胰腺实性假乳头状瘤与胰岛细胞瘤鉴别诊断的探讨

目的探讨胰腺实性假乳头状瘤(SPTP)与胰岛细胞瘤(ICT)的鉴别诊断要点。方法8例SPTP与11例ICT分别做HE、PAS、免疫组化(SP法)染色观察。结果8例SPTP患者平均年龄20.1岁,术后均无复发;肿块均有包膜,囊实性相间;组织学上,以瘤细胞围绕血管排列成假乳头状结构且伴有退行性改变为其特征。11例ICT患者平均年龄43.2岁,术后有2例复发;部分肿块有包膜,多为实性;组织学上,瘤细胞胞质少,细胞核内染色质呈细颗粒状,细胞排列成小梁状、腺泡状或实性。免疫组化显示,SPTP组瘤细胞AACT、ACT、Vim多为( ),CgA、CKI、ns多为(-)。结论瘤细胞的退行性变及假乳头状结构、免疫组化ACT、AACT、Vim( ),CK(-),有助于胰腺SPTP与ICT的鉴别。

Differential diagnosis of solid-pseudopapillary tumor and islet cell tumor in pancreas

Objective To explore essential points in differentiation between solid-pseudopapillary tumor of the pancreas(SPTP) and islet cell tumor(ICT).Methods 8 cases of SPTP and 11 cases of ICT were studied by using HE stain,PAS and immunohistochemistry(S-P method).Results 8 patients with SPT had a mean age of 20.1 years and had no recurrence after tumor resection.Those tumors were all encapsulated and solid alternately with cystic change.Histologically,pseudopapilla with fibro-vascular core and degenerative changes were remarkable.However,11 patients with ICT had a mean age of 43.2 years and had recurrences in two cases after tumor resection.Those tumors were usually encapsulated,and solid(focally cystic).Histologically,cells with thin rim of cytoplasm and fine salt-and-pepper chromatin were arranged in trabecular(ribbon-like),acinar(duct-like) and solid patterns.Immunohistochemically,difference between SPTPs and ICTs was that the tumor cells of the vast majority of SPTPs stained positive for AACT,ACT and Vim but negative for CgA,CK and Ins.Conclusion The degenerative changes and pseudopapillary pattern,positive for AACT,ACT and Vim but negative for CK and CgA,are helpful to differentiate SPTPs from ICTs.