摘要
目的 探讨胰腺腺泡细胞癌（PACC）的临床病理特点及治疗方法,以提高对此疾病的诊断水平和治疗效果.方法 回顾性分析第二军医大学附属长海医院胰腺外科2005年11月至2014年3月收治的17例经病理证实的PACC病例,分析其临床病理特征及治疗方法.结果 本组男性10例,女性7例.年龄37 ～ 77岁,平均59岁.11例主诉腹痛或腹胀;3例主诉皮肤及巩膜黄染;3例为体检发现.术前4例血清CA19-9、1例CEA、1例AFP超过正常参考值范围.B超检查见实性或囊实性低回声占位,内部回声欠均匀;CT和（或）MR、MRCP检查示多为边界较清的乏血供肿块,伴或不伴有胆管或胰管的扩张.肿块位于胰头6例、胰颈2例、胰体尾9例.肿块大小为1.5～7.3 cm,平均3.7 cm.实性肿块13例（76.5％）,伴有囊性变4例（23.5％）.免疫组化检查α1-抗胰凝乳蛋白酶（α1-ACT）和极低分子量细胞角蛋白（CAM5.2）均为阳性.3例行药物敏感性试验,其中抑制率均＞70％的有紫杉醇（TAX）和5-氟脲嘧啶.2例（14.3％）于术后第10和第17个月复发,5例（35.7％）于术后3 ～19个月出现肝脏转移伴或不伴腹膜后淋巴结转移.14例获得随访,其中3例死亡,术后生存时间分别为19、43和49个月,平均生存37个月;其余11例均健在,平均已生存31.5个月.结论 胰腺腺泡细胞癌是胰腺少见肿瘤,临床表现无特异性,肿瘤α1-ACT阳性表达率高达100％.局部PACC的治疗以手术切除为主,化疗主要采用紫杉醇、5-氟脲嘧啶.PACC总体预后较差.
Objective To investigate the clinicopathological features and therapy of pancreatic acinar cell carcinoma （PACC） in order to improve the diagnosis and therapy of PACC.Methods The clinical data of 17 patients with pathologically confirmed PACC,who were admitted from November 2005 to March 2014 to Department of Pancreatic Surgery,Changhai Hospital,Second Military Medical University,were retrospectively reviewed,and the clinicopathological features and therapeutic methods were summarized and analyzed.Results The 17 cases included 10 men （58.8%） and 7 women （41.2%）,ranging from 37 to 77 years old with an average of 59 years old.The chief complaints of 11 cases were abdominal pain or abdominal distension,3 cases reported jaundice,3 cases was detected by medical check-up.The preoperative serum test of CA19-9 in 4 cases,CEA in 1 case,AFP in 1 case was higher than the normal upper limit.Ultrasound showed solid or cystic hypoechoic mass with less uniform internal echo; CT and/or MR,MRCP showed relatively clear boundary tumor with lack of blood supply,with or without biliary or pancreatic duct dilation.The tumors were located in the head of the pancreas in 6 cases,in the neck in 2 cases,and in the body or tail in 9 cases.The diameter of tumor was 1.5-7.3 cm with an average of 3.7 cm.Thirteen （76.5%） cases were solid,4（23.5%） cases with cystic degeneration.Immunohistochemical staining showed α1-ACT and CAM5.2 were positive in all cases.Three cases underwent drug susceptibility test,the inhibition ratio of taxol and 5-fluorouracil （5-Fu） was more than 70%.Two （14.3%） cases had recurrence at the 10 th and 17 th month postoperatively,and 5 cases had liver and/or lymph node metastasis in the 3rd to 19th month postoperatively.Till the deadline of follow-up 3 cases died,and the survival time was 19,43 and 49 months,respectively,with a median survival of 37 months,the remaining 11 cases were alive,with an average of 31.5 months survival.Conclusions The pancreatic acinar cell carcinoma is a rare tumor o
出处
《中华胰腺病杂志》
CAS
2014年第6期361-365,共5页
Chinese Journal of Pancreatology
关键词
腺泡细胞癌
胰腺肿瘤
病理学
临床
治疗
Acinar cell carcinoma
Pancreatic neoplasm
Pathology,clinical
Therapy
