摘要
目的探讨伴破骨细胞样巨细胞的未分化胰腺癌(PUC-OGC)病人的临床与病理学特征及诊治要点。方法回顾性分析哈尔滨医科大学附属第一医院2014年10月到2017年12月期间收治的5例PUC-OGC病人的临床资料与随访结果。结果 5例病人中,以上腹部疼痛不适为主诉者4例,寒战、发热者1例。5例病人中4例术前癌胚抗原(CEA)、CA19-9均正常,仅1例CA19-9轻度升高。其中4例行胰体尾脾切除术,1例行胆总管空肠吻合、胃空肠吻合术。病理学特点:肿瘤位于胰腺体尾部者4例,位于头颈部者1例,肿瘤的中位直径为4.0(3.2~10.0)cm;切面呈囊实性者3例,且同时伴出血或坏死,呈实性者1例,所有病例送检淋巴结均未见癌转移。镜下可见大量梭形的单核肿瘤细胞和散在分布的多核的体积较大的非肿瘤性破骨细胞样巨细胞(OGC)。5例PUCOGC中1例伴有黏液性囊腺癌。1例病人接受吉西他滨联合替吉奥化疗。随访至2017年12月,4例无病存活,1例已死亡,术后生存时间为8(1~28)个月。结论 PUC-OGC临床表现缺乏特异性,确诊主要依据病理学检查,完整手术切除和术后辅助治疗可能是治疗的最佳方案,预后尚无定论。
Objective To investigate the clinicopathological feature, diagnosis and treatment of pancreatic undifferentiated carcinoma with osteoclast-like giant cells （PUC-OGC）. Methods The clinical and follow-up data of 5 patients with PUC-OGC who were admitted to the First Affiliated Hospital of Harbin Medical University from October 2014 to December 2017 were analyzed and studied retrospectively. Results As for chief complaint, 4 patients had epigastric pain while one had chill and fever. Four of five patients were normal in CEA and CA19-9 preoperatively and only one was slightly elevated in CA19-9. Four patients underwent distal pancreatectomies with splenectomies and 1 choledochojejunostomy and gastrojejunostomy. Pathological features： Four tumors were located at the body and tail of pancreas while one at the head and neck. The median diameter of the tumor was 4.0 （3.2—10.0） cm. Cystic-solid sections with hemorrhage or necrosis was found in 3 cases and solid section in another one, and no metastasis was seen in the lymph nodes of the whole series. There were a huge number of spindle-shaped mononuclear neoplastic cells and distributed large multinucleated non-neoplastic osteoclast-like giant cells（OGCs） microscopically. One of the 5 PUC-OGC cases was accompanied by mucinous cystadenocarcinoma. Another one received chemotherapy of gemcitabine and S-1 postoperatively. Follow-up to December 2017, 4 patients survived without diseases, 1 had died, and the postoperative survival time was 8 （1—28） months. Conclusion The clinical manifestations of PUC-OGC are not specific, and the diagnosis is mainly based on pathological examination. The optimal treatment may be en-bloc resection and postoperative adjuvant therapy, and the prognosis is inconclusive.
作者
谭晓开
李乐
陈华
朱宏
田凤宇
孙备
TAN Xiao-kai;LI Le;CHEN Hua;et al(Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University,Harbin 150001, China)
出处
《中国实用外科杂志》
CSCD
北大核心
2018年第5期564-568,574,共6页
Chinese Journal of Practical Surgery
基金
国家自然科学基金资助项目(No.81670583
No.81372613)
关键词
破骨细胞样巨细胞
未分化胰腺癌
病理学
化学治疗
osteoclast-like giant cells pancreatic undifferentiated carcinoma pathology chemotherapy
