胰腺腺鳞癌与导管腺癌的影像特点及病理对照分

目的 分析总结胰腺腺鳞癌（adenosquamous carcinoma ASqC）的CT、MRI表现及病理特点，并与胰腺导管腺癌(Invasive ductal adenocarcinoma of pancreas，IDAC)进行对照，探讨其影像及病理的特征。方法 回顾性分析经手术病理证实胰腺ASqC 11例、IDAC 22例的CT、MRI影像及病理资料，将ASqC组的性别、年龄、术前CA199；病理中神经束受侵、淋巴结转移、脉管癌栓、ki67%、胰腺切缘受累情况；影像资料的位置、大小、形态、坏死、出血、钙化及CT、MR表现与导管腺癌组进行对照分析。结果 ASqC与IDAC两组在病变大小、形态、坏死、强化程度（期）、脉管癌栓、胰腺切缘受累情况方面差异显著，差异性有统计学意义（P〈0.05）。与IDAC相比，ASqC直径较大（53.86±23.28mm VS.28.38±9.12mm），直径大于30mm个数百分比为（81.82%VS.31.82%）；呈类圆分叶状较多（63.64%VS.18.18%），广泛的中央坏死明显（91%VS.31.82%）； 强化程度（期）延时期较明显（75%VS.27.27%）；脉管癌栓多见（45.45%VS.9.09%）。结论：ACqC多为类圆形或分叶状，体积较大并具有广泛的中央坏死区，弥散受限更明显；病变癌栓发生率较高，这些特征可以为ASqC的诊断提供参考。

CT and MR imaging features in adenosquamous carcinoma of pancreas, with pathologic correlations and comparison with invasive ductal adenocarcinoma of pancreas

Purse: To investigate the CT and MR imaging features of adenosquamous carcinoma of pancreas (ASqC), with pathologic correlations and comparison with invasive ductal adenocarcinoma of pancreas (IDAC). To explore the imaging and pathologic features of ASqC and IDAC. Methods: Eleven patients with ASqC and twenty patients with IDAC were retrospectively analyzed in this study. Radiologic and pathologic findings were reviewed in each lesion, and compared between ASqC and IDAC groups. Results: Significant differences between ASqC and IDAC groups were noted in lesion size, shape, necrosis, enhancement pattern, vascular tumor emboli and the pancreas cut edge involvement(P<0.05). Compared with IDAC, ASqC tended to be large diameter (53.86±23.28mm VS.28.38±9.12mm), diameter larger than 30mm percentage (81.82% VS.30%), round-lobulated shape (63.64% VS.20%), have a wide range of central necrotic portions (91% VS.35%), showed the highest absolute attenuation on delayed phase (75% VS.30%), and have more vascular tumor thrombus (45.45% VS.10%). Conclusions: ASqC tended to be a larger size, round-lobulated lesion with extensive central necrosis and more obvious limited dispersion. Additionally, ASqC has a high incident of tumor thrombus in the portal vein system. These CT and MRI imaging feature could be powerful clues for diagnosing ASqC.