胰腺间变癌的临床病理特点——附6例报告

目的胰腺间变癌是少见的胰腺外分泌恶性肿瘤，本文探讨其临床病理学特点。方法回顾性分析6例胰腺间变癌的临床特点并结合文献讨论。结果本组6例，其中男5例，女1例，年龄4j～74岁。肿瘤位于胰头3例，胰体尾3例。行胰头十二指肠切除术3例，其中1例作肠系膜上静脉切除重建术，另1例同时行肠系膜上动、静脉切除重建术。3例胰体尾肿块，2例行胰体尾切除、脾切除术．另1例肿瘤已侵犯周围脏器，行全胃、结肠脾曲、腹腔动脉切除术。病理检查：肿瘤细胞呈多形性．可见圆形、卵圆形、多边形和梭形的肿瘤细胞，核大深染，异型明显，也可见巨核或多核的瘤巨细胞及破骨细胞样巨细胞。随访5例，术后平均生存5．5月．均死于肿瘤腹腔内和肝脏转移。结论胰腺间变癌组织学特点为肿瘤细胞的多形性，并可见巨核或多核的巨细胞或破骨细胞样巨细胞．呈侵袭性生长，易侵犯周围脏器、大血管和发生肝脏、淋巴结转移，恶性程度高，预后差。

A clinicopathologic study of anaplastic carcinoma of pancreas: report of 6 cases and review of the literature

Objective To investigate clinicopathologic features, diagnosis and treatment of anaplastic carcinomas of pancreas, a rare exocrine malignancy of pancreas. Methods Six cases of anaplastic carcinoma of pancreas were retrospectively analysed and the related literature was reviewed. Results The six patients with anaplastic carcinomas of pancreas included 5 men and one woman ranging in age from 45 to 74 years with a mean of 61. 5 years. In 3 patients the tumors were in the head of pancreas, and in the other 3 patients, in the body and tail. The tumors were surgically resected by pancreaticoduodenectomy in one patient, by pancreaticoduodenectomy combined resection and reconstruction of superior mesenteric vein (SMV) in one patient, by pancreaticoduodenectomy combined resection and reconstruction of SMV and superior mesenteric artery (SMA) in one patient, by distal pancreatectomy in 2 patients, and by distal pancreatectomy combined total gastrectomy in the remaining patient. Liver metastasis was found in one patient. Follow-ups showed that the prognosis was poor, with a mean survival of postoperative 5. 5 months. All patients died due to tumor recurrence and liver metastasis. Conclusions Histologically, anaplastic pancreatic carcinoma is characterized by pleomorphism of tumor cells consisting of pleomorphic giant/small cells and spindle cells, or osteoclast-like giant cell tumor composed of pleomorphic small cells, or pleomorphic giant cell carcinoma with osteoclastoid giant cells, growth of which is invasive, likely to invade adjoined organs and major vessels causing liver and lymph node metastases. The prognosis of this tumor appears to be very poor.