胰腺囊性肿瘤的临床诊治

提高对胰腺囊性肿瘤诊断和治疗的认识,减少这种少见肿瘤的误诊误治。方法:对1958年4月～1995年7月经病理证实的15例胰腺囊性肿瘤病人进行回顾性分析。结果:15例胰腺囊性肿瘤中,浆液性囊腺瘤6例,粘液性囊性肿瘤9例。肿瘤位于胰头部4例,体尾部10例,全胰1例。15例病人全部进行手术治疗,其中12例获手术切除,切除率为80％。术前明确诊断为胰腺囊性肿瘤者仅6例,其余9例术前被误诊为胰腺假性囊肿或中、上腹肿块而行手术,其中7例术中被诊为囊性肿瘤而获相应的根治性切除,另2例被错误地进行了内引流术。结论:胰腺囊性肿瘤临床上常被误诊,只要综合运用病史分析、影像学特点、囊液分析、术中活检等方法,就能提高诊断的准确率。胰腺囊性肿瘤手术切除率高,预后较好。     

胰腺囊性肿瘤的诊断和手术对策

胰腺囊性肿瘤并不常见，但在胰腺外科中有重要意义。胰腺囊性肿瘤约占胰腺囊肿的10％～15％，其中囊腺癌占胰腺恶性肿瘤的1％、最常见的有浆液性囊腺瘤、粘液性囊腺瘤和囊腺癌，其他如囊性胰岛细胞瘤、囊性畸胎瘤、血管瘤、囊性绒癌等均极为罕见。如北京协和医院30年间仅收治胰腺囊性肿瘤20例，第四军医大学唐都医院25年间收治16例。     

无症状性胰腺囊性肿瘤的临床及病理特征分析

目的 探讨及分析无症状性胰腺囊性肿瘤的临床及病理特征。方法 回顾性分析北京协和医院1984年1月至2008年6月126例经手术治疗的胰腺囊性肿瘤的病例资料。结果 126例胰腺囊性肿瘤的病人中,60例无症状,其中56例为良性,28例为浆液性囊腺瘤,25例为黏液性囊腺瘤,3例为导管内乳头状黏液性肿瘤;4例为恶性,3例为黏液性囊腺癌,1例为侵袭性导管内黏液性肿瘤。 采用单因素和多因素变量分析结果显示病人的性别,肿瘤大小和影像学特征性表现（包括实性成分和主胰管扩展）在胰腺良、恶性囊性肿瘤之间差异有统计学意义,男性在恶性肿瘤中显著多于女性（P=0.01）; 影像学特征性表现是常常是判断肿瘤恶性可能的独立因素。对于直径<3cm的肿瘤,无症状的胰腺囊性肿瘤更多见于良性肿瘤。结论 在无症状胰腺囊性肿瘤中,恶性肿瘤发病率比较低,尤其对于肿瘤直径<3cm的无症状囊性肿瘤,如果影像学检查显示囊肿内无实性成分或乳头状突起,胰管不扩张者,可采用保守观察的方法,定期随访。     

胰腺囊性肿瘤研究进展

胰腺囊性肿瘤（cystic neoplasms of the pancreas）是临床比较少见的一类疾病，仅占胰腺囊性病变的10％-15％，而在全部胰腺肿瘤中，仅占1％左右。由于胰腺囊性肿瘤位置较深，生长缓慢，早期无任何临床症状，故过去很少发现。近年来随着影像学和各种内镜技术的发展及临床医生对该病认识的深入，发现的病例明显增多。本文就胰腺囊性肿瘤的研究进展作一综述。     

胰腺囊性肿瘤的治疗方法

胰腺囊性肿瘤(PCN)是指一类胰管或腺泡组织上皮细胞增生,致使分泌物潴留而发生的肿瘤性囊性病变.发病率较低,仅占胰腺原发性肿瘤的1%,胰腺囊性病变的10%～15%[1],其中以浆液性囊腺瘤(serous cystic neoplasm,SCN)最高,黏液性囊腺瘤(mucinous cystic neoplasm,MCN)或囊腺癌次之,近年来实性假乳头性肿瘤(solid pseudopapillary tumor,SPT)和导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)的报道逐渐增多.一般认为浆液性囊性肿瘤主要为良性病变,而黏液性囊性肿瘤、导管黏液性扩张及乳头囊性肿瘤为潜在恶性病变[2].胰腺囊性肿瘤对放疗、化疗不敏感,手术是胰腺囊性肿瘤唯一有效的治疗手段.本文主要介绍胰腺囊性肿瘤的治疗方法.     

胰腺囊性肿瘤的临床诊治

目的：提高对胰腺囊性肿瘤诊断和治疗的认识、减少这种少见肿瘤的误诊误治。方法：对１９５８年４月￣１９９５年７月经病理证实的１５例胰腺囊性肿瘤病人进行回顾性分析，结果：１５例胰腺囊性肿瘤中，浆液性囊腺瘤６例，粘液性囊性肿瘤９例。肿瘤位于胰头部４例，体尾部１０例，全胰１例。１５例病人全部进行手术治疗，其中１２例获手术切除，切除率为８０％，术前明确诊断为胰腺囊性肿瘤者仅６例，其余９例术前被误诊为胰腺假性囊     

胰腺囊性肿瘤的诊断与治疗

目的探讨胰腺囊性肿瘤的诊断与外科治疗。方法回顾性研究北京大学第一医院外科1994—2004年所收治45例胰腺囊性肿瘤的临床资料。结果本组病例涉及8种不同囊性肿瘤，男12例，女33例，平均年龄49．1岁，临床表现无特异性。B超及CT检查提示囊性或囊实性占位，ERCP、EUS等可提供鉴别诊断线索。根据肿瘤位置及性状选择局部切除术13例，Whipple术12例，胰体尾切除术18例，全胰腺切除术1例，单纯活检术1例。无围手术期死亡，术后胰瘘2例经保守治疗痊愈。随访38例，平均32．6个月。随访期内死亡4例，其中3例死于肿瘤复发，其余病人无瘤生存。结论胰腺囊性肿瘤包括多种亚型，临床表现均无特异性，诊断须综合各项检查结果，诊断明确者应积极手术治疗，切除率高，预后较好。     

胰腺囊性肿瘤的诊断和治疗

目的 提高对胰腺囊性肿瘤的认识。方法 对1982年1月-2002年5月诊治的16例胰腺囊性肿瘤进行回顾性研究。结果 术前CT确诊9例。手术及术后病理证实15例。保守治疗1例。手术治疗15例，其中手术切除8例，外引流4例。内引流3例。结论 胰腺囊性肿瘤生长缓慢，应尽快切除。胰腺癌恶性程度低，转晚，较实性肿瘤切除容易，对不能切除者，应行外引流而不应行内引流，待化疗后争取二期切除。     

胰腺囊性肿瘤13例临床分析

目的总结胰腺囊性肿瘤(pancreatic cystic neoplasms,PCN)的诊断与治疗体会。方法回顾性分析手术治疗的13例PCN的临床资料。结果术前B超确诊率为61.5%(8/13),CT确诊率为84.6%(11/13),肿瘤切除率为84.0(11/13),术后发生胰漏、切口感染各2例,腹腔感染1例。10例平均随访3.6年,3例死亡,其余均无复发。结论PCN术前定位困难,主要依靠影像学检查与胰腺假性囊肿鉴别。外科手术是PCN的主要治疗手段。     

Large Mucinous Cystadenoma of the Pancreas During Pregnancy: Report of a Case

A 33-year-old woman, gravida 2, para 1, was diagnosed to have a benign mucinous cystic neoplasm of the pancreas 5 months before delivery. The tumor measured 12 cm in diameter at the time of diagnosis. The antenatal course was uneventful, and a vaginal delivery produced a normal infant. By 2 months after delivery, the tumor reached 18 cm. At surgery, a huge cyst was found to originate from the pancreas, and a distal pancreatectomy with splenectomy was performed. The cystic mass was multilocular 18 × 17 × 12 cm, 2450 g, and red to yellowish-gray. The histologic diagnosis was benign mucinous cystadenoma. The postoperative course was uneventful, and the patient remains free of recurrence at 7 months after surgery. To our knowledge, this is only the fifth reported case of pancreatic mucinous cystadenoma in association with pregnancy. This is the first reported case of a successful resection of such a tumor after delivery.     

Mucinous cystic tumors of the pancreas

Purpose: This study was conducted to clarify the clinicopathologic characteristics relevant to the specific diagnosis of mucinous cystic tumors of the pancreas. Methods: We retrospectively reviewed the clinical features and histopathologic findings of five patients who underwent curative resection for mucinous cystic tumors of the pancreas at our hospital between 1975 and 2000. Results: All five patients were women, ranging in age from 36 to 69 years, and the tumors were located in the pancreatic body and tail. Histopathologically, three tumors were mucinous cystadenomas and two were mucinous cystadenocarcinomas. All five tumors had ovarian-type stroma, and stromal luteinization was found in the three adenomas. These tumors were classified into two groups according to whether the epithelial lining was endocervical or intestinal. All tumors were spherical and multilocular with a fibrous pseudocapsule. On T1-weighted magnetic resonance images, mucinous cystadenomas with watery mucin showed low signal intensity, but mucinous cystadenocarcinomas with gelatinous mucin or hemorrhagic contents demonstrated high signal intensity. Conclusions: Signal intensity on T1-weighted magnetic resonance images provides highly useful diagnostic information on mucinous cystic tumors of the pancreas. Furthermore, tumors may be classified into two groups according to the type of epithelial lining. Received: December 19, 2001 / Accepted: May 7, 2002 Reprint requests to: T. Hara     

Intraductal Papillary Mucinous Tumor of the Pancreas in a Young Man: Report of a Case

We report the rare case of an intraductal papillary mucinous tumor (IPMT) in a man younger than 30 years of age. The patient was admitted with upper abdominal pain and an elevated amylase level of 662 IU/l. Ultrasonography showed a cystic mass in the pancreatic body and endoscopic retrograde cholangiopancreatography (ERCP) revealed a dilated pancreatic duct with a filling defect communicating with the tumor. He was successfully treated by segmental resection, which seems to be the best surgical option for pancreatic body tumors since it results in long-term survival and preserves as much pancreatic parenchyma as possible. Nevertheless, it can only be done in the absence of additional nodules along the pancreatic duct. A pathological diagnosis of intraductal papillary adenocarcinoma of the noninvasive type was confirmed, and both stumps were free of tumor. Received: August 8, 2001 / Accepted: July 2, 2002 Reprint requests to: T. Tokoro     

Mucinous Cystic Neoplasms

Mucinous cystic neoplasms of the pancreas are uncommon tumors of the pancreas that occur predominantly in middle-aged women and almost exclusively in the body and tail of the pancreas. They are lined by a mucinous epithelium that can exhibit varying grades of dysplasia and are surrounded by a characteristic ovarian-like stroma. Surgery is the treatment of choice, and prognosis is excellent in the absence of invasive carcinoma. This paper was originally presented as part of the SSAT/AGA/ASGE State-of-the-Art Conference on Management of Cystic Lesions of the Pancreas at the SSAT 48th Annual Meeting, May 2007, in Washington, DC. The other articles presented in the conference were Adsay NV, “Cystic Neoplasia of the Pancreas: Pathology and Biology”; Scheiman JM, “Management of Cystic Lesions of the Pancreas: Diagnosis: Radiographic Imaging, EUS and Fluid Analysis”; Tseng JF, “Management of Serous Cystadenoma of the Pancreas”; and Farnell MB, “Surgical Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas.”     

胰腺囊性肿瘤临床诊治分析

目的探讨胰腺囊性肿瘤的诊治方法。方法回顾性分析29例胰腺囊性肿瘤患者的临床资料,包括一般资料、临床表现、辅助检查、手术方法、病理结果、术后并发症和随访结果。结果 8例(28%)浆液性囊性肿瘤(SCN),12例(41%)黏液性囊性肿瘤(MCN),3例(10%)导管内乳头状黏液肿瘤(IPMN),6例(21%)实性假乳头状肿瘤(SPT)。8例SCN、7例MCN、1例IPMN和5例SPT均是良性肿瘤。76%(22/29)患者是女性,年龄(49±17)岁(15～78岁)。29例中行手术治疗23例,其中切除肿瘤22例,探查活检1例,围手术期无死亡病例;另外6例未手术者中4例SCN者行随访观察处理,2例IPMN者拒绝手术治疗。29例患者中获随访21例,随访时间为(2.7±2.3)年(6个月～8年),失访8例。16例肿瘤切除者随访期内肿瘤无复发,1例探查活检者术后1年死亡;4例未手术的SCN患者随访期内肿瘤无明显增大。结论胰腺囊性肿瘤中最常见的是黏液性肿瘤和浆液性肿瘤,多见于女性;浆液性肿瘤均为良性,42%的黏液性肿瘤是恶性;误诊将延误治疗,增加死亡率。胰腺囊性肿瘤手术切除率高,根治性切除后预后好。     

Cystic Neoplasia of the Pancreas: Pathology and Biology

In contrast with solid tumors, most of which are invasive ductal adenocarcinoma with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. Those that are mucinous, namely, intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), constitute the most important category, not only because they are the most common, but more importantly because they have well-established malignant potential, representing an adenomacarcinoma sequence. While many are innocuous adenomas — in particular, those that are small and less complex, and in the case of IPMN, those that are branch-duct type are more commonly benign, some harbor or progress into in situ or invasive carcinomas. For this reason, pancreatic cysts with mucinous differentiation ought to be evaluated carefully, preferably by experts familiar with subtle evidences of malignancy in these tumors. In the past few years, the definition of IPMNs and MCNs has become more refined. The presence of ovarian-type stroma has now almost become a requirement for the diagnosis of MCN, and when defined as such, MCN is seen almost exclusively in women of perimenopausal age group as thick-walled multilocular cystic mass in the tail of the pancreas in contrast with IPMN which afflicts an elder population, both genders in almost equal numbers, and occur predominantly in the head of the organ. While mucinous lesions have well-established pre-malignant properties, most of the entities that fall into the nonmucinous true cyst category such as serous tumors, lymphoepithelial cysts, congenital cysts, and squamoid cyst of ducts have virtually no malignant potential. In contrast, the rare cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia such as the rare cystic ductal adenocarcinomas, cystic endocrine neoplasia, and most importantly, solid-pseudopapillary tumor (SPT) in which cystic change is so common that it used to be incorporated into its name (“solid-cystic,” “papillary-cystic”) are malignant neoplasia, albeit variable degrees of aggressiveness. SPT holds a distinctive place among pancreatic neoplasia because of its highly peculiar characteristics, undetermined cell lineage, occurrence almost exclusively in young females, association with β-catenin pathway, and also by being a very low-grade curable malignancy. In conclusion, cystic lesions in the pancreas constitute a biologically and pathologically diverse category most (but not all) of which are either benign or treatable diseases; however, a substantial subset, especially mucinous ones, has malignant potential that requires careful analysis. This paper was originally presented as part of the SSAT/AGA/ASGE State-of-the-Art Conference on Management of Cystic Lesions of the Pancreas at the SSAT 48th Annual Meeting, May 2007 in Washington, DC. The other articles presented in the conference were Scheiman JM, Management of Cystic Lesions of the Pancreas: Diagnosis: Radiographic Imaging, EUS and Fluid Analysis; Tseng JF, Management of Serous Cystadenoma of the Pancreas; Fernández-del Castillo C, Mucinous Cystic Neoplasms; and Farnell MB, Surgical Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas.     

Mucinous cystic neoplasm of the pancreas during pregnancy: the importance of proper management

We describe a case of huge mucinous cystic tumor of the pancreas in a 26-year-old woman during pregnancy. Ultrasonography demonstrated a well-delimited cystic mass in the left upper abdominal quadrant, suggestive of benignity. Magnetic resonance imaging showed a large cystic mass resembling a mucinous cystic tumor of the pancreas. After this assessment the patient underwent surgical exploration and a huge cystic tumor of the pancreas was discovered. The tumor was enucleated and distal pancreatectomy was performed. The resected margin of the specimen was free of tumor. In this case report we discuss the management of mucinous pancreatic tumors during pregnancy and we briefly review the previously reported cases of mucinous pancreatic tumors in pregnant patients. We conclude that surgical resection of these tumors should be strongly considered in pregnancy. Removal of the tumor appears to be a safe procedure without harmful effects to the fetus.     

The Morphological Classification of a Serous Cystic Tumor (SCT) of the Pancreas and Evaluation of the Preoperative Diagnostic Accuracy of Computed Tomography

Background  Although the honeycomb microcystic type is common and typical for a serous cystic tumor (SCT), clinical and radiological features are diverse. Systematic classification of SCT subtypes is not well established. The purpose of this study was to classify the subtypes of SCT and to clarify its clinical and pathological characteristics. Methods  Clinical data from 52 patients with a pathologically confirmed SCT were prospectively collected using a standard data form. According to cyst size and multiplicity, on gross and radiological evaluation, the cysts were classified as microcystic when they were smaller than 2 cm, and macrocystic when larger than 2 cm. The microcystic tumors were subdivided into honeycomb and solid types, while the macrocystic tumors into unilocular and multilocular types based on the number of cysts. Results  There were 22 cases with microcystic SCTs that were subclassified into the honeycomb (n = 21) and solid types (n = 1), while 30 cases were macrocystic type and were subclassified into multilocular (n = 16) and unilocular types (n = 14). There were no differences between four subtypes with regard to gender, tumor location, and size. The preoperative diagnostic accuracy of the unilocular macrocystic SCT was only 35.7%, while that of honeycomb microcystic SCT and multilocular macrocystic SCT were 81% and 87.5%, respectively (P = 0.005). Conclusion  Microcystic SCTs and multilocular macrocystic SCTs can be accurately diagnosed preoperatively; therefore conservative treatment and observation are possible in some cases. However, the unilocular macrocystic SCT is difficult to differentiate from the other pancreatic cystic tumors with malignant potential, therefore resection must be considered. Seung Eun Lee, M.D. and Yujin Kwon, M.D., contributed equally in this work.