目的探讨胰腺实性假乳头状肿瘤(solid pseudopapillary tumor of the pancreas,SPTP)复发和转移病例的临床病理特征、诊断、鉴别诊断、治疗及预后。方法采用HE染色和免疫组化EnV ision法分析3例SPTP的病理学及免疫表型特征,并复习相关...目的探讨胰腺实性假乳头状肿瘤(solid pseudopapillary tumor of the pancreas,SPTP)复发和转移病例的临床病理特征、诊断、鉴别诊断、治疗及预后。方法采用HE染色和免疫组化EnV ision法分析3例SPTP的病理学及免疫表型特征,并复习相关文献。结果镜下可见肿瘤细胞围绕小血管形成特征性的假乳头状结构,可见少量出血及坏死、黏液样变性及胆固醇沉积等现象;细胞分化较好,异型性不明显,未查见细胞核分裂象。免疫表型:β-catenin、vimentin、CK、CK8、PR、CD56等均呈阳性,Syn、CEA、CgA等呈弱阳性;ER呈阴性,Ki-67增殖指数<5%。结论 SPTP是胰腺外分泌肿瘤的特殊类型,临床较少见,恶性程度低,预后良好,诊断主要依赖其组织病理学特征及免疫表型。展开更多
AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant...AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant potential. METHODS： A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations. RESULTS： Of the 24 cases of SPTs, 11 cases （45.8%） occurred in the pancreatic head and seven （29.1%） in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results （Kappa = 0.6, P 〈 0.05）. The size of SPTs ranged from 3 to 15 cm （mean, 5.8 cm）. When the size of the tumor was greater than 6 cm （including 6 cm）, the possibilities of vascular （8 vs 1） and capsular invasion （9 vs 0） increased significantly （P 〈 0.05）.Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors. CONCLUSION： Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyrna and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.展开更多
胰腺实性假乳头状瘤（solid pseudopapillary tumor of the pancreas,SPTP）是一种少见的胰腺肿瘤,其CT表现具有一定的特征性。本研究收集了北京协和医院14例经病理确诊的SPTP患者的CT影像资料,分析并讨论SPTP的CT诊断及鉴别诊断,旨在...胰腺实性假乳头状瘤（solid pseudopapillary tumor of the pancreas,SPTP）是一种少见的胰腺肿瘤,其CT表现具有一定的特征性。本研究收集了北京协和医院14例经病理确诊的SPTP患者的CT影像资料,分析并讨论SPTP的CT诊断及鉴别诊断,旨在提高放射科医师对本病的认识。展开更多
目的探讨胰腺实性假乳头状瘤(solid-pseudopapillary tumor of pancreas,SPTP)的螺旋CT及高场强MRI表现。资料与方法回顾性分析21例经手术病理证实的SPTP影像学资料。21例中,男2例,女19例,年龄12～57岁,中位年龄34.5岁,男女比例1∶9.5...目的探讨胰腺实性假乳头状瘤(solid-pseudopapillary tumor of pancreas,SPTP)的螺旋CT及高场强MRI表现。资料与方法回顾性分析21例经手术病理证实的SPTP影像学资料。21例中,男2例,女19例,年龄12～57岁,中位年龄34.5岁,男女比例1∶9.5。19例行薄层胰腺CT,13例行MRI,其中6例行磁共振胰胆管成像(MRCP),10例患者接受CT联合MRI。结果 21例肿瘤均为单发,14例肿瘤边界清楚,15例呈类圆形,6例呈团块状,其中3例呈分叶征象。CT平扫,10例肿瘤密度稍低或明显低于胰腺组织,3例肿瘤内局部密度高于胰腺组织,2例肿瘤钙化,6例囊实性混杂密度。MRI脂肪抑制T2WI上3例呈高低混杂信号,9例呈稍高、中等高信号,1例呈均匀极高信号,4例肿瘤边缘可见环形细线状包膜低信号,T1WI上4例呈高低混杂信号,6例呈低信号,2例呈高信号,1例呈等信号(与胰腺信号相仿)。CT和MR动态增强扫描动脉期肿瘤均有不同程度强化,门静脉期和延迟期肿瘤仍持续强化,CT延迟期病灶与胰腺组织有"杯口"状分界,MRI门静脉期及延迟期肿瘤中央和囊性部分无强化。MRCP示胆总管扩张1例,胰管扩张1例。1例术后复发者为外生性分叶状肿块,肿块最大径10.5cm,伴局部钙化,与周围组织界限欠清,增强后肿块内见直径0.7cm的小斑片状囊性无强化区。21例定期行影像学检查,平均随访时间40个月,2例出现肝脏转移,生存率为100%。结论平扫、动态增强螺旋CT及高场强MRI和MRCP能反映SPTP的影像学特点,提高了该病的诊断准确率。展开更多
文摘目的探讨胰腺实性假乳头状肿瘤(solid pseudopapillary tumor of the pancreas,SPTP)复发和转移病例的临床病理特征、诊断、鉴别诊断、治疗及预后。方法采用HE染色和免疫组化EnV ision法分析3例SPTP的病理学及免疫表型特征,并复习相关文献。结果镜下可见肿瘤细胞围绕小血管形成特征性的假乳头状结构,可见少量出血及坏死、黏液样变性及胆固醇沉积等现象;细胞分化较好,异型性不明显,未查见细胞核分裂象。免疫表型:β-catenin、vimentin、CK、CK8、PR、CD56等均呈阳性,Syn、CEA、CgA等呈弱阳性;ER呈阴性,Ki-67增殖指数<5%。结论 SPTP是胰腺外分泌肿瘤的特殊类型,临床较少见,恶性程度低,预后良好,诊断主要依赖其组织病理学特征及免疫表型。
基金Supported by Shanghai Leading Academic Discipline Project (S30203)
文摘AIM： To retrospectively analyze the imaging features of solid-pseudopapillary tumors （SPTs） of the pancreas on multi-detector row computed tomography （MDCT） and define the imaging findings suggestive of malignant potential. METHODS： A total of 24 consecutive cases with surgically and pathologically confirmed SPTs of the pancreas underwent preoperative abdominal MDCT studies in our hospital. All axial CT images, CT angiographic images, and coronally and sagittally reformed images were obtained. The images were retrospectively reviewed at interactive picture archiving and communication system workstations. RESULTS： Of the 24 cases of SPTs, 11 cases （45.8%） occurred in the pancreatic head and seven （29.1%） in the tail. Eighteen were pathologically diagnosed as benign and six as malignant. MDCT diagnosis of SPTs was well correlated with the surgical and pathological results （Kappa = 0.6, P 〈 0.05）. The size of SPTs ranged from 3 to 15 cm （mean, 5.8 cm）. When the size of the tumor was greater than 6 cm （including 6 cm）, the possibilities of vascular （8 vs 1） and capsular invasion （9 vs 0） increased significantly （P 〈 0.05）.Two pathologically benign cases with vascular invasion and disrupted capsule on MDCT presented with local recurrence and hepatic metastases during follow-up about 1 year after the resection of the primary tumors. CONCLUSION： Vascular and capsular invasion with superimposed spread into the adjacent pancreatic parenchyrna and nearby structures in SPTs of the pancreas can be accurately revealed by MDCT preoperatively. These imaging findings are predictive of the malignant potential associated with the aggressive behavior of the tumor, even in the pathologically benign cases.
文摘胰腺实性假乳头状瘤（solid pseudopapillary tumor of the pancreas,SPTP）是一种少见的胰腺肿瘤,其CT表现具有一定的特征性。本研究收集了北京协和医院14例经病理确诊的SPTP患者的CT影像资料,分析并讨论SPTP的CT诊断及鉴别诊断,旨在提高放射科医师对本病的认识。
文摘目的探讨胰腺实性假乳头状瘤(solid-pseudopapillary tumor of pancreas,SPTP)的螺旋CT及高场强MRI表现。资料与方法回顾性分析21例经手术病理证实的SPTP影像学资料。21例中,男2例,女19例,年龄12～57岁,中位年龄34.5岁,男女比例1∶9.5。19例行薄层胰腺CT,13例行MRI,其中6例行磁共振胰胆管成像(MRCP),10例患者接受CT联合MRI。结果 21例肿瘤均为单发,14例肿瘤边界清楚,15例呈类圆形,6例呈团块状,其中3例呈分叶征象。CT平扫,10例肿瘤密度稍低或明显低于胰腺组织,3例肿瘤内局部密度高于胰腺组织,2例肿瘤钙化,6例囊实性混杂密度。MRI脂肪抑制T2WI上3例呈高低混杂信号,9例呈稍高、中等高信号,1例呈均匀极高信号,4例肿瘤边缘可见环形细线状包膜低信号,T1WI上4例呈高低混杂信号,6例呈低信号,2例呈高信号,1例呈等信号(与胰腺信号相仿)。CT和MR动态增强扫描动脉期肿瘤均有不同程度强化,门静脉期和延迟期肿瘤仍持续强化,CT延迟期病灶与胰腺组织有"杯口"状分界,MRI门静脉期及延迟期肿瘤中央和囊性部分无强化。MRCP示胆总管扩张1例,胰管扩张1例。1例术后复发者为外生性分叶状肿块,肿块最大径10.5cm,伴局部钙化,与周围组织界限欠清,增强后肿块内见直径0.7cm的小斑片状囊性无强化区。21例定期行影像学检查,平均随访时间40个月,2例出现肝脏转移,生存率为100%。结论平扫、动态增强螺旋CT及高场强MRI和MRCP能反映SPTP的影像学特点,提高了该病的诊断准确率。
文摘胰腺实性假乳头状瘤(solid pseudopapillary tumor,SPT)是一种少见的良性或低度恶性肿瘤,在所有胰腺外分泌肿瘤中占比不超过1%~2%,占全部胰腺囊性肿瘤的5%。这一类肿瘤有低度恶性潜能,手术可完全切除且预后良好,若肿瘤较大或囊变坏死明显容易误诊为胰腺恶性肿瘤。本研究回顾性分析SPT的多层螺旋CT及3.0 T MRI影像学表现,探讨不同影像学检查的优势和局限性,指导临床合理应用影像学检查方法。
