胰腺实性-假乳头瘤临床病理学观察分析

目的探讨胰腺实性．假乳头瘤（solid-pseudopapillary neoplasm of the pancreas，SPN）的临床病理特点。方法收集四川省医学科学院·四川省人民医院病理科2008年9月至2013年2月诊断的10例SPN患者的临床病理资料，对其临床表现、病理形态学、免疫表型特征及预后进行分析，并结合文献进行总结。结果10例患者中男1例、女9例；发病年龄15—55岁，中位年龄24岁。肿瘤发生于胰头2例、胰体尾4例、胰尾4例。3例表现为左上腹部疼痛，2例为腹部出现无痛性包块，1例上腹不适，4例为体检时CT发现胰腺占位就诊。肿瘤最大直径2—22cm，平均7．4cm；切面呈分叶状，均可见淡黄色、黄白或灰白相间的实性区，质地较细，可见明显出血、坏死及囊性变区；组织形态学表现为大小一致且黏附性差的肿瘤细胞成巢状或围绕纤细的血管周围排列呈假乳头样，可见不同程度的出血坏死。免疫表型：10例肿瘤细胞均表达Vimentin、β-catenin、CgA、CD10、α1-抗糜蛋白酶、α1-抗胰蛋白酶；还不同程度的表达pan—CK、Syn和PR；Ki-67均为低表达，阳性率1％～5％。10例患者均行肿块切除术。随访6个月至4年，10例患者均存活无复发。结论SPN为胰腺较少见肿瘤，好发于年轻女性，虽然形态学表现良性肿瘤的特征，但具有低度恶性潜能，最后诊断需靠病理组织学及免疫组化检测。

A clinico-pathological study of pancreatic solid-pseudopapillary neoplasm

Objective To study the clinico-pathologic features of solid-pseudopapillary neoplasm（SPN） of pancreas. Methods Clinical and pathological data of 10 SPN cases between Sep. 2008 and Feb. 2013 were selected from the files of the pathology department, Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital. Clinical manifestations, pathological morphology, immunophenotype and prognosis were retrospectively analyzed,and summarized with literature concerned. Results Of the SPN 10 cases,there were 1 male and 9 female. The age of patients ranged from 15 to 55 years old with a median age of 24 years. Two cases had tumors in pancreatic head ,4 in pancreatic body and tail, and 4 in pancreatic tail. Three patients had left epigastric pain,2 patients presented a painless mass in abdomen, 1 with abdominal discomfort, and 4 were found by CT during physical examination. The sizes of tumors, ranged from 2 to 22 cm with an average of 7.4 cm. Cross section of the tumors showed lobulated appearance. All cases had well, preserved solid areas and appeared stramineous to gray. Some tumors showed prominent hemorrhage, necrosis, and cystic degeneration. The SPN tumor cells presented adhesivenessless form nests or pseudopapillary architecture between delicate vasculature, and necrosis was presented in varying degrees as well. By using immunochemical analysis all cases were positive for vimentin, β-catenin, CgA, CDIO, α1-antichymotrysin and ctl-antitrypsin, but positive for pan-CK, Syn and PR in varying degrees. Ki-67 was weak expressed with positive rate from 1% to 5%. All patients were treated with mass resection, and lived without recurrence during the follow-up period for six months to 4 years. Conclusion SPN is an uncommon neoplasm of pancreas with low malignant potential. It has the morphological features of benign neoplasm, generally occurring in young women. Its diagnosis mainly depends on the histo-pathological and the immunohistochemical examinations.