胰腺实性假乳头状瘤的临床病理特点及诊治体会

目的 探讨胰腺实性假乳头状瘤（SPTP）临床病理特点及诊治经验。方法 回顾性分析2004年2月至2012年11月经病理证实的23例SPTP病例的临床特征、手术及病理资料和随访结果。结果 男7例，女16例；年龄10～63岁，中位年龄39岁。肿瘤位于胰头/颈部8例，胰体尾部15例。1例行单纯胰腺肿瘤局部切除，4例行胰十二指肠切除，2例行胰腺中段节段性切除（1例为腹腔镜手术），5例行胰腺体尾切除（其中1例因合并肝癌加行肝右后叶切除），11例行胰腺体尾切除加脾切除。术后住院6～35 d，中位术后住院日13 d。术后总并发症发生率43.5%（10/23），无再手术及围手术期死亡病例。肿瘤直径1.5～15 cm，平均（5.9±0.7）cm。病理特征为肿瘤细胞围绕纤细血管轴心形成特征性的假乳头状结构，细胞形态一致，核异型性不明显。8例表现为胰腺组织、神经浸润或脾脏侵犯，诊断为恶性胰腺实性假乳头状瘤。免疫组化显示AAT/AACT、Vimentin、β-catenin、CD56阳性率均100%，Syn、CgA、CD10、PR部分阳性。23例均获随访，平均38个月，无术后复发转移及死亡，1例合并肝癌患者术后2年因肝癌复发再次行肝癌切除术，无SPTP复发转移。结论 SPTP临床表现无明显特异性；增强CT检查有助于肿瘤定位和手术风险评估；确诊依赖于病理学诊断和免疫组化；手术完整切除肿瘤能获得良好预后。

Clinicopathologic features,diagnosis and treatment of solid-pseudopapillary tumor of the pancreas

Objective To study the clinicopathologic features, diagnosis and treatment of solid pseudopapillary tumor of the pancreas (SPTP). Methods Between Feb. 2004 and Nov. 2012, 23 patients were diagnosed with SPTP by histological findings in our hospital. The medical records of clinical, radiological, and pathologic data were retrospectively reviewed. The therapeutic results and follow-up data were also reviewed. Results There were 7 male and 16 female patients. Aging from 10 to 63 years with an average age of 39 years. The tumor was located at pancreatic head or neck in 5 patients, at pancreatic body and tail in 18 patients. Of the 23 patients, 1 underwent simple resection of pancreatic tumor, 4 underwent pancreaticoduodenectomy, 2 underwent middle segmental pancreatectomy (1 by laparoscopy), 5 underwent distal pancreatectomy (1 underwent right posterior lobectomy of liver for hepatocellular carcinoma), 11 underwent distal pancreatectomy plus spleen resection. The median period of postoperation stay in hospital was 13 d (ranging 6 to 35 d). No reoperation or perioperative deaths. The mean diameter of tumor was 5.9±0.7 cm (ranging 1.5～15 c m). Histologically, tumors were composed of papillary and microcystic solid structures, with uniformed population of cells without atypia. Pseudopapilla with fibro-vascular core was remarkable. The pancreas, nerve, or spleen invasion were identified in 8 cases. Immunohistologically, the tumors were positive for AAT/AACT, Vimentin,β-catenin, CD56. Totally 23 cases were followed-up withan average period of 38 months without tumor recurrence or metastasis. Conclusion SPTP has no obvious specific clinical manifestations. Enhanced CT helps tumor localization and surgical risk assessment. The correct diagnosis depends on histopathology examination. Excellent prognosis would be achieved with surgical resection.