死、囊变及星状瘢痕,平扫及多期增强扫描病灶强化情况,以及有无肾周组织侵犯及淋巴结转移。结果 24例患者中22例行CT检查,5例行MRI检查。共发现25个病灶,23例为单侧单发,1例为双侧单发;9例位于右肾,16例位于左肾;病灶最大径(3.4±1.2)cm。CT检查22例23个病灶,平扫13例病灶呈等密度,2例可见钙化,3例见囊状低密度影,12例见星状瘢痕;增强扫描均强化明显,动态增强曲线呈“速升缓降”型。MRI检查5例5个病灶,平扫5例T₁WI呈等、低信号,T₂WI呈混杂稍高信号,DWI呈混杂高信号;增强扫描1例见囊状低密度影,1例见星状瘢痕。所有病例肾周脂肪间隙清晰,肾静脉及下腔静脉内均未见瘤栓,肾门及腹主动脉旁均未见肿大淋巴结。结论 RO的CT及MRI表现具有一定的特征性,术前提高对RO的认识,可减少不必要的根治性肾切除术,具有重要的临床应用价值。     

输卵管妊娠的临床与CT表现特点(附六例)

目的探讨输卵管妊娠的临床和CT表现的特点。方法分析6例经手术病理证实的输卵管妊娠的临床资料和CT表现。结果 6例输卵管妊娠发生于壶腹部3例、峡部2例、伞部1例。CT表现为附件区不规则形囊实性混杂密度包快,内见高密度出血灶5例,孕囊1例,盆腔高密度血性积液4例。增强扫描软组织包快轻到中度不均匀强化,高密度出血灶基本无强化,1例孕囊边缘明显环形强化。2例子宫略增大。结论附件区不规则形囊实性混杂密度包快,内见高密度出血灶、孕囊,同时伴有腹盆腔高密度积液为输卵管妊娠的典型CT表现。