胰腺囊性肿瘤31例临床诊治分析

目的 探讨胰腺囊性肿瘤的诊断和治疗.方法 对2001年7月至2006年11月河南中医学院第一附属医院收治的31例胰腺囊性肿瘤的临床资料进行回顾分析.结果 31例均行手术治疗并随访,1例黏液性囊腺癌因复发转移于术后6个月死亡,其余均存活,无复发.结论 伴有症状的胰腺浆液性囊腺瘤、黏液性囊腺瘤及导管内乳头状黏液性肿瘤因有恶变倾向及临床不能鉴别其良恶性,需手术治疗,而无症状的浆液性囊腺瘤可观察随访.胰腺囊腺瘤手术切除后可获治愈,囊腺癌手术疗效也较满意.     

20例胰腺囊性肿瘤的诊断和治疗

[目的]探讨胰腺囊性肿瘤的诊断和治疗。[方法]总结1996年10月～2006年10月诊治的20例胰腺囊性肿瘤的临床资料。[结果]20例行B超检查：7例囊腺瘤，影像表现为囊性、内部回声不均匀的低回声光团；13例囊腺癌。影像表现为多发囊性或囊性与实性共存、单发囊性。16例行CT检查：5例囊腺瘤。影像表现为囊性呈多层状、不均匀的低密度影：11例囊腺癌，影像表现为多发囊性或囊性和实性共存、单发囊肿。20例均行手术治疗，其中2例行探查术，2例行姑息性切除，16例行治愈性切除。良性肿瘤中1例囊壁空肠吻合者3年后发生恶变。2例恶性肿瘤分别于术后6和16个月死于肿瘤复发，恶性肿瘤有5年存活者7例。[结论]B超和CT是诊断胰腺囊性肿瘤的有效方法。胰腺囊性肿瘤生长缓慢，应尽快切除。     

胰腺囊性肿瘤10例

目的 探讨胰腺囊性肿瘤诊断和治疗的方法.方法 对1988年5月至2007年9月收治的10例胰腺囊性肿瘤患者的临床资料进行回顾性分析.结果 该疾病的临床表现无特异性,超声和CT检查对胰腺囊性肿瘤的诊断正确率高,但不能准确区分其组织类型,术中多次多部位取材的冷冻活检对明确诊断十分重要.1例囊腺癌晚期无法切除,其余9例均行手术治疗并获随访,2例黏液性囊腺癌患者因复发转移分别于术后12个月和19个月死亡,其他胰腺浆液性及黏液性囊腺瘤患者术后最长随访5年,均生存,无复发.结论 胰腺囊性肿瘤包括多种亚型,临床不能鉴别其良恶性,术中冷冻活检可明确诊断.诊断明确者应积极手术治疗,手术切除率高,预后较好.     

胰腺囊性肿瘤11例诊治分析

[目的]分析胰腺囊性肿瘤的临床病理特征。[方法]收集并分析1992年2月至2007年10月共诊治11例胰腺囊性肿瘤的临床资料,病例均经病理学证实。[结果]术前误诊4例06．4％1。病变位于胰头部4例,胰体尾部7例。肿瘤直径5．0～20．5cm,平均7．5cm。从发病到就诊时间最短1个月。最长4余年。胰十二指肠切除3例,胰体尾及脾切除4例,单纯性囊性肿瘤切除术2例．单纯剖腹探查、肿瘤活检1例。无手术死亡病例。[结论]胰腺囊性肿瘤易误诊．临床上应予仔细鉴别诊断。治疗首选手术切除。     

胰腺囊腺癌临床诊治分析

  目的 探讨胰腺囊腺癌的临床特点及疗效，提高胰腺囊腺癌的诊治水平。方法 对1990年1月至2006年6月年收治的13例胰腺囊腺癌患者临床资料进行回顾性分析。结果 术前诊断为胰腺囊腺癌6例，囊腺瘤2例，胰腺癌1例，胰腺假性囊肿4例，误诊率53.8 %。13例全部手术：行根治性手术10例，术后随访5年仍生存者6例，其中1例已经无瘤生存11年；姑息手术3例，均于术后3年内死亡。结论 胰腺囊腺癌临床表现缺乏特异性，术前诊断较为困难，根治性手术是最有效的治疗方法。     

胰腺囊性肿瘤10例

目的探讨胰腺囊性肿瘤诊断和治疗的方法。方法对1988年5月至2007年9月收治的10例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果该疾病的临床表现无特异性,超声和CT检查对胰腺囊性肿瘤的诊断正确率高,但不能准确区分其组织类型,术中多次多部位取材的冷冻活检对明确诊断十分重要。1例囊腺癌晚期无法切除,其余9例均行手术治疗并获随访,2例黏液性囊腺癌患者因复发转移分别于术后12个月和19个月死亡,其他胰腺浆液性及黏液性囊腺瘤患者术后最长随访5年,均生存,无复发。结论胰腺囊性肿瘤包括多种亚型,临床不能鉴别其良恶性,术中冷冻活检可明确诊断。诊断明确者应积极手术治疗,手术切除率高,预后较好。     

胰腺囊性肿瘤诊疗及进展

胰腺囊性肿瘤(PCNs)是少见肿瘤,发病原因尚不明确,不良生活习惯（吸烟、饮酒、重咖啡、高脂高蛋白饮食等）、慢性胰腺炎、环境污染因素及遗传因素等是潜在致病因素。PCNs分为浆液性囊性肿瘤（SCN）、黏液性囊性肿瘤（MCN）、胰腺导管内乳头状黏液肿瘤(IPMN)和实性假乳头状瘤（SPN）四种类型。发病症状常不典型,早期诊断难。PCNs具有典型影像特点,单个影像检查技术对PCNs的准确性和局限性不同,CT检查在胰腺病变中仍是最基本、最主要的检查方式。MRI对于小的囊性病灶比CT更有优势。超声内镜（EUS）充分结合了内镜和超声检查的优势,与CT、MRI检查相辅相成,同时还可进行细针穿刺取病理及囊液分析。尽管PCNs大部分为良性,但只要达到切除标准,均应推荐患者进行手术治疗,严格遵循PCNs诊治流程,制订个体化PCNs治疗策略,使患者利益最大化。     

胰腺囊性病变的诊治:附36例报告

目的 探讨胰腺囊性病变的诊断和手术治疗.方法 对2002年1月1日～2009年1月1日期间我院收治的36例胰腺囊性病变患者的临床资料进行回顾性分析,复习文献,总结其诊断和治疗.结果 36例患者中只有4例主诉有上腹部不适非特异性症状,7例表现为腹部包块.6例胰腺假性囊肿均无胰腺炎病史,4例经B超或CT诊断为囊性肿瘤可能性大,剩余2例诊断为囊腺瘤;其它30例患者影像学检查均提示胰腺囊性肿瘤.病理结果胰腺假性囊肿6例,胰腺浆液性囊腺瘤15例,黏液性囊腺瘤8例,胰腺导管内乳头状黏液性肿瘤4例,胰腺实性假乳头状瘤3例.所有患者均接受手术治疗,其中12例行胰十二指肠切除术,9例行胰体尾切除术,2例行腹腔镜下胰尾切除术,6例行胰腺肿瘤摘除术,7例行胰腺节段切除术.结论 胰腺囊性病变临床表现不典型,不同的影像学检查对胰腺囊性病变的诊断有不同的指导意义.合理的手术是治疗胰腺囊性病变的重要手段.     

原发性支气管腺样囊性癌的诊断和治疗

目的 探讨原发性支气管腺样囊性癌的临床、病理特征和治疗原则。方法 1980年1月～1997年5月手术治疗8例原发性支气管腺样囊性癌,均经手术和病理证实。结果 原发性支气管腺样囊性癌占同期原发性肺部恶性肿瘤的0.48％(8/1676);男性5例,女性3例;中心型6例,周围型2例;除1例肿瘤固定不能切除外,余7例均行手术切除,且其中4例存在癌残留。3年生存率为83.3％(5/6),5年生存率为60％(3/5)。结论 原发性支气管腺样囊性癌是一种罕见的低度恶性肿瘤,好发于主、叶支气管,X线表现与肺癌不易区别,纤维支气管镜检查最重要。目前认为手术切除是腺样囊性癌最有效的治疗方法,即便是姑息性切除,术后也能生存多年。     

原发性气管腺样囊性癌15例临床病理分析

目的:探讨15例原发性气管腺样囊性癌患者临床病理学特征,诊断与鉴别诊断以及治疗原则.方法:回顾性分析上海长海医院近2年诊治的15例原发性气管腺样囊性癌患者临床病理资料.结果:原发性气管腺样囊性癌多以呼吸道症状就诊,早期容易误诊.显微镜下:肿瘤组织由腺管状、筛孔状和实性团巢状结构构成,管腔内可见过碘酸雪夫反应(PAS)阳性的黏液样物质.免疫组化显示,肿瘤细胞表达腺上皮和肌上皮标记.结论:原发性气管腺样囊性癌是一种少见的低度恶性肿瘤,临床症状无特异性,行支气管镜检查以及病理活检利于早期诊断,治疗以手术切除及局部放疗较好.     

Cystic neoplasms of the pancreas: a heterogeneous disorder.

Cystic neoplasms of the pancreas are rare tumors with a relatively better prognosis as compared to other pancreatic cancers. They may be mistaken for pseudocysts. Seventeen patients who underwent surgical resection were analyzed. Seventy percent of the patients were females and 76.7% of the tumors were located in the tail of the pancreas. Preoperative diagnosis was made on the basis of ultrasonography and/or computed tomography findings in 60% of patients. Retrospective review of the imaging modalities revealed one or more findings suggestive of cystic neoplasms in 90% of the patients. These included multiloculated cysts, thickened cyst wall, intracystic mass or calcifications, and presence of liver metastasis. All the tumors were completely or partly excised. The final histopathological diagnosis was microcystic adenoma in 2, mucinous cyst adenoma in 1, papillary cystic neoplasm in 3, cystic neuroendocrine tumor in 5, and cystadenocarcinoma in 6. Of the 17 patients, 10 had malignant tumors. Seven patients with benign tumors and 3 patients with malignant tumors are disease free 12-30 months after resection. Cystic neoplasm must always be considered as a possibility when dealing with cystic lesions of the pancreas and a careful evaluation of ultrasonography and computed tomographic scan may give a clue to the diagnosis.     

Cystic neoplasms of the pancreas; what a clinician should know

Primary cystic neoplasms of the pancreas (serous cystic neoplasms, mucinous serous neoplasms, and intraductal papillary mucinous neoplasms) are lesions of emerging importance. With the wide availability of modern imaging methods, these neoplasms are being recognized with increasing frequency. Due to the improvement of these sophisticated imaging techniques, it is often possible to differentiate preoperatively these primary pancreatic cystic neoplasms not only from other cystic pancreatic disorders (such as pancreatic pseudocysts) but also from one another. This differentiation is very important for the clinician, since these neoplasms have radically different biologic behavior. Serous cystic neoplasms are uniformly benign and usually do not mandate resection unless the lesion is symptomatic. In contrast, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms have a premalignant or overtly malignant tendency, and therefore should be managed aggressively by pancreatic resection. In these mucinous cystic neoplasms, recognition of an underlying malignancy is often not possible without a detailed histopathologic examination of the entire resected specimen. In the absence of invasive disease, prognosis is excellent after appropriate surgery. The presence of invasive malignancy signifies a poor prognosis.     

Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms

Primary pancreatic cystic neoplasms have been recognized increasingly during the two recent decades and include mainly serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Serous cystic neoplasms represent about 30% of all cystic neoplasms of the pancreas and are characterized by their microcystic appearance (on imaging, macroscopically, and microscopically) and their benign biologic behavior. Modern diagnostic methodology allows the preoperative diagnosis with an acceptable accuracy. Currently, indications for resection of serous cystic neoplasms of the pancreas include the presence of symptoms, size > 4 cm (because these ‘large’ neoplasms have a more rapid growth rate and probably will soon become symptomatic), and any uncertainty about the diagnosis of a serous versus a mucinous cystic neoplasm. Resection should also be considered for lesions in the body/tail of the pancreas. Conservative treatment is a reasonable option in selected patients (for example in the presence of small, asymptomatic lesions in the pancreatic head, especially in the frail or elderly patient).     

Clinical significance of magnetic resonance cholangiopancreatography for the diagnosis of cystic tumor of the pancreas compared with endoscopic retrograde cholangiopancreatography and computed tomography.

BACKGROUND: Cystic tumor of the pancreas has been investigated by a variety of imaging techniques. Magnetic resonance cholangiopancreatography (MRCP) is being widely used as a non-invasive diagnostic modality for investigation of the biliary tree and pancreatic duct system. The purpose of this study was to compare MRCP images with those of endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT) in order to clarify the diagnostic efficacy of MRCP for cystic tumor of the pancreas. METHODS: We retrospectively studied 15 patients with cystic tumor of the pancreas that had been surgically resected and histopathologically confirmed. There were five cases of intraductal papillary adenocarcinoma, five of intraductal papillary adenoma, two of serous cyst adenoma, two of retention cyst associated with invasive ductal adenocarcinoma and one of solid cystic tumor. RESULTS: In all cases MRCP correctly identified the main pancreatic duct (MPD) and showed the entire cystic tumor and the communication between the tumor and the MPD. On the other hand, the detection rate by ERCP of the cystic tumor and the communication between the cystic tumor and the MPD was only 60%. Although the detection rates by CT for the septum and solid components inside the cystic tumor were 100 and 90.0%, respectively, those of MRCP for each were 58.3 and 20.0%. CONCLUSION: MRCP is capable of providing diagnostic information superior to ERCP for the diagnosis of cystic tumor of the pancreas. Although MRCP may provide complementary information about the whole lesion of interest, the characteristic internal features of cystic tumor of the pancrease should be carefully diagnosed in combination with CT.     

Characterization of gene expression in mucinous cystic neoplasms of the pancreas using oligonucleotide microarrays

Mucinous cystic neoplasms (MCNs) of the pancreas are uncommon neoplasms usually located in the body or tail of the pancreas and usually in females (>90% of cases). Clinically, they are often misdiagnosed as non-neoplastic pseudocysts leading to failed opportunities for curative resection. To better understand the biology of MCNs and to identify markers of the disease, we performed global gene expression profiling of MCNs using oligonucleotide microarrays. Using laser capture microdissection applied to frozen sections, RNA was extracted from the neoplastic epithelium of MCNs, from the adjacent 'ovarian-type' stroma of MCNs, from histologically normal pancreatic ductal epithelium, from pancreatic acinar tissue and from fibrous stroma in pancreata affected by chronic pancreatitis. Each RNA sample was subjected to two rounds of linear amplification followed by hybridization with U133A gene chips (Affymetrix). The expression patterns of selected genes were confirmed by quantitative RT-PCR and by immunohistochemistry using tissue microarrays containing 19 resected MCNs. A total of 114 known genes were overexpressed in the neoplastic epithelium compared to normal pancreatic ductal epithelium (>3-fold) including S100P, PSCA, c-myc, STK6/STK15, cathepsin E and pepsinogen C. Activation of the Notch pathway in the epithelial component of MCNs was evident by the demonstration of overexpression of Jagged1 and the downstream Notch pathway member Hes1. In the 'ovarian-type' stroma, several genes involved in estrogen metabolism were overexpressed including STAR and ESR1 genes. Some of the genes identified as overexpressed in these neoplasms may be useful as markers that can distinguish MCNs from non-neoplastic pancreatic cystic lesions.     

胰腺囊性肿瘤15例的外科治疗

回顾分析了 1987年 1月 12日～ 2 0 0 4年 1月 17日外科治疗 15例胰腺囊性肿瘤患者的临床资料。其中术前诊断率 60 0 % ( 9/15 ) ,手术切除率 73 3 % ( 11/15 ) ,术后 7个月～ 16年随访率 80 0 % ( 12 /15 ) ,无复发者 83 3 % ( 10 /12 ) ,2例黏液性囊腺癌术后 6及 8年仍健在。分析结果提示 ,根据临床表现、影像学检查 (B超、CT)、实验室检查、囊内液肿瘤标记物、酶及细胞学检查综合分析 ,可提高诊断率 ;本病手术切除率及治愈率较高 ,应采取积极的外科治疗措施。     

Solid and cystic pancreatic tumors. Clinical, histochemical, and electron microscopic features in ten cases

Ten cases of the rare solid and cystic pancreatic tumors are presented. All except one occurred in young women (mean age, 25 +/- 9.2 years). The large neoplasms were evenly distributed across the pancreas; in one case, metastasis occurred; all other cases were free from disease after complete resection. Histologic hallmarks of solid and cystic neoplasms were papillary growth, large intracytoplasmic granules, and immunoreactivity with alpha 1-antitrypsin, alpha 1-antichymotrypsin, phospholipase A2, and neuroendocrine markers (neuron-specific enolase [NSE], synaptophysin). This suggests both endocrine as well as exocrine differentiation.     

胰腺头部实性假乳头状瘤的手术治疗

目的:观察手术切除术治疗胰腺头部实性假乳头状瘤的临床疗效。方法:回顾性分析2008年11月至2014年7月间,盛京医院普通外科14例因患胰腺头部实性假乳头状瘤而行手术治疗的患者临床资料,女性12例,男性2例,平均年龄36.2岁。8例行胰十二指肠切除术,2例行保留幽门的胰十二指肠切除术,2例行胰腺部分切除术,1例行胰十二指肠切除术联合门静脉切除术,1例行胰腺部分切除术联合胰体尾空肠Roux-en-Y吻合术。评价手术效果,分析影像特点,并随访远期效果。结果:肿瘤平均7.1cm×6.1cm,所有患者术后病理及免疫组化证实胰腺实性假乳头状瘤,平均住院时间26天,有5例发生术后胰瘘,发病率35.7%,无死亡病例。术后随访8~82个月,中位随访时间27.5个月,有 1例于术后66个月复发,其余13例均无复发。结论:手术治疗胰腺头部实性假乳头状瘤是安全的,完整切除肿物远期疗效确切。     

Giant serous microcystic adenoma of the pancreas safely resected after preoperative arterial embolization

Serous microcystic adenomas are rare and account for 1-2% of all exocrine pancreatic tumors and 25% of all pancreatic cystic neoplasms. Recently, with advances in imaging techniques, these adenomas have been identified at an increasing frequency. A 63-year-old woman visited her doctor in 1999 due to a gastric deformity detected by upper gastrointestinal endoscopy. An abdominal computed tomography scan revealed a cystic lesion measuring 6.0 cm in diameter, resulting in a diagnosis of serous microcystic adenoma of the pancreatic head. During follow-up, the tumor increased steadily in size, measuring 6.0 cm in diameter in 1999 and 13.0 cm in 2008, while remaining asymptomatic throughout this period of time. The risk of malignant transformation appears to be low even over the long-term. However, some cases of malignant transformation to serous cystadenocarcinoma have recently been reported. In this case, assessment of the relationship between the tumor and adjacent vascular structures, such as massive drainage vein development on the surface or tumor flow into the portal and superior mesenteric veins and the celiac and superior mesenteric arteries, was critical for determining tumor resectability. The risk of massive intra-operative hemorrhage was felt to be considerable, given the extent of the veins on the surface of the tumor, as well as the size and location of the primary pancreatic mass. Therefore, preoperative embolization of the tumor-feeding arteries arising from the celiac axis (gastroduodenal, splenic and dorsal pancreatic arteries) was performed. Tumor resection with pancreaticoduodenectomy was performed without a blood transfusion, with an estimated blood loss of 570 ml. The final pathology confirmed the diagnosis of serous microcystic adenoma. The patient is currently alive and disease-free. Preoperative partial embolization of the tumor feeding arteries and intra-operative resection of the right gastric and inferior pancreatoduodenal arteries, allowed the tumor blood supply to be arrested without preoperative tumor necrosis. Subsequently, intraoperative blood loss was reduced. Preoperative partial embolization of the feeding arteries is useful for the resection of hypervascular large tumors of the pancreas.     

Primary pancreatic cystic neoplasms of the pancreas revisited. Part IV: rare cystic neoplasms

Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms-serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm-there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome.